Beyond Opioids: The Future of Pain Management


Cindi Scheib wanted to die.

A three-day weekend spent jumping and dancing on Labor Day 2014 had left her with a neck injury – specifically the cervical spine – that was possibly an exacerbation of an unrecognized mountain biking injury earlier that year. To make matters worse, her doctor performed the surgery to fix the injury on the wrong part of her spine.

Cindi Scheib

Now 54, Scheib has lived with constant neck pain and other unusual sensations throughout her body ever since. These sensations, including electrical shocks down her spine, buzzing, vibrating, burning sensations, ringing in her ears and sensitivity to normal noises, had gotten so bad, she said, that “I wanted to go to bed and not wake up tomorrow. This life was so bad, so horrible, that I couldn’t imagine how I was going to live the rest of whatever life I had,” says the Harrisburg, PA, nurse.

Today, the pain may be worse than it was in 2014, but Scheib is better. She says that’s because she stepped off the well-trodden path of lifelong prescription painkillers and took the less traveled road of pain management — a combination of pharmaceutical and non-pharmaceutical treatments that gave Scheib her life back.

Like Scheib, an estimated 100 million Americans live with long-term pain. Since the 1990s, physicians’ go-to treatment for constant pain has been prescription opioids, such as oxycodone or hydrocodone. Though the evidence that opioids work for long-term pain is lacking, Americans get more prescriptions for them than the citizens of any other country in the world. The prescribing epidemic has led to a national crisis of opioid misuse, overdose, and death. Now, as policymakers and health care providers work to stem the tide of addiction and abuse, patients and some prescribers worry that the changes will take pain medications out of the hands of people who truly need them.

New Drugs

Access to painkilling medications that can’t cause addiction, abuse, and overdose would make life easier for prescribers and could save the lives of patients.

Development of such drugs has been slow-going, in part because scientists don’t completely know how chronic pain works. They believe the body has multiple pathways to chronic pain, and that means multiple targets for painkillers. But researchers don’t have proven ways to identify which pathway is causing the pain in each person.

Drugmakers may have zeroed in on a target for chronic back pain and osteoarthritis pain. The FDA recently fast-tracked the drug tanezumab for approval. Federal regulators had previously halted work on tanezumab and other drugs like it over concerns about side effects.

The non-opioid blocks the production of nerve growth factor, a substance that’s needed for certain types of pain to happen. Several other anti-nerve growth factor drugs are in clinical trials.

Opioids address pain in a different way. They look like chemicals that the body produces naturally to regulate pleasure, pain, and emotions. So, when you take an opioid, the drug attaches to parts of nerve cells called opioid receptors, where they can block pain. But they also cause the pleasurable feelings that make people want more opioids. And they slow breathing, which is why overdoses can kill.

A team of researchers at Wake Forest University and the University of Bath in the U.K. is exploring a new kind of opioid that could relieve pain without affecting breathing or raising the chance for abuse. The new drug, only called by its chemical compound name BU08028, relieved pain in rhesus macaque monkeys. When they had the opportunity to take as much of the drug as they wanted, they didn’t abuse it. When taken off the drug, they didn’t show signs of painful withdrawal.

Although in early development, safely and successfully using the drug in this type of monkey is a key step on the path toward human clinical trials.

A second drug, also in early development, could harness the pain-relieving effects of opioids while bypassing the negative effects. The drug eased pain in mice. It’s still a long way from human testing.

New Approaches

The bottom line is that opioids should not be the first thing doctors try in patients who have chronic pain. The CDC’s latest guideline for opioid prescribing, released in 2016, notes that most proof of how well opioids work is based on short-term pain. It directs doctors to try nondrug treatments, such as physical therapy and talk therapy, as well as non-opioid treatments first. If those aren’t enough, before adding opioids, doctors should work with patients to set realistic goals for easing pain, with an emphasis on making the body work better rather than eliminating pain.

The U.S. Department of Health and Human Services, too, released a “National Pain Strategy” in 2016 that emphasized many of the same points. The HHS document also called for an approach to treatment that would include mental health, social and work concerns of the patient, and alternative therapies.

“We need to teach our patients that you may never be able to get rid of the pain completely,” says Joji Suzuki, MD, a psychiatrist who specializes in substance abuse at Brigham and Women’s Hospital in Boston. “So how do you cope with it? How do you restore function?”

Exercise, physical therapy, and talk therapy have proven benefits in the areas of function, or making the body work better, and coping. Health care providers ought to approach long-term pain with a combination of those treatments, says Ellen Edens, MD, a psychiatrist who treats veterans with chronic pain and long-term opioid use in the VA Connecticut Healthcare System.

“It’s not clear [in clinical trials] that opiates actually improve function in the long run,” she says. “In fact, there’s some evidence that people on chronic opiates lose function over the long run.” Loss of function is due in part to the side effects of these drugs, which include nausea, vomiting, and constipation. While they might ease pain, the side effects can keep a person from getting on with their life. What’s more, most people typically need to increase the dosage over time to keep getting the same level of pain relief.

HHS has compiled a report for doctors to use when treating long-term pain that summarizes the research behind many nondrug treatments and how they work.

“An opiate might bring your pain score down from an 8 to a 6.5, but if we add physical therapy, we can bring you down to a 6,” Edens says. “Ibuprofen might bring you down to 5.75. Then we’re going to get you therapy for your depression and your mood. Then acupuncture will bring you down to 5.25 and so on.”

It was a varied approach that got Cindi Scheib her life back.

She learned about a pain rehab program in her area that put many methods into one treatment plan. There, 2 years after that fateful Labor Day weekend, she had physical therapy, talk therapy, swim therapy, meditation training, hypnosis, yoga, and biofeedback — a treatment that uses electronic monitoring of seemingly involuntary bodily functions (such as pain) to teach a person to control it.

Health insurance plans might soon include more nondrug ways to treat chronic pain.

“I think we’re seeing some shifts within the private insurance sector in how we are paying for pain care,” says Christopher Jones, PharmD, a pharmacist and director of the National Mental Health and Substance Use Policy Laboratory at the Substance Abuse and Mental Health Services Administration. The Department of Health and Human Services is researching insurance coverage policies on treatment of long-term pain. “That’s an important step in trying to start the conversation on changing coverage policies.”

Coverage is one barrier to a varied, nondrug way to treat chronic pain. Time is another. Some people won’t want to invest the time in what might appear to be a slower approach. Still, it’s what worked for Scheib. “Everything started to gel,” she says. “I realized that my brain is adaptive. I could keep sending it the message that life is horrible and I’m dying, or I could start sending it good messages. It’s literally mind over matter.”

Scheib hasn’t gotten rid of her pain. “Actually, it’s probably worse now,” she says, matter-of-factly. But her body works better now. In spades. Incredibly, she hikes, bikes, scuba dives, and rappels down waterfalls. She attributes much of her improvement to changing her expectations.

Too often, says Suzuki, patients have unrealistic beliefs about pain. “There’s this automatic expectation that pain should be completely eliminated.”

That’s what’s changed for Scheib. “Before, I had an expectation of a perfect life, but now, I’m reprogramming my brain. I have a realistic expectation to accept and adapt. The most powerful tool in my toolbox is my ability to be positive and hopeful.”

7 Period Problems You Shouldn’t Ignore


Read this if your red tide wipes you out.
woman-lying-on-bed-period

There are some period problems that are unfortunately par for the course, like cramps, irritability, and bleeding more than you would like to be bleeding from your vagina.

But there are also some period problems that you should bring up to your doctor—just in case—because they’re a bit outside of what’s normally expected during menstruation. Here are some things to keep an eye out for.

1. You soak through a pad or tampon in an hour or less, your period lasts longer than seven days, or both.

The clinical term for an exceedingly heavy or long period is menorrhagia. These are basically horror movie-style periods, but some people don’t even realize this kind of bleeding is abnormal. “One of the biggest problems is someone being so used to heavy bleeding that she underplays the amount,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. “She’ll come in and say her periods aren’t too bad, then say she has to change her tampon every hour.” Passing clots larger than a quarter is also a sign your bleeding is too heavy, according to the Centers for Disease Control and Prevention (CDC).

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It’s not just that bleeding way too much or for too long is messy and inconvenient. Losing more than the typical two to three tablespoons of blood during your period or bleeding for longer than seven days can lead to anemia, the CDC says. If you have anemia, you lack enough healthy red blood cells to get oxygen to all your tissues, so you may feel tired and weak, according to the Mayo Clinic.

Bleeding too much can also be a sign of various health issues, like uterine fibroids, which are benign growths in and on the uterus that can sometimes come along with problems like pelvic pain and frequent urination. Uterine polyps, which are growths on the inner lining of the uterus, can also cause heavy bleeding, as can cervical polyps, which are lumps that emerge from the cervix. Both types of polyps are typically non-cancerous but, in rare cases, may contain cancer cells.

The hormonal issue polycystic ovary syndrome (PCOS) can also cause heavy bleeding. Worse, this bleeding can strike after months of an MIA period. This gives your uterine lining a chance to build up over time, leading to an abnormally heavy period when it finally comes, Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale Medical School, tells SELF. PCOS can also cause symptoms like excess face and body hair or severe acne, thanks to high levels of male hormones.

Heavy menstrual bleeding could even be a sign of a disorder that causes you to lose too much blood, like idiopathic thrombocytopenic purpura (ITP). ITP usually comes along with other symptoms like easy and excessive bruising or a rash of reddish-purple dots on a person’s lower legs.

Clearly, figuring out what’s causing your heavy bleeding won’t be easy on your own, so you should see your doctor. They’ll typically ask about your other symptoms and perform exams to determine what exactly is going on, and treatment will depend on what you’re dealing with.

2. Your period brings days of pain that make it practically impossible to leave your bed.

Dr. Streicher’s rule is essentially that if you’re experiencing even an iota of period pain beyond what you’re fine with, it’s too much. The first step is typically to take nonsteroidal anti-inflammatory drugs, since they block hormone-like chemicals known as prostaglandins that cause uterine cramping. If that knocks out your cramps, you’re good to go. If you’re still curled up in the fetal position after a few hours, that’s a sign that you need evaluation, Dr. Streicher says. You’re dealing with dysmenorrhea (severe menstrual cramps), and doctors can help.

There are many different causes of overboard menstrual cramps. Fibroids are a common culprit. So is endometriosis, a condition many experts think happens when tissue lining the uterus travels outside of it and begins growing on other organs. (Other experts believe that tissue is actually different in that it can make its own estrogen, which can create painful inflammation in people with endometriosis.) In addition to causing extremely painful periods, endometriosis can lead to painful intercourse, occasional heavy periods, and infertility, according to the Mayo Clinic.

Adenomyosis, which happens when the endometrial tissue lining the uterus grows into the muscular walls of the organ, can also cause terrible menstrual pain, along with expelling big clots during your period and pain during intercourse.

3. You never know when your period is going to show up.

Pour one out for all the times you thought you’d have a period-free vacation, only for it to show up right as you hit the beach. Fun! Irregular periods could be due to a number of different things that are (at least somewhat) in your control, like stress and travel, Dr. Streicher says. But they can also happen because of various health conditions.

Take thyroid issues, for instance. Hypothyroidism, which is when your thyroid gland in your neck doesn’t produce enough hormones, can lead to an irregular period, according to the Mayo Clinic. It can also cause myriad other symptoms, like heavier than usual periods, fatigue, constipation, dry skin, weight gain, impaired memory, and more. Treatment typically involves taking medication that mimics the thyroid hormone.

On the flip side, hyperthyroidism, which is when your thyroid gland is overactive, can cause light or infrequent menstruation, along with issues like sudden weight loss, rapid heart rate, increased appetite, and more frequent bowel movements, according to the Mayo Clinic.

Irregular periods are also a sign of premature ovarian failure, which is when a person younger than 40 starts losing their normal ovarian function, according to the Mayo Clinic. It can also cause menopausal symptoms like hot flashes, night sweats, vaginal dryness, and difficulty conceiving. Doctors can offer estrogen therapy to relieve symptoms like hot flashes (typically in conjunction with progesterone to avoid the precancerous cells that may take hold if you take estrogen alone). They can also counsel you about the possibility of in vitro fertilization if you’d like to physically conceive and carry children in the future.

PCOS and uterine polyps be behind irregular bleeding, too.

4. Your period decides not to show up for a while.

While it’s true that you can sometimes randomly miss a period for reasons like stress, you shouldn’t just ignore a long-term missing period. Suddenly being period-free may feel blissful, but you’ll want to make sure there’s not a health issue going on, like PCOS, an eating disorder or excessive exercise affecting your menstruation…or, yes, pregnancy.

“If you’re menstruating normally then suddenly go months without a period, that’s not something to ignore,” Dr. Streicher says. If your period vanishes for three months or longer (this is known as amenorrhea), see your doctor for evaluation.

It’s worth noting that the use of some hormonal birth control methods—especially the hormonal IUD—can make your period basically disappear. Still, check with your doctor, just in case, when this happens.

5. You’re dealing with a lot of unexpected spotting between periods.

There are times when this is normal, like if you’ve just started a new type of birth control, or even if you’re pregnant (spotting can be totally fine during pregnancy), Dr. Minkin says. But if nothing in your life has changed and you start spotting between periods, call your doctor for an appointment.

It could be something that’s ultimately pretty harmless, like a benign uterine or cervical polyp that’s causing bleeding between periods. But spotting is also a hallmark of pelvic inflammatory disease (PID), which is the result of sexually transmitted bacteria from infections like chlamydia and gonorrhea spreading to reproductive organs like your uterus, fallopian tubes, and ovaries. In addition, pelvic inflammatory disease can cause issues like fever, strange vaginal discharge that smells bad, and burning when you pee.

If you have PID, your doctor will first address the STI in question with antibiotics, says the CDC, then treat your partner for an STI if necessary. Pelvic inflammatory disease is a leading cause of chronic pelvic pain and infertility in women, so if you suspect you have it, treatment is of the essence.

More rarely, spotting in between periods can be a sign of cervical cancer, according to the Mayo Clinic. Cervical cancer can come along with watery, bloody discharge that might have a bad odor and pelvic pain, including during intercourse. Even though this likely isn’t your issue, you’ll want to get checked out, just in case. Treatment for cervical cancer may involve a hysterectomy, radiation, or chemotherapy.

6. You experience debilitating mood issues before your period.

When your estrogen and progesterone drop before your period, you may experience the typical mood swings that mark premenstrual syndrome (PMS). (Bear in mind that this may not be as drastic if you’re on hormonal birth control, which stabilizes your hormones throughout your cycle.)

But if you deal with severe mood swings, irritability, anger, a lack of enjoyment in things you usually enjoy, and other symptoms that affect your life, you may have premenstrual dysphoric disorder (PMDD). PMDD happens when you experience these symptoms in the week before your period, then they start getting better in the first few days of bleeding, and disappear in the weeks after your period. It’s listed in the DSM-5, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, for good reason: This psychological issue can completely turn your life upside down.

“If you suspect you have PMDD, the one thing I would encourage is keeping a daily record of the severity of your symptoms,” Dr. Minkin says. If these symptoms only rear their head the week before your period, PMDD might be your issue. If you realize you’re constantly dealing with them and your period just makes them worse, it might be premenstrual exacerbation, which is another way of saying you have a mental illness like depression that gets worse during your period.

Either way, a doctor can help. If you have PMDD, your doctor may have you take antidepressants in the timeframe when you usually experience symptoms, then stop once your period starts, Dr. Minkin says. (If you have premenstrual exacerbation, they may recommend staying on the antidepressants through the month and potentially upping your dosage in the week before your period.)

Or your doctor may suggest you go on birth control using a synthetic version of progesterone called drospirenone, Dr. Minin says, like Yaz and Beyaz. These are FDA-approved to treat PMDD. Though experts aren’t sure why they can be so successful in this arena, it may be because drospirenone reduces a person’s response to hormonal fluctuations. It’s also a diuretic, meaning it can flush out liquids that could otherwise cause fluid retention and contribute to annoying issues like bloating.

7. You have excruciating migraines before or during your period.

If migraines had any home training, they’d at least leave you alone when you’re about to get your period. Unfortunately, period migraines are indeed a thing.

It’s not that menstruation will just randomly cause migraines in unsuspecting people who have never had one, but women with a history of migraines may experience them before or during their periods, according to the Mayo Clinic, which adds that this may be due to estrogen fluctuations. “They tend to get the headache right as they go into their periods, and it seems to get better after they have had their menses for a day or two,” Dr. Minkin says.

If you’re dealing with this, your typical migraine medication may work for you. As you probably know if you’ve grappled with migraines, the treatment options are legion. They include pain-relieving medications to relieve symptoms ASAP and preventive drugs to ward off migraines altogether, according to the Mayo Clinic. In the former camp, you have choices like anti-nausea meds and triptans, which constrict swollen blood vessels and block pain pathways in the brain. In the latter, you’ve got meds like tricylic antidepressants, which affect brain chemicals like serotonin that may be implicated in migraines.

No matter what your period problem may be, you don’t have to suffer in silence.

You have no reason to feel embarrassed about your period—or the myriad problems that can come with it. After all, celebrities are out here talking about menstruation! Some pad commercials even—gasp—use red “blood,” these days! What a time to be alive.

If you’re having period problems, see your doctor for help. If they aren’t committed to relieving your symptoms, that’s a sign you should try to find a more sympathetic medical professional who can help you find the best treatment.

11 Times The Experts Say You Should Skip Your Regular Workout


That whole “no excuses” thing isn’t always entirely true.

Confession: I ask myself should I really go work out? at least once a week. And 90 percent of the time, I end up telling myself to suck it up, buttercup—and am almost always grateful I pushed through my own inertia. Because sure enough, almost 100 percent of the time I do that I feel more clear-headed and confident after my workout. But that doesn’t mean there’s never a real reason to ditch regularly scheduled workout plans: While exercise can improve your mood and boost your energy, sometimes the benefits actually don’t outweigh the reason to skip it.

If you’ve ever found yourself Googling “should I work out if [insert dilemma here],” this list is for you. We asked the experts for simple guidelines on when you should forego that boot camp class or strength-training session (or at least take it a little easier, instead of going for a hardcore sweat).

Of course, you should always follow your doctor’s advice first and foremost, but here are six times it’s actually smart to play gym hooky and five times you should opt for a lower-intensity workout.

Skip your workout if…

1. You’re sleep deprived. Even though exercise can give you a boost when you’re feeling low on energy, getting your zzz’s is an extremely important part of a fitness routine. “Exercise is a physical stress applied to the body, and muscles get stronger in the period after the workout when the body is repairing the damage,” explains exercise physiologist Pete McCall, host of the All About Fitness podcast.

Working out when you’re super tired not only means you probably won’t have the energy to go as hard, but you also have a bigger chance of hurting yourself. “Too much fatigue can reduce motor skills and increase the risk of injury, especially in a movement-based class like Zumba, kickboxing, or CrossFit,” says McCall (as opposed to a more stationary workout, like indoor cycling).

Ultimately, the answer to the sleep-versus-workout dilemma comes down to the individual, but as a rule of thumb, McCall recommends choosing a nap instead if you’ve gotten three to five nights of minimal sleep or you’re running on five hours or less. “Less than five hours of sleep can affect reaction times and cognitive function, both of which are critical for optimal performance during exercise,” he explains.

2. You might be injured. If you’re sore the day after a tough workout, exercise can actually help you recover by increasing circulation, which speeds healing, according to McCall. Injury’s an entirely different story, though. “Pain is a physical sign that something is wrong. Doctors use a one to 10 scale of pain, where one is no pain and 10 is excruciating. If a muscle is sore, around a three to five on the scale, then light movement is good. But if a muscle is in pain, think a six or above, then too much movement can place a lot of stress on the tissue and keep it from properly healing.” (Here are some other ways to tell the difference between soreness and injury.)

Not only do you risk further injury, but you could also injure other muscles or joints as your body tries to compensate. “A muscle that’s injured will be inflamed. This will keep it from working properly and can change the way the attached joints function,” says McCall. “Trying to work through muscle pain could cause other parts of the body to become injured, so it’s just not worth it. Let it heal, and if it hurts after more than a few days of rest then see a doctor.”

3. You’re sick. “Fever is an indication that your body is working hard to defeat a foreign invader,” says McCall. If you’re dealing with a full-blown illness, you want your body to be putting its energy toward getting better, not dealing with the stress of exercise. Plus, you don’t want to spread your germs at the gym (or pick up any more for your body to handle). “Feeling sick is an indication that something is wrong, so listen to your body and respect it. It’s better to take two to four days off and fully recover than to have a lingering illness for an extended period of time,” says McCall.

4. You just had a treatment at the dermatologist. “I ask my patients to wait 24 hours before exercising after any injectable treatment such as fillers or Botox, and also after many laser, microneedling, or other treatments that may damage the skin surface temporarily,” says dermatologist Jessica Krant, M.D., founder of Art of Dermatology in NYC. “We want the injected materials to stay in place for a couple of days to be set in, or absorbed, and we want any tiny needle punctures to heal to minimize the risk of increased bruising,” she explains.

5. You’re insanely sunburnt. Chances are, you know that getting scorched by the sun is pretty unsafe in the long term, but your body needs some TLC in the short-term too—and this means skipping your workout if you’re really red. “With extreme sunburn, there is a risk of heatstroke, sunstroke, imbalance of electrolytes and body fluid management, and overheating,” warns Krant. “It should be handled with rest, hydration, and soothing creams until everything settles. I would say wait about 48 hours before judging if the skin has calmed down and you feel well enough to exercise.”

6. You just got a spray tan. OK, so maybe this isn’t a health reason to skip your workout, but if you’ve spent the cash on a spray tan you’re probably not looking for a streaky, messy look. “A traditional self tan requires eight hours to fully develop, so you should not go to the gym or shower while the tan is developing,” says Sophie Evans, St. Tropez skin finishing expert. Unless you’re using an express formula that some salons offer, wait eight hours, then rinse off so the color stays even, and then you’re safe to sweat it out.

Skip your intense workout and try light activity if…

7. You’re just feeling a little under the weather. Like McCall says, you should still skip your workout if you’re full-on sick, but keeping up with your routine with some light exercise when you’re just feeling a little ‘ick’ should be fine (and might make you feel a little more like yourself again). “Lower intensity is better—you can burn some energy, but too much intensity can downgrade your immune system. So a long, fast paced walk=good, but high-intensity cycling=not good,” says McCall.

8. You just got a bikini wax. Be strategic about your workouts post-wax—after all, you’ve been through enough pain already. “I would definitely recommend holding off on indoor cycling class for a few days, since the excessive friction and pressure from the bike seat and tight clothing could cause irritation,” Krant says. (That doesn’t sound good.) “Running is a tough one, too. Any lighter exercise with looser clothing is a better [option] for post-wax days,” she adds. Of course, do what feels right for you and your specific needs and goals.

9. You have a brand new tattoo. While sweat itself won’t get in the way of the healing process, you do have to be careful about making sure you don’t damage it while it’s fresh, says Krant. Plus, you don’t want to risk infection, and gyms tend to be germ central. What you can do depends on where the tattoo is and how big it is, says Krant. It’s also important to avoid friction so you don’t damage or irritate your tattoo. “I recommend low activity to prevent any accidental scratches or injuries to the newly tattooed area until it heals after 10 days or so,” suggests Krant.

10. You’ve done two days of high-intensity workouts in a row. While McCall says you can work out pretty much every day, the key is alternating the intensity of your workouts—as a rule of thumb, after one to two high-intensity days, you should mix in a low to moderate session. “Muscle tissue needs time to repair,” he explains. “High-intensity exercise places physical stress on the tissue, and too much stress with minimal repair time could lead to a long term injury,” he says. If you’re not giving your body the recovery time it needs, you could be overtraining—here are six signs to watch for.

11. You’re hungover AF. We’ve all been there. And while getting some movement increases circulation (which might make you feel better), says McCall, it’s best to keep it gentle. “Too intense could hurt the head, plus motor skills will be affected, so doing hard exercises when you’re hungover could increase the risk of injury,” he says. “A long walk or a light jog is good the day after a good night out, but not a hard indoor cycling class or a challenging WOD.”

Don’t have to tell me twice.

What to Expect After IUD Removal: Ob/Gyn Experts Explain


Breathe a sigh of relief: Getting it taken out is nothing like getting it inserted.
iud-removed_feature

Whether you have an IUD removal on the books or you’re just wondering what the procedure is like, you’ve come to the right place. IUDs, also known as intrauterine devices, are little T-shaped instruments that reside snugly inside the uterus and ward off pregnancy with a variety of mechanisms. The hormonal kinds release levonorgestrel, a synthetic form of the hormone progestin, to prevent ovulation, thicken cervical mucous, and thin the lining of the uterus, according to the U.S. National Library of Medicine. The non-hormonal IUD releases copper ions, which are toxic to sperm.

IUDs sound like some impressive sci-fi invention, but they’re real, and they’re giving women excellent control over their reproductive futures. But after a certain point, the IUD has got to go, whether you’re ready to start trying for a baby or it’s just reached its time limit.

If you’ve been through the insertion process, which usually ranges from uncomfortable to downright painful, you might think about your future removal date with at least a little trepidation. Good news: Chances are you’ve got nothing to fear. Here, ob/gyns explain exactly what to expect during the removal of your Mirena, ParaGard, or other kind of IUD—both in the moment and afterward.

When do I need to get my IUD removed?

The official recommendations are to remove Mirena, a common hormonal option, five years after insertion. The same goes for Kyleena, another hormonal option from the maker of Mirena. You’ll need to replace hormonal IUDs Liletta and Skylaa bit earlier (four and three years, respectively). As for the copper ParaGard, which doesn’t use hormones? You can keep that superstar in for up to 10 years.

But, of course, you can always get your IUD removed earlier than any of these benchmarks if you want to get pregnant or if you’ve decided another birth control option makes more sense for you.

What actually happens during the IUD removal?

You know those strings hanging out of the bottom of your IUD? This is their time to shine. “The vast majority of the time, [IUD removal] simply involves doing a simple exam much like a Pap smear,” board-certified ob/gyn Antonio Pizarro, M.D., tells SELF. “If the strings are visible, the doctor grasps them using an instrument called ring forceps and gently pulls the IUD out.”

“Usually patients get really worked up, then when it’s done, they say, ‘Oh, that’s it?'” Jacques Moritz, M.D., an ob/gyn at Weill Cornell Medicine and NewYork-Presbyterian Hospital, tells SELF. The ease of removal comes down to a few major things, he explains: The doctor isn’t using an instrument to push past your cervix (the way they do during insertion), the IUD’s wings don’t have to open up in your uterus (ditto), plus the IUD’s arms just fold in on themselves when it’s being removed, so it’s as small as possible.

Is it painful to have an IUD removed?

“Anyone who has an IUD basically paid the price when getting it—the pain happens during insertion,” Dr. Moritz says. Keep in mind that even when rating the experience as terrible, many women say the pain of getting an IUD was well worth it since they provide such stellar protection against pregnancy.

“Everybody gets nervous about [removal], but it should almost not be felt. Just one deep breath, and it’s done,” Dr. Moritz says. Can’t you practically feel your uterus relaxing at this very welcome news? Even better, depending on your insurance, the entire cost of the removal may be covered.

Are there any IUD removal complications?

Most often, the process only takes a few minutes, then you’re good to go. But in the rare case that the doctor can’t find the strings, removal becomes a bit more involved. The IUD strings can shift a bit, sometimes curling up around the cervix so they’re harder to access, or maybe they were cut too short in the first place. In those instances, doctors can try to “tease” them out using some instruments, and it won’t exactly feel pleasant, Dr. Moritz says. “It’s not super painful, but definitely uncomfortable,” he explains. He gives himself a cutoff of 10-15 minutes to try teasing the IUD out. If that doesn’t work, other measures will.

“Rarely do IUDs become dislodged or the strings get lost,” Dr. Pizarro says. But on the off chance that something like that happens, doctors may use an ultrasound or hysteroscope (a thin lit tube that allows a doctor to see inside the uterus) to locate the IUD so they can remove it, potentially with anesthesia depending on the situation. “Even then, it’s limited invasiveness,” Dr. Pizarro says.

What kind of IUD removal side effects should I be prepared for?

You might feel a cramp as it the doctor pulls it out (again, it shouldn’t feel anything like the one some women experience during insertion) or you might not even realize it’s happened, Dr. Pizarro says. You may also experience some residual cramping or a little bleeding after an IUD removal, but as long as it isn’t severe and goes away in a few hours or, at worst, a couple of days, you don’t have anything to worry about.

One thing to really think about is that your period may change. The specific way it might change after IUD removal depends on what kind of IUD you had and how the device changed your cycle over time. Hormonal and non-hormonal IUDs change periods in different ways. You might enjoy lighter, less painful periods on a hormonal IUD like Mirena—or they may stop completely. So, when you get a hormonal IUD removed, your period will probably revert to what it was like without hormones, Dr. Moritz says.

As for the copper IUD, it’s all about how your body adjusted to it over time. Copper IUDs can make periods heavier and crampier at first, but for some women, that abates, while others deal with more intense periods the entire time. After getting a copper IUD removed, your period might become lighter and less annoying or not change much at all, the experts explain.

How long does it take to get pregnant after an IUD?

“Fertility is possible immediately,” Dr. Pizarro says. If you’re not ready to have kids yet or ever and your removal was normal, it might make sense for you to get another IUD in the same visit (this is often easier both time-wise and mindset-wise).

If you decide not to get a new IUD for whatever reason and you’re not interested in making babies, be sure to find another solid form of contraception you can rely on to keep you childfree.

Here’s Why Your Poop Can Be So Freaking Weird on Your Period


You know what we’re talking about.
Poop-And-Periods

Most people are pretty open about the “joys” that come with having a period, like cramps, bloating, and sore boobs. But there’s one period side effect people really need to discuss more often, because maybe sharing the burden can at least make the load a little lighter: period poop.

Everyone’s situation is different, but it’s not uncommon for your regular poop habits to take a temporary vacation when you’re on your period, or be suddenly replaced with a whole lot of diarrhea, or both. “Many women do get bowel changes just before or during their period,” Kyle Staller, M.D., a gastroenterologist at Massachusetts General Hospital, tells SELF.

You’ve probably noticed this and dismissed it as just one of those body things, but there’s an actual biological cause you should know about.

“The reason that this happens is largely due to hormones,” says Dr. Staller. Pre-period constipation could be a result of an increase in the hormone progesterone, which starts to increase in the time between ovulation and when you get your period. Progesterone can cause food to move more slowly through your intestines, backing you up in the process.

So what about that diarrhea, though? Hormone-like substances called prostaglandins could be to blame for that. The cells that make up the lining of your uterus (known as endometrial cells), produce these prostaglandins, which get released as the lining of your uterus breaks down right before and during your period. If your body makes a lot of prostaglandins, they can make their way into the muscle that lines your bowels. There, they can cause your intestines to contract just like your uterus and push out fecal matter quickly, causing diarrhea in the process, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California, tells SELF. (Fun fact: These prostaglandins are also responsible for those painful cramps you might get every month.)

Of course, this can all vary in different people. But if you notice you experience constipation or diarrhea right around your period like clockwork, this may be why.

Having certain health conditions can also exacerbate period-related bowel changes.

If you struggle with a health condition like endometriosisCrohn’s diseaseirritable bowel syndrome, or ulcerative colitis, having your period can cause a flare-up of your symptoms. Ultimately, the symptoms you experience depend on your condition, Dr. Farhadi says.

For example, if you struggle with Crohn’s disease, which can often cause diarrhea, or IBS-D (a form of IBS that causes people to have diarrhea), your body’s release of prostaglandins during your period may cause you poop even more than usual. But if you suffer from IBS-C (IBS that causes people to have constipation), you may find yourself struggling even more to have a BM on your period as progesterone further slows your bowels’ activity. Since ulcerative colitis can lead to both diarrhea and constipation, you might experience an uptick in either during your period.

And unfortunately endometriosis can lead to pain during bowel movements around your period, Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. Endometriosis is a disease where endometrial tissue that normally grows inside the uterus (or, as is up for debate, tissue similar to endometrial lining) grows outside of the uterus. This tissue can attach to your bowels and start trouble. “You then have bleeding around that area, and that can cause pain when you have a bowel movement,” Dr. Greves explains.

If your poop gets weird on your period, there are a few things you can do to cope.

The most important step is knowing what’s normal for you on your period and doing what you can to minimize any additional triggers. For instance, if you always get diarrhea during your period, and you know that coffee tends to make you poop more, it’s a good idea to cut back a little when you’re actually on your period, Dr. Farhadi says. You can also take Immodium on the first day of your period in anticipation of diarrhea, or carry it with you in case it strikes, he says. If you deal with constipation during your period, try upping your fiber and water intake in the middle of your cycle, when constipation-prompting progesterone levels start rising.

It can also help to pop some non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs, a common class of pain relievers, can block certain enzymes in your body from making prostaglandins. With fewer prostaglandins roaming around, you may get some relief from an achy belly and incessant pooping.

If you’re really having a hard time with poop issues on your period, talk to your doctor. They may be able to recommend next steps or refer you to a specialist who can. Your period is already annoying enough without spending forever on the toilet, either basically pooping water or straining hard to go in the first place.

Gastroenterologists Share 7 Things to Do When You Have Painful Gas


Pain is the cruel cherry on top.
Gas-Pains

Pretty much no one is happy to have gas (with the exception of the elementary school set, who of course finds it hilarious). Gas is a normal part of having a body, but it can also be straight-up painful sometimes.

Since you probably don’t feel comfortable calling out sick from work with gas or otherwise letting it disrupt your life, you likely want to get things sorted out ASAP. As it turns out, the key to fixing painful gas is knowing why it happens in the first place.

There are a few reasons gas can develop, and, well, it has to go somewhere.

Gas often happens as a normal part of your digestive process. Your stomach and small intestine don’t entirely break down certain carbohydrates you eat, so they end up getting to your large intestine intact, according to the National Institute of Diabetes and Digestive and Kidney Diseases. There, bacteria make gas as they process these undigested sugars, fibers, and starches. Certain foods, like dairy products and cruciferous vegetables such as Brussels sprouts, are more likely to cause gas than others, but everyone’s triggers are different.

You can also get gas if you swallow a lot of air. While it’s unlikely that you’re actually trying to suck down a bunch of oxygen, certain habits like regularly using a straw, drinking carbonated beverages, eating too quickly, and chewing gum can cause you to take in more air than normal. When this causes gas, it’s typically via burping, since the air comes back up before it can go all the way to your stomach.Beyond those causes, gas can happen if you have health conditions that affect your digestive system, like irritable bowel syndromeulcerative colitis, or Crohn’s disease, or bacterial overgrowth in the small intestine, according to the Mayo Clinic.

OK, but why does gas sometimes hurt so bad that you want to cry and check yourself into the ER?

Good question. Painful gas and other bothersome symptoms like bloating can happen if gas builds up in your system because you can’t expel it (like if you’re purposely holding it in), if you eat something that really doesn’t agree with you, or if you have an underlying condition that prevents gas from moving through your system normally. All of this can cause spasms and distension in your large intestine during the digestive process, which can be pretty painful, Jamile Wakim-Fleming, M.D., a gastroenterologist at the Cleveland Clinic, tells SELF.

Unfortunately, there isn’t one magic pill that will immediately get rid of any painful gas you may be experiencing. The drug simethicone, which is an anti-foaming agent present in medicines like Gas-X, is designed to reduce bloating and pain from gas and may help, but it’s not a guarantee, Kyle Staller, M.D., M.P.H., a gastroenterologist at Massachusetts General Hospital, tells SELF.

There are, however, a few tricks you can try to either make the gas go away or, at the very least, make you feel better.

1. Sip a glass of water slowly.

Drinking water does two things, says Dr. Wakim-Fleming: It can help move any gas-causing foods in your system through the digestive process, and it makes it harder for your intestines to contract in a way that gasses you up. See, your intestines contract to move food, and if they contract too strongly or for too long, that can lead to or exacerbate gas.

2. Try to stop swallowing so much air—seriously.

Downing some water can be counterproductive if you’re doing it in a way that will only lead to more gas. Until the pain abates, avoid habits that can lead to swallowing a ton of air, like taking big gulps of water at a time, using straws, drinking fizzy beverages, sucking your food down too quickly, talking a lot while eating, and chewing gum, Dr. Wakim-Fleming says.

3. Try getting up and walking around.

Exercise isn’t just great for your overall health—it can also help clear up painful gas and bloating. While a five-mile run probably isn’t first on your to-do list when you’re doubled over in pain, if you can manage a quick walk or other gentle movement, that can make a big difference.

“Exercise helps exercise your intestines, too,” Dr. Wakim-Fleming says. Experts don’t know exactly why exercise helps move gas along, but something about physical activity helps to boost your intestines’ muscle activity, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, Calif., tells SELF. (This is part of why exercise is recommended for constipation.)

4. Consider if dairy is actually the culprit.

If you’re currently in the fetal position dealing with gas pain, think back to how much cheese, milk, and ice cream you had recently—even if you don’t think you’re lactose intolerant. You can spend years having zero issues when you drink a venti latte in the A.M., followed by a grilled cheese sandwich at lunch…until you suddenly do. As most people age, they start making less lactase, an enzyme that breaks down lactose, the sugar in dairy products, Dr. Staller says. This is one cause of lactase deficiency and lactose intolerance. As your digestive system’s bacteria tries to break down lactose without enough lactase to do the job, you may experience annoying symptoms like more painful gas than usual.

“Many people in their 20s and 30s have symptoms and don’t suspect that it’s the dairy products,” Dr. Staller says. If you think dairy is behind your painful gas, try cutting it out for a few weeks (or at the very least, the rest of the day) and see where that gets you.

5. Have some peppermint oil or peppermint tea.

It’s not just for your breath—peppermint can act as a spasmolytic, meaning it may help stop your intestines from spasming too much (which is what increases gas), says Dr. Staller. While this mechanism has mainly been studied in regard to irritable bowel syndrome, the muscle contractions in that disorder are the same ones that can make gas feel so terrible, he says.

Doctors aren’t totally sure whether it’s better to take peppermint in a capsule form or via something more standard like a mint or peppermint tea, so feel free to try whatever you have handy (but be sure to follow the instructions if you’re ingesting peppermint oil as a pill).

6. Snuggle under a blanket with a heating pad on your abdomen.

It’s not a hard sell when you feel like crap, but cozying up under a blanket with a heating pad on your abdomen can actually help fight gas. Like peppermint, warmth can have an antispasmodic effect on your body and help your intestines to relax instead of contract too hard or too much, lessening that achy sensation that all too often comes along with gas, Dr. Wakim-Fleming says. And don’t worry that lying down means your gas is having to struggle against gravity to exit—it makes no difference either way, Dr. Farhadi says. (Though, as we said, getting up and walking around for a bit can also be helpful to do before or after you settle in with a heating pad.)

7. And lastly, commit to keeping your fiber intake in check.

Fiber is a key part of a healthy diet and digestive system. It bulks up your stool, which helps you stay regular instead of getting constipated. But on the flip side, having too much fiber can make you gassy as the bacteria in your colon works to break this tough nutrient down, Dr. Farhadi says.

If you find that you’re always in pain after you eat a salad with both broccoli and Brussels sprouts, it’s really best to avoid those foods (or whatever the fiber-heavy food may be) until you feel better—and to try to space out when you eat them in the future.

These tips should, at the very least, help make your painful gas feel a bit better. But if you’re struggling with incredibly painful gas and nothing is helping, call your doctor. They should be able to help you find the root of the issue—and how to stop it.

Beautiful Noise


Sound helps you to release blocked energy, says music therapist and sound healing practitioner, PANKAJ BORICHA


Among the world’s noisiest cities are Shanghai,Tokyo,New York and Mumbai — cities full of sound pollutants.We are surrounded by different sound frequencies, some of which are not even audible. Unconsciously, these noise forms have multiple adverse effects on our health.As the effects of noise pollution pile up, we end up with hearing loss, stress, sleep disturbance and heart disease. According to a new analysis, stress hormones such as cortisol, adrenaline, and noradrenaline released over time could eventually lead to high blood pressure, stroke and heart failure. We are also losing our power of listening due to these excessive sound pollutants. Eventually, these affect us mentally and physically and lead to behavioural changes. We must educate ourselves on how we can harness this ancient technique and use the power of sound and music for healing and curing diseases. Once we understand this knowledge,we can spread awareness about sound and use it as a healing tool.

Different modalities of sound have been used in medical science — ultra sound and lithotripsy are among a few of them. But the majority of us are not aware about the power of sound as a sonic and acoustic weapon. Sound has been used in various cultures for centuries as a tool for healing — through the use of mantras and chanting, by playing instruments such as didgeridoo to heal bone fractures, and Tibetan bowl bells and gongs to produce different sound frequencies to align mental and physical health.All these techniques use sound to move us from imbalance to a balanced state of mind. Sound therapy offers cure for a variety of health problems including sleep disorders,anxiety,depression,stress management, PTSD (post-traumatic stress disorder), and pain management.

Our brainwaves are tuned to different sound vibrations through sound rhythm and frequency.We entrain our brainwaves to down-shift our normal waking consciousness beta state to a relaxed alpha state and can reach theta meditative state and deep sleep delta state where internal healing can occur. This same concept has been utilised in meditation by regulating the breath,but with sound and music at a certain frequency, it’s easier to influence a shift.In sound therapy, as you prepare yourself to become the receiver of sound,by becoming more receptive and aware of each sound, it creates a pathway of stillness,the same way as meditation or chanting a mantra does.Eventually, this helps us reach the still point to an active subconscious state of mind. The tools here are sound, voice, rhythm, drumming and frequency. Awareness plays a huge role in our own healing. Also, we must realise that our voice is incredibly powerful. It is our body that has the ability to fine-tune our greatest vibrational instrument. Sound frequency helps in releasing blocked energy and you are able to recycle your energy back into your life force,toward the energetic filtration system of each chakra.You must be aware of the different kinds of sounds that you take in daily from your immediate living environment. For instance,we are usually irritated with traffic sounds and the constant high decibel levels in local trains.Loud sounds elevate our stress levels, creating imbalances in our nervous system,lower our immunity and in extreme cases, cause hearing loss. When we are stressed, our whole relationship to sound changes.Even routine, everyday sounds become magnified and contribute to the feedback cycle of the stress. However, by utilising sound therapy techniques, we can become better listeners and more aware of the sounds we take in. Many of us already have a pretty good understanding of the benefits of healthy eating, yoga,meditation,and exercise.The same is true of sound therapy. We know mindfulness practices like chanting and vocal toning help us to find a centre and feel grounded. Our body, mind and spirit always want to move in a direction toward balance from noise to silence, yet we often have excess outer stimulus and noise and not enough time to dedicate to ourselves. This prevents us from achieving a better state of harmony. Sound has a way of helping us reach the source of the inner peace that we all seek. Let’s improve our power of listening and be aware consciously of different sounds, so that we can gradually improve the quality of our life and that of people around us.

Source: speakingtree.in

2014 Top Stories in Primary Care: Pain Management.


The most important development in pain management in 2014 has been greater scrutiny regarding pain medication use and misuse as well as greater attention paid to appropriate alternatives for the management of pain. We have known for some time of escalating issues including a three- to four-times increase in the number of overdose deaths since the 1990s related to pain medications. This rise seems to be the sharpest in groups such as the military and in women, with an overall estimate of 46 deaths per day from prescription painkiller overdoses in the US:

These finding were highlighted in the 2014 White House Summit on the Opioid Epidemic (http://www.whitehouse.gov/blog/2014/06/19/white-house-summit-opioid-epidemic) and have been followed by a shift in medication options to combat the problem. This has included the FDA rescheduling of hydrocodone to Schedule II, the approval of a new hand-held naloxone auto-injector to reverse overdose, as well as the November 2014 approval of an abuse deterrent version of hydrocodone:

The most significant change in policy has probably been the recent revision to the Joint Commission pain management standards (http://www.jointcommission.org/assets/1/18/Clarification_of_the_Pain_Management__Standard.pdf). The previous standards had been in place since 2000 and said very little about nonpharmacological approaches that should be considered. The new policy, which becomes effective January 1, 2015, states that:

“When considering the use of medications to treat pain, organizations should consider both the benefits to the patient, as well as the risks of dependency, addiction, and abuse of opioids.” More specifically, the Commission mentioned specific interventions to consider:

“Both pharmacologic and nonpharmacologic strategies have a role in the management of pain. The following examples are not exhaustive, but strategies may include the following:

  • Nonpharmacologic strategies: physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy),
  • Relaxation therapy,
  • Cognitive behavioral therapy, and
  • Pharmacologic strategies: nonopioid, opioid, and adjuvant analgesics.”

Of note, these recommendations are intended not only for inpatient settings, but “for the ambulatory care, critical access hospital, home care, hospital, nursing care centers, and office-based surgery programs.”

In addition to policy and regulatory initiatives underway, a number of publications have noted the need for a more comprehensive approach to truly reduce what is one of the leading causes of accidental or preventable deaths in most US states.1

This coming year will likely see more initiatives in this regard. What hopefully will come out of the discussion is a sharp reduction in overdose deaths. During this pendulum swing, which we have seen before in pain management, it is hoped that the care of those persons in pain is not sacrificed. To balance these goals, it is important to systematically improve the care options of those in pain by consideration, incorporation, and coverage of the integrative approaches outlined in the Joint Commissions report. In this way, we will not only have meaningful recommendations but meaningful pain relief.

FDA Okays First Single-Entity Extended-Release Hydrocodone.


The US Food and Drug Administration (FDA) has approved the first single-entity extended-release formulation of hydrocodone bitartrate (Zohydro ER, Zogenix Inc) for the management of pain severe enough to require daily around-the-clock long-term treatment and for which alternative options are inadequate.

“Zohydro ER, a Schedule II controlled substance under the Controlled Substances Act, is the first FDA-approved single-entity (not combined with an analgesic such as acetaminophen) and extended-release hydrocodone product,” a statement from FDA released today notes.

“Zohydro ER will offer prescribers an additional therapeutic option to treat pain, which is important because individual patients may respond differently to different opioids.”

This formulation belongs to the class of extended-release/long-acting (ER/LA) opioids, the statement notes. “Due to the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with ER/LA opioid formulations, Zohydro ER should be reserved for use in patients for whom alternative treatment options are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain,” the FDA release said.

It is not approved for as-needed pain relief.

In addition, the labeling approved for this drug conforms to updated labeling requirements for all ER/LA opioids announced by the FDA on September 10 and reported at that time by Medscape Medical News, the first opioid to be labeled in this way, the statement notes.

“The new class of labeling and stronger warnings will more clearly describe the risks and safety concerns associated with ER/LA opioid analgesics, along with the appropriate use of these medications,” the FDA said. “These warnings are expected to improve the safety of all such medicines by encouraging more appropriate prescribing, patient monitoring, and patient counseling practices.”

Schedule II drugs can be dispensed only by prescription, and no refills are allowed. Stringent record-keeping, reporting, and physical security requirements are also in place for these substances.

The FDA will require postmarketing studies of this agent to assess the “known serious risks of misuse, abuse, increased sensitivity to pain (hyperalgesia), addiction, overdose, and death associated with long-term use beyond 12 weeks,” the FDA release said. “These studies will also be required for other ER/LA opioid analgesics.”

Safety of this new formulation of hydrocodone is based on clinical studies that have included more than 1100 patients with chronic pain. Efficacy is based on a clinical study that enrolled more than 500 patients with chronic low back pain and showed a significant improvement in chronic pain vs placebo.

It will also be part of the ER/LA Opioids Analgesics risk evaluation and mitigation strategy (REMS) approved in 2012. The REMS requires companies to make educational programs on how to safety prescribe these agents to healthcare professionals and provide medication guides and patient counseling documents with information on safe use, storage, and disposal of ER/LA opioids.

The most common adverse effects of this single-entity hydrocodone are constipation, nausea, somnolence, fatigue, headache, dizziness, dry mouth, vomiting, and pruritus.

In December 2012, FDA’s Anesthetic and Analgesic Drug Advisory Committee of independent experts voted 11 to 2, with 1 abstention, to recommended against approval of this agent for the treatment of moderate to severe chronic pain.

Most panel members voted that the drug had met regulatory requirements for safety and efficacy, as indicated by their responses to questions on efficacy and safety. However, for the last question voted on — “Based on the data presented and discussed today, do the efficacy, safety and risk-benefit profile of Zohydro ER support the approval of this application?” — most had negative responses.

The main concern of those voting against approval was that the potential for abuse of these agents; because the product does not include acetaminophen, they feared the potential for abuse might be even greater.

Anesthetic reduced frequency of menopausal hot flashes by half.


Menopausal women treated with a stellate ganglion blockade showed a 50% reduction in moderate-to-severe hot flashes, according to preliminary data presented at Anesthesiology 2013.

Bupivacaine is currently indicated for local or regional anesthesia or analgesia.

“This is the first effective, non-hormonal treatment for hot flashes, which for many women have a serious negative effect on their lives. This treatment will also help breast cancer patients who suffer from hot flashes as a side effect of their treatments of medication. Some breast cancer patients stop taking their medication (tamoxifen) because of hot flashes,”David R. Walega, MD, chief of the division of pain medicine and program director of the multidisciplinary pain medicine fellowship department of anesthesiology at Northwestern University Feinberg School of Medicine, said in a press release.

Researchers randomly assigned 40 menopausal women aged 30 to 65 years with more than 25 vasomotor symptoms per week to an injection of 0.5% bupivacaine 5 mL or sterile saline.

There was a 19% reduction in hot flashes 4 to 6 months after the injection in the bupivacaine group, according to researchers.

Analyses revealed hot flashes decreased 34% from baseline to 6 months among patients in the bupivacaine group vs. placebo. Further, reductions in moderate-to-severe hot flashes were significantly greater among the bupivacaine group vs. the placebo group (RR=0.5; 95% CI, 0.34-0.73), according to data.

“This is a fast, relatively painless, long-lasting and cost-effective treatment for hot flashes,” Walega said. “It has tremendous potential to help not only menopausal women, but also breast cancer patients and women in surgical menopause (whose ovaries have been removed), who have had to put up with ineffective treatments or simply ‘grin and bear it.’”

Source: Endocrine Today.

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