Alternatives to Opioid Pain Medications for Injured Workers

Workplace injuries affect approximately 4.1 million Americans annually (1) .  More than half of these injured individuals will have to miss work and receive long-term medical care.  Worker’s compensation plans provide partial wages during the time of injury and recovery period in addition to covering the cost of medical care.  The recent trend among physicians treating work related injuries has been the practice of prescribing high and sometimes dangerous doses of opioid pain medications for extended periods of time.  Data from 2005-2008 in 17 states showed an average number of 1,599 cases requiring narcotics for non-surgical cases, with more than seven work days missed due to injury(2).  Additionally, in an average of 6% of these cases, the narcotics were prescribed for long-term periods of time.  These drugs may include but are not limited to hydrocodone, fentanyl, methadone, and oxycodone.  Approximately 50-90% of injured workers will receive narcotics for chronic pain conditions (3).  Opioid pain medications can have deadly side effects and the increased availability and dosages of these medications can be detrimental to an injured worker and prolong the time it takes to return to work.

Opioid pain medications are the most commonly prescribed medication in the United States(4).  They work to decrease the perception of pain and increase pain threshold.  While these drugs are helpful to decrease overall pain of various injuries and conditions, they are highly addictive and only address a portion of the pain process.  Common side effects may be mild such as constipation and fatigue, however, they have also been linked to more severe side effects including sleep apnea, decreased hormone production, and increased falls and broken bones among the elderly population(4).  Additionally patients taking opioid pain medications for long periods of time can become addicted and experience serious symptoms of withdrawal which include nausea, shaking, chills, and sweating when finishing a course of these medications (5).  Lately there has also been in an increase in drug overdose leading to death.  In a study that observed 10,000 patients who were prescribed opioids for 90 days, 51% experienced at least one overdose, and six individuals died as a result of overdose 6.  In 2008 the number of deaths resulting from overdose reached nearly 15,000 individuals(1).

Increased availability and access to opioid pain medications is one of the main problems leading to addiction and overdose among injured workers.  Some physicians are prescribing these medications to treat acute and long-term pain disorders such as arthritis and musculoskeletal pain.  Oftentimes high doses are prescribed and the dosage continues to increase over time as tolerance to the effects of the medications increases.  Instead of treating the underlying physiological conditions causing the painful condition, opioid pain medications are prescribed to help manage and mask the pain associated with a work related injury. They are prescribed for many reasons, however, a few of the most common are pressure from patients to prescribe a strong medication that will lead to decreased pain, as well as pressure from insurance companies to prescribe the most cost-effective generic pain medications. Patients may experience temporary pain relief while on these medications, however chronic pain may persist long after the injury has healed.

Prescribing high dose opioid pain medications for work related injuries often leads to other injuries and physiologic impairments.  In many cases, patients remain out of work for much longer than individuals who are not prescribed opioids, as they often develop new health conditions and require more medications.  In the study conducted by the Danish Health Interview Survey in 2000 observing 10,434 individuals, patients who were not prescribed opioid pain medications to treat their injuries recovered four times more often than individuals prescribed opioid pain medications(7).  Additionally, in this study patients taking opioid pain medications were shown to have a lower quality of life and higher death risk than those patients managing pain without opioids.

Some patients who are prescribed opioid pain medications, especially long-term, may develop other serious conditions such as obesity, mood disorders, and depression.  An injured worker who is taking medication for a pain condition may not be able to exercise regularly and weight gain is fairly common.  Opioid pain medications can also have an effect on overall mood and quality of life.  If an individual takes these medications long-term it can be very hard to stop taking them.  The patient can experience large amounts of anxiety and depression when decreasing the dosage or attempting to discontinue the medication all together.  Research has found that of the 1.9 million workers claims that were filed between 2007-2008, those who previously had or developed a co-morbidity as a result of injury such as depression, obesity, or hypertension, experienced more costly treatments and often longer treatment plans all together(8).

Work related injuries will continue to be an issue for insurers and employers.  The overprescribing of opioid pain medications in this country must be addressed by physicians, insurance companies, and drug manufacturers.   The conversion of acute pain to chronic pain associated with a work related injury can be managed in a more efficient way that will allow an injured worker to return to work as soon as they are healed without the burden of addiction or other opioid pain medication related side effects.  Theramine can be used as a complimentary or standalone therapy among this vulnerable population and can provide treating physicians with the ability to prescribe the lowest effective dose of an opioid pain medication while addressing the underlying pathology of the pain process.

Theramine is a prescription only medication regulated by the FDA as a medical food. Medical foods are prescription only medications which address the underlying pathology of pain associated with the work related injury or illness.  Theramine is clinically proven to correct amino acid deficiencies associated with chronic pain syndromes, and improve the overall perception of pain(9).  Theramine is designed to manage the increased nutritional requirements associated with acute or chronic pain conditions.  Theramine is a proprietary amino acid formulation that, by providing neurotransmitter precursors, helps stimulate production of neurotransmitters that are often deficient in pain conditions.  The ingredients in Theramine are Generally Recognized as Safe by the FDA, and are specially formulated utilizing a proprietary Targeted Cellular Technology to facilitate the uptake and metabolizing of milligram quantities of amino acids and other nutrients.  There have been no reported adverse side effects associated with the clinical application of over 50 million individual doses of Theramine. The most common side effects associated with amino acid therapies are headache, dry mouth, and upset stomach and are often short term, and can be decreased with increased fluid intake.  Theramine can be administered in conjunction with the lowest effective doses of an opiate or NSAID pain medication without loss of efficacy(10).  Treating work related injuries with Theramine may prove to be one possible medication solution to control pain and help decrease the quantity and dosages of opioid pain medications administered in the United States.

1)      http://www.workers-comp-news.com/injury_stats.php

2)      http://www.wcrinet.org/studies/public/books/WCRI_2012_Annual_Report.pdf

3)      http://ehstoday.com/health/workers-compensation/injured-workers-opiate-addiction-0209/

4)      http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions-pose-danger-without-oversight.html?pagewanted=all

5)      http://www.opiates.com/opiate-withdrawal.html

6)      http://www.crcotp.com/crcotp_featured/even-when-prescribed-opioids-can-cause-addiction-and-overdose.php

7)      A Population-based Cohort Study on Chronic Pain:The Role of Opioids Per Sjøgren, MD, DMSC,* Morten Grønbæk, PhD, Vera Peuckmann, PhD,  and Ola Ekh-+olm, PhDw, Lippincott Williams & Wilkins, 2010.

8)      http://coventrywcs.com/web/groups/public/@cvty_workerscomp_coventrywcs/documents/webcontent/c054910.pdf

9)      Shell WE, Silver D, Charuvastra E, Pavlik S, Bullias D; “Theramine and Ibuprofen for the treatment of chronic low back pain double blind clinical trial”, 2010 Targeted Medical Pharma Inc.

10)   Shell WE et al.; “Theramine and Naproxen for the treatment of low back pain, a double bind clinical trial”; Americal Journal of Therapeutics April,2012.

Safe Alternative Therapies for Post-traumatic Stress Disorder

Post-traumatic Stress Disorder (PTSD) can occur after a person has been through a traumatic event, such as combat exposure, a terror attack, a serious accident, a natural disaster, or sexual or physical assault or abuse.  Not everyone who experiences a traumatic event will be diagnosed PTSD.  About 60% of men and 50% of women experience trauma in their lives and it is estimated that about  7-8% of the entire U.S. population will have PTSD during their lifetime.[1]  People who have been diagnosed with PTSD can experience  a variety of psychological and physical symptoms which include reliving the event, avoidance, negative changes in beliefs and feelings, hyperarousal, sleeplessness, muscle fatigue, and digestion disorders.

PTSD is such a complex disease, affecting the body and brain in such a way that makes standardizing treatment very difficult.  The current treatment protocols available for people suffering from PTSD can be effective but are also limited.  One of the most effective treatment protocols currently used to manage PTSD, is cognitive behavioral therapy (CBT).  There are different types of CBT, including Cognitive Processing Therapy (CPT) which is used to help a person understand how trauma can change thoughts and feelings. Prolonged Exposure Therapy (PE), which is designed to condition or desensitize a person with PTSD, by helping them relive the experience through talk therapy repeatedly until the memories are no longer upsetting.  This may also include physically going to the location where the traumatic event occurred that may be intentionally avoided.[2]

Medications are often prescribed as an adjunct to CBT and other therapies used for treating PTSD. According to the Department of Veterans Affairs, “Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms.” Pain medications are also often used to treat pain associated with PTSD, but can be very dangerous and addicitve. A recent study by a VA researcher found that veterans with PTSD were two times as likely to be prescribed opioids as those without mental-health problems. They were more likely to get two or more opioid painkillers at the highest doses. Veterans with PTSD were more than twice as likely to suffer bad outcomes like injuries and overdoses if they were prescribed opioid painkillers, the study found.

As the intelligence about the causes and effects of PTSD has improved, attention has been directed towards specific abnormalities associated with the human nervous system, particularly the parasympathetic autonomic nervous system. The parasympathetic nervous system is the “rest and digest” part of the nervous system and it is responsible for many restorative functions. The parasympathetic nervous system is responsible for many of the automatic body functions such as heart rate, breathing and digestion.  According to numerous studies in patients with PTSD, there appears to be a blunting of total autonomic activity, marked in particular by a reduction of nighttime parasympathetic activity. The inability of PTSD patients to effectively initiate parasympathetic activity can lead to an imbalance of nervous system activity and yield symptoms including anxiety, rapid heartbeat, panic spells and increased sweating. Parasympathetic suppression can also cause sleep dysfunction, abnormal dreams and memory disturbances. There is an emerging consensus that sleep disturbance may be a core feature of PTSD.

Improving nervous system health and balancing parasympathetic and sympathetic activity is a key component in the successful treatment of PTSD. Providing clinically validated alternatives to the currently prescribed medications is essential to improving the treatment of PTSD.   There are currently natural medication options available that can help to manage the increased physiologic and metabolic demands of PTSD. Recent studies involving the medical foods  Sentra AM® (acetyl l-carnitine HCL, choline bitartrate, l-glutamic acid) and Sentra PM® (acetyl l-carnitine HCL, choline Bitartrate, 5-HTP, l-glutamic acid)  have yielded very positive results in patients suffering from symptoms related to PTSD. These products are specially formulated using amino acids, nutrients and certain botnaicals and are believed to influence the production and absorption of neurotransmitters essential to autonomic nervous system function. They may be particularly effective at targeting symptoms of PTSD and provide a new, safe treatment option for this condition.[3] Civilians, active service and military veterans are often reluctant to seek treatment for PTSD symptoms because of the perceived stigma associated with a psychiatric diagnosis and psychiatric medications. Medical foods like Sentra AM and Sentra PM provides patients and providers with a safe, effective and reliable therapeutic alternative to the current drug protocols being prescribed.



[1] Gradus, Jamie L. “Epidemiology of PTSD” ptsd.va.gov.  January 30 2014.  Web.  June 2014.  http://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp

[2] “What is PTSD?” ptsd.va.gov. January 17 2014. Web. June 2014. http://www.ptsd.va.gov/public/PTSD-overview/basics/what-is-ptsd.asp

[3]Targeted Medical Pharma, Inc.. Administration of an Amino Acid-Based Regimen for the Management of Autonomic Nervous System Dysfunction Related to Combat Induced Illness. Publication Pending. Print.