Medical News: AAPM: At Any Age Depression Dx Tracks Opioid Use - in Meeting Coverage, AAPM from MedPage Today

WASHINGTON -- Teens and young adults with mental health disorders may be more likely to become chronic users of opioid drugs, according to results of a large study reported here. The study of more than 59,000 chronic pain patients (ages 13-24) found that overall, 17.1% of chronic opioid users had a mental health or substance use diagnosis, compared with 10.6% among non-chronic users, and 8.2% for those who did not use opioids, Mark Sullivan, MD, professor of psychiatry and behavioral sciences at the University of Washington in Seattle, and colleagues reported. Their findings were presented in a poster session at the annual meeting of the American Academy of Pain Medicine. It is well-known that adults with mental health problems have a higher risk of suffering from chronic opioid use and abuse compared with those without mental health issues. Sullivan's group wanted to find out more about younger opioid users. "Since the group of adolescents are at the highest risk for opioid abuse, we felt it was important to focus on how these individuals get prescribed opioids for chronic pain," Sullivan told MedPage Today. The investigators looked at data from the HealthCore Integrated Research Database involving claims for 59,077 patients ages 13-24 years seen for a non-cancer related chronic pain condition (back/neck pain, headache, or arthritis/joint pain) from January 1, 2001 to June 30, 2008. Chronic opioid use was defined as receiving more than 90 days of opioids within a six-month period, with no gap in use of more than 30 days. The researchers found that 351 patients (0.5%) met criteria for chronic opioid use, while 6,172 (27.4%) had some opioid use but did not meet criteria for chronic opioid use, and 42,584 (72.1%) had no opioid use. The average age of the chronic users was around 20; and a little over half were male. Anxiety disorders and depression were the most common mental health diagnoses among chronic opioid users, at 8.1% and 5.9%, respectively. After controlling for demographic and clinical factors, patients with any mental health diagnosis had a more than two-fold increased risk for receiving chronic opioids compared to no opioids (OR 2.36, 95% CI 1.73 to 3.23) and a 1.8-fold increased risk for receiving chronic opioids versus some opioids (OR 1.83, 95% CI 1.34 to 2.50), Sullivan and colleagues reported. They also found that there were demographic predictors of chronic opioid abuse, including living in areas with lower education and a higher percentage of white residents. "It's consistent with overall substance abuse literature ... prescription drug abuse tends to be focused in rural, low-income, low-education white communities," said Sullivan. The researchers plan to expand their research and analyze the effects of various policy initiatives that are underway to help adolescent and young adult patients, including health system quality improvement, state-based prescription drug monitoring programs, and forthcoming Risk Evaluation and Mitigation Strategies for opioids from the FDA, he added. The results of the study carry an important message for physicians, Sullivan stressed. "We've documented that mental health diagnoses are predictive of opioid use, and I imagine that a lot of times opioid-prescribing physicians didn't even know about the mental health problems because they haven't asked about them. Doctors need to be inquiring about whether these patients have concurrent mental health problems, and if so they need independent treatment," he said. The study was funded by the National Institute on Drug Abuse and the Alcohol and Drug Abuse Institute at the University of Washington. Sullivan and the other authors made no financial disclosures.

Primary source: American Academy of Pain Medicine Source reference: Sullivan, MD "Initiation of Opioid Treatment Among Adolescents with Chronic Pain" AAPM 2011; Abstract 129.

Medical News: AAPM: RF Zaps Some Low Back Pain - in Meeting Coverage, AAPM from MedPage Today

Medical News: AAPM: RF Zaps Some Low Back Pain - in Meeting Coverage, AAPM from MedPage Today

WASHINGTON -- Low back pain caused by degenerative spondylolisthesis can be successfully treated by minimally-invasive radiofrequency therapy, researchers reported here. In 67 cases of degenerative spondylolisthesis, greater than a 50% reduction in pain was achieved in 64.2% of the patients, said Stephan Klessinger, MD, a neurosurgeon at Nova Clinic, Biberach in Baden-Wurttemburg, Germany, at the annual meeting of the American Academy of Pain Medicine. In a retrospective chart review of 1,470 patients who underwent radiofrequency therapy for low back pain over a three-year period, 83 of whom had spondylolisthesis -- abnormalities of the zygapophysial joints. "Degenerative spondylolisthesis is one of the major causes for low back pain," he told MedPage Today at his poster presentation. "Radiofrequency neurotomy seems a rational therapy. Our objective was to determine if radiofrequency neurotomy is effective for patients with low back pain and degenerative spondylolisthesis." The treatment involves inserting needles through the skin under imaging guidance to locations near the lower back vertebrae. Radiofrequency waves are then used to destroy impinged nerves in the lumbar region believed to be causing the patients' pain. Klessinger said that, to his knowledge, the study was the first attempt "to determine the effect of radiofrequency neurotomy in patients with degenerative spondylolisthesis." Because the treatment does not require surgery, "it is worth trying radiofrequency neurotomy because if it doesn't work, you can still do surgery if there are no other options," he said. However, his study showed that, for the majority of patients, radiofrequency nerve ablation was effective in markedly reducing pain. All of the patients included in his analyses had undergone magnetic resonance imaging of the spine. Patients with previous spinal surgeries and those with neurological deficits were excluded. For the purposes of the study, patients were considered successfully treated with radiofrequency neurotomy if the treatment produced at least a 50% reduction in self-reported pain and patients also said they were satisfied with the outcome of the procedure. "This procedure is greatly underutilized for treating low back pain," Craig Cartia, MD, an anesthesiologist with the Sacred Heart Medical Group in Pensacola, Fla., told MedPage Today. "This is a fairly common procedure that can be performed pretty accurately with success. We can see these patients get better and achieve long-term pain relief with this procedure," he remarked. Cartia said he believes that with careful patient selection, the percentage of patients with spondylolisthesis might also be higher. In his report, Klessinger noted that patients who appeared to have abnormalities within the zygapophysial joint did better than patients with osteoarthritis and stenosis in the same area. Most of the patients -- 52 of in the study group -- were between ages 60-79. Using the 5-Grade Meyerding Grading System, Klessinger found that 42 of the patients had Meyerding Grade 1 abnormality -- up to a 24% "slip" of the disc; and 25 patients were classified as Meyerding Grade 2 -- a 25% to 49% slip. In his study group, Klessinger also identified 16 patients who were diagnosed with spondylolytic spondylolisthesis who were also treated with radiofrequency neurotomy. "The etiology and the mechanisms of pain are different in patients with spondylolytic spondylolisthesis," he noted in his poster presentation. "Patients are younger; there are less degenerative changes and seldom a spinal stenosis." "However, our number of patients with this condition were small, so more research will be required to determine how effective this treatment may be," he added. Klessinger and Cartia had no disclosures.

Primary source: American Academy of Pain Medicine Source reference: Klessinger S, "Radiofrequency neurotomy for conservative management of lumbar spondylolisthesis" AAPM 2011.

Unreliable detection and twice the radiation - FDA approves new mammogram technology

Unreliable detection and twice the radiation - FDA approves new mammogram technology

(NaturalNews) The cancer industry is in the process of rolling out its latest tool of detection which is meant to improve current mammogram technology by offering three dimensional (3-D) imaging of breasts. Now with FDA approval, the first x-ray device of its kind meant to be used for cancer screening purposes has been developed. It appears the system costs more and for your money you get twice the radiation.

The two studies used by the FDA to approve this new screening method relied on the existing technology as applied in conjunction with 3-D technology. No study was performed using only 3-D technology; therefore, its distinct merits have yet to be measured. Using both 2-D and 3-D imaging, radiologists were able to obtain a 7 percent improvement in discerning cancerous tumors from non-cancerous tumors. It is important to note that improvement was not based on finding tumors but rather in the reduction of false positives. The FDA went on to admit the additional imaging doubled the radiation dose for the patient but that is not a matter of concern. Apparently, women should ignore the fact that mammograms expose the body to 1,000 times the radiation than that of a chest x-ray.

A Woman's Best Hope for Detection of Breast Cancer Does Not Need to Involve Radiation

We are frequently reminded that annual mammograms remain a woman's best option for detecting breast cancer. But is this really the case? Is exposing the body to radiation a logical approach to cancer detection?

As women are herded by the mainstream medical establishment toward their annual mammogram, the obvious and safe alternative is never mentioned. Digital Infrared Imaging (DII), also known as thermography, offers a safe and effective method of cancer screening, yet it is virtually ignored. While mammograms search for lumps, DII measures heat. Tumors are always seeking nutrients to feed and thus by their very nature increase circulation of blood and metabolic activity. DII screening measures this heat and the technician rates the level of heat on a scale of 1 to 5. Studies have shown DII to be highly effective at detecting tumors.

The Effectiveness of Thermograms Stand the Test When Compared to Mammograms

Mammograms offer 80 percent sensitivity to cancers with 20 percent of cancers missed. Mammograms are less effective in women under the age of 50, missing as many as 40 percent of cancers. Hormone use decreases sensitivity making it less useful as does large, dense and fibrocystic breasts. Also, there are areas of the breast which offer no visualization such as the medial upper triangle.

DII offers 90 percent sensitivity to cancers, missing only 10 percent of cancers. The same effectiveness applies for all age groups; it is not affected by hormone use and can visualize all areas of the breast with the same level of accuracy.

In the case of mammograms, the most insidious forms of cancer are sometimes unrecognizable while it frequently picks up benign tumors whether using 2-D or 3-D imaging. Remember, 3-D technology merely offers up less false positives with no noted improvement in detection. The opposite is true with regards to thermograms. The less aggressive lesions are sometimes missed because they fail to generate enough blood vessel activity to show up on the scan.

The contrast between these two technologies is quite dramatic. One form radiates the breast while the other safely scans. Three times zero equals zero which is quite possibly what we have here with mammograms offering 3-D imaging. If you must look for lumps, your best option remains Digital Infrared Imaging.

Sources included:

http://www.fda.gov/NewsEvents/Newsr...

http://www.breastthermography.com/b...

http://articles.latimes.com/2011/fe...

About the author

Paula Rothstein is a freelance writer and Holistic Health Coach active in the area of natural health. Through educating clients on the necessity of self-awareness and bio-individuality with regards to diet and lifestyle, she helps effect life long health changes. For more information, please visit :http://www.curativecoaching.com.


Learn more: http://www.naturalnews.com/031628_mammograms_radiation.html#ixzz1G0uX1le3

Study Points To The Liver, Not The Brain, As The Origin Of Alzheimer's Plaques

Study points to liver, not brain, as origin of Alzheimer's plaques


Unexpected results from a Scripps Research Institute and ModGene, LLC study could completely alter scientists' ideas about Alzheimer's disease—pointing to the liver instead of the brain as the source of the  "amyloid" that deposits as brain plaques associated with this devastating condition. The findings could offer a relatively simple approach for Alzheimer's prevention and treatment.

The study was published online today in The Journal of Neuroscience Research.

In the study, the scientists used a mouse model for Alzheimer's disease to identify genes that influence the amount of amyloid that accumulates in the brain. They found three genes that protected mice from brain amyloid accumulation and deposition. For each gene, lower expression in the liver protected the mouse brain. One of the genes encodes presenilin—a cell membrane protein believed to contribute to the development of human Alzheimer's.

"This unexpected finding holds promise for the development of new therapies to fight Alzheimer's," said Scripps Research Professor Greg Sutcliffe, who led the study. "This could greatly simplify the challenge of developing therapies and prevention."

An estimated 5.1 million Americans have Alzheimer's disease, including nearly half of people age 85 and older. By 2050, the number of people age 65 and over with this disease will range from 11 million to 16 million unless science finds a way to prevent or effectively treat it. In addition to the human misery caused by the disease, there is the unfathomable cost. A new report from the Alzheimer's Association shows that in the absence of disease-modifying treatments, the cumulative costs of care for people with Alzheimer's from 2010 to 2050 will exceed $20 trillion.

A Genetic Search-and-Find Mission

In trying to help solve the Alzheimer's puzzle, in the past few years Sutcliffe and his collaborators have focused their research on naturally occurring, inherited differences in neurological disease susceptibility among different mouse strains, creating extensive databases cataloging gene activity in different tissues, as measured by mRNA accumulation. These data offer up maps of trait expression that can be superimposed on maps of disease modifier genes.

As is the case with nearly all scientific discovery, Sutcliffe's research builds on previous findings. Several years ago, researchers at Case Western Reserve mapped three genes that modify the accumulation of pathological beta amyloid in the brains of a transgenic mouse model of Alzheimer's disease to large chromosomal regions, each containing hundreds of genes. The Case Western scientists used crosses between the B6 and D2 strains of mice, studying more than 500 progeny. 

Using the results from this study, Sutcliffe turned his databases of gene expression to the mouse model of Alzheimer's, looking for differences in gene expression that correlated with differences in disease susceptibility between the B6 and D2 strains. This intensive work involved writing computer programs that identified each genetic difference that distinguished the B6 and D2 genomes, then running mathematical correlation analysis (known as regression analysis) of each difference. Correlations were made between the genotype differences (B6 or D2) and the amount of mRNA product made from each of the more than 25,000 genes in a particular tissue in the 40 recombinant inbred mouse strains. These correlations were repeated 10 times to cover 10 tissues, the liver being one of them.

"A key aspect of this work was learning how to ask questions of massive data sets to glean information about the identities of heritable modifier genes," Sutcliffe said. "This was novel and, in a sense, groundbreaking work: we were inventing a new way to identify modifier genes, putting all of these steps together and automating the process. We realized we could learn about how a transgene's pathogenic effect was being modified without studying the transgenic mice ourselves."

Looking for a Few Good Candidates

Sutcliffe's gene hunt offered up good matches, candidates, for each of the three disease modifier genes discovered by the Case Western scientists, and one of these candidates—the mouse gene corresponding to a gene known to predispose humans carrying particular variations of it to develop early-onset Alzheimer's disease—was of special interest to his team.

"The product of that gene, called Presenilin2, is part of an enzyme complex involved in the generation of pathogenic beta amyloid," Sutcliffe explained. "Unexpectedly, heritable expression of Presenilin2 was found in the liver but not in the brain. Higher expression of Presenilin2 in the liver correlated with greater accumulation of beta amyloid in the brain and development of Alzheimer's-like pathology."

This finding suggested that significant concentrations of beta amyloid might originate in the liver, circulate in the blood, and enter the brain. If true, blocking production of beta amyloid in the liver should protect the brain.

To test this hypothesis, Sutcliffe's team set up an in vivo experiment using wild-type mice since they would most closely replicate the natural beta amyloid-producing environment. "We reasoned that if brain amyloid was being born in the liver and transported to the brain by the blood, then that should be the case in all mice," Sutcliffe said, "and one would predict in humans, too."

The mice were administered imatinib (trade name Gleevec, an FDA-approved cancer drug), a relatively new drug currently approved for treatment of chronic myelogenous leukemia and gastrointestinal tumors. The drug potently reduces the production of beta amyloid in neuroblastoma cells transfected by amyloid precursor protein (APP) and also in cell-free extracts prepared from the transfected cells. Importantly, Gleevec has poor penetration of the blood-brain barrier in both mice and humans.

"This characteristic of the drug is precisely why we chose to use it," Sutcliffe explained. "Because it doesn't penetrate the blood-brain barrier, we were able to focus on the production of amyloid outside of the brain and how that production might contribute to amyloid that accumulates in the brain, where it is associated with disease."

The mice were injected with Gleevec twice a day for seven days; then plasma and brain tissue were collected, and the amount of beta amyloid in the blood and brain was measured. The findings: the drug dramatically reduced beta amyloid not only in the blood, but also in the brain where the drug cannot penetrate. Thus, an appreciable portion of brain amyloid must originate outside of the brain, and imatinib represents a candidate for preventing and treating Alzheimer's.

As for the future of this research, Sutcliffe says he hopes to find a partner and investors to move the work into clinical trials and new drug development.

More information: "Peripheral reduction of β-amyloid is sufficient to reduce brain Aβ: implications for Alzheimer's disease," http://onlinelibra … 603/abstract

Provided by The Scripps Research Institute (news : web)

Birth Control Methods and Their Effects on Women With Chronic Health Conditions

The most important thing for you, if you have a chronic condition, is to have an understanding of birth control methods and how they can affect your health. Some of these methods can present specific concerns for certain rheumatic conditions. If you have antiphospholipid syndrome or antiphospholipid antibodies in your blood, lupus or RA, here is what is known about the concerns and the appropriate birth control methods.

Antiphospholipid antibodies and antiphospholipid syndrome: APL or antiphospholipid antibodies are proteins that affect the balance in the blood between clotting and bleeding and are a risk factor for blood clots. APS or antiphospholipid syndrome, is an autoimmune disorder that is characterized by antiphospholipid antibodies, blood clotting, and miscarriages and the syndrome can happen alone or with lupus, even though you have the antibodies you may not have lupus.

If you have antiphospholipid antibodies you are more likely to develop blood clots if you have another risk factor for blood clotting such as a severe illness, surgery, prolonged bed rest, malignancy, or pregnancy or it can be a lifestyle risk factor such as smoking or using combination contraceptives. That's why this second risk factor can be one of the variants in the blood that makes clotting possible. When you have lupus and antiphospholipid antibodies you are more likely to have other medical risk factors for a stroke or heart attack, like migraines, atherosclerosis or clogged arteries, or elevated cholesterol levels.

Contraceptives with estrogen are know to increase the risk of blood clots and when you have moderate to high antiphospholipid antibodies you should stay away from combination hormonal contraceptives. If you have low or borderline levels of the antiphospholipid antibodies, it may depend on whether you have had other risk factors for blood clots, to determine if you should stay clear from the combination hormonal contraceptives. Progesterone-only contraception is a good alternative for you if you have antiphospholipid antibodies and are unable to safely take estrogen. This method is also an effective way to decrease the heavy menstrual flow if you are on blood-thinning medications like warfarin, also known as Coumadin, which is often used to treat APS, Antiphospholipid syndrome.

Systemic lupus erythematosus: It was thought for many years that estrogen increased disease activity in lupus. This assumption was based on the findings in laboratory animals, and the fact that lupus is found mostly in women, 4 out of 5 people with lupus are women, and the reports of birth control pills and pregnancy where women said their lupus got worse. There are early reports that suggested there was an increase risk of lupus flares with the use of contraceptives containing estrogen. But, there are more recent studies that were better-designed, using large numbers of participants and standardized methods of measuring flares that found that estrogen-containing contraceptives are safe in some women with lupus.

And there were two randomized clinical trials published at the end of 2005 that found combination birth control pills don't significantly increase the risk of flares in women with inactive or stable, moderate lupus. The Safety of Estrogens in Lupus Erythematosus National Assessment, or SELENA, trial included 183 women with inactive or stable, moderate lupus and compared the effects of a standard combination birth control pill with the effects of an inactive placebo pill. Women who had active lupus, a history of blood clots, or antiphospholipid antibodies couldn't take participant in the study and the number and severity of the lupus flares showed no difference in the two groups. There was another study of 162 women with stable mild-to-moderate lupus that also found no adverse effects on flare rates whether the women used a combination pill, a progesterone-only pill or a copper IUD.

Based on these studies, it would appear that combination pills are safe for you if you have inactive or stable, moderate lupus and don't have antiphospholipid antibodies. Remember, though, that you may not even be able to tell how active your lupus is and often lupus activity can only be detected through blood test or other tests. So if you have lupus and you want to use a combination pill, your rheumatologist must be involved in the decision making. Since about 1/3 of the women with lupus have antiphospholipid antibodies, you have lupus you should be screened for the antibodies before starting a combination birth control pill.

It seems that it would be smart for you if you have lupus to avoid the contraceptive patch, Ortho Evra, given the recent FDA warning that it increases the risk of blood clots above that of combination pills. There's also the birth control pills that contain drospirenone, Yasmin, Yaz, that are more likely to elevate blood levels of potassium, an important consideration for you if you have lupus-related kidney problems. The safety of IUDs, if you are taking immunosuppressive drugs to treat your lupus, is not certain, because the drugs and the IUDs can raise the risk of infection. If you have active lupus, barrier methods or progesterone-only contraceptives are your options. Depo-Provera injections may be a problem if you are taking corticosteroids, because both the Depo-Provera and the corticosteroids increase the risk of bone loss.

Rheumatoid arthritis: There are some who believe that if you have RA you might actually benefit from treatment with estrogen-containing birth control pills because your symptoms improve during pregnancy. But, there's little research into using the pill to treat RA and research does suggest that women with RA have normal estrogen levels but lower than normal androgen levels, so hormonal therapy attempts have focused on supplementing androgens (androgens are primarily male sex hormones, but women have small amounts of them), with mixed results and no clear benefit. Postmenopausal estrogen therapy has also been studied in women with RA but showed no effect on the activity of the RA, and although there are no grounds for saying that combination hormonal contraceptives reduce the activity in Ra, there's no evidence that suggest their use would make a flare more likely to happen. Combination pills or the patch, may be effective and convenient for you if you have RA, but there is a concern that the risk of blood clots from the patch is higher than the risk from the pill. Inserting a vaginal ring or a diaphragm may be difficult if you have severe RA and like with lupus, it's not sure how safe IUDs are if you are taking immunosuppressive drugs such as ethotrexate, corticosteroids, or cyclosporine to treat their RA. There are no studies that have addressed this question specifically with newer RA medicines such as the biologics, among them Enbrel, Remicade and Humira.

There are other concerns as well and they are the hormone containing contraceptives can interact with other medicines, and this can reduce your medicine's effectiveness or increase its side effects. Some of these medicines are used to treat arthritis and related conditions. Some anticonvulsants like anti-seizure medications that are used to treat seizures, headaches, or chronic pain disorders may decrease the effectiveness of birth control pills. There are also, corticosteroids, warfin, and cyclosporine that can interact with the contraceptives even though the interactions are weak. Other medications that are used to treat other health conditions, some antibiotics, may also interact with hormone containing contraceptives and if you are using one of these contraceptives you should always remind your doctor of that fact when your doctor prescribes you new medications.

When you have rheumatic conditions and you have to stay in bed for a while, maybe because of a flare-up of the condition, or after surgery you should stop using combination birth control pills, the patch and the vaginal ring. Also, and especially if you have antiphospholipid antibodies, your doctor should give you low doses of a blood-thinning medicine. If you are planning elective surgery, you should talk to your doctor about stopping you combination hormonal contraceptive two months in advance, because estrogen's effects on blood clotting takes up to six weeks to reverse.

There are so many different types of birth control available to you today that if you have a rheumatic condition you can choose a safe and effective method. There are also many factors that have to be taken into consideration and it's essential that you, your gynecologist, and your rheumatologist work together to decide which of these methods is best for you.