Pain Management

MARCH 2020 | FUTUREOFPERSONALHEALTH.COM

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PAIN MANAGEMENT

Kristin Chenoweth The Broadway and TV star talks about living with Meniere’s disease

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Handling Pain, Anxiety, and Depression Without Drugs In 1992, Richard Hanbury was in a terrible Jeep accident. His nerve damage was so extensive that doctors gave him only a few years to live. Instead of accepting his fate, he began seeking a solution.

Hanbury founded Sana Health, which developed a device poised to revolutionize pain management. Sana recently won the UCSF Digital Health Award for Best Behavioral Health Company, and its device has taken the top spots in both the NATO Innovation Challenge and the P&G Innovation Award.

The Sana device uses neuromodulation patterns and biometric sensors to induce a therapeutic “flow state” — a state of deep relaxation — in the brain.

This allows the brain to essentially reset and reprogram itself, reducing or even eliminating chronic pain. This flow state has also been shown to be effective at reducing anxiety, depression, and insomnia.

“I wanted to find a way to meditate from the outside in, so I could lower my pain levels,” Hanbury said. “I had no idea it would cure my pain.”

Jeff Somers

How the Right Plan Can Ensure Safe Opioid Use While using opioids to manage pain can become dangerous and create dependency, collaborating with your healthcare provider to put together a thoughtful pain management plan can make the process much safer.

When you or a loved one is prescribed an opioid, there are a number of ways to ensure your success and improve safe use. First, we recommend working with your physician to develop reasonable treatment goals. Your pain treatment plan should provide clearcut, individualized, and measurable goals at the start of treatment.

If you don’t know where to start, we suggest goals that include a reduced level of pain accompanied by an increase in function or measurable improvements in quality of life. Lower levels of pain without improvement in activity is rarely a recipe for success.

Include an accountability partner in your plan and create a weekly accountability statement for yourself to see if you’re meeting your goals.

Others can learn to recognize side effects earlier than you can, which makes them key resources if life-threatening, adverse effects occur.

Naloxone, the reversal antidote for opioid side effects that impair the ability to breathe, can be administered via simple instructions but only if someone recognizes the side effect is occurring.

Planning for the future Life circumstances will evolve, so adapt your pain treatment plan based on successes or challenges you encounter along the way to reaching your goals. Make it a point to review the list of all your medications, even medications used for disorders other than pain and any overthe-counter medications.

Relying on your pharmacist to review or delve deeper into

the discussions you’ve had with other members of your healthcare team is an often overlooked opportunity.

Throughout the course of opioid therapy, you and your healthcare team should regularly weigh the potential benefits and risks of continuing treatment to determine whether opioid medications remain the best option.

Healthcare providers like you to ask questions — it shows you understand the treatment plan and allows us to fill in gaps. If you or a loved one notes you’re taking medications longer than originally intended, become unsuccessful in your efforts to cut down use, or develop cravings for medications, mention these challenges to your physician to help further customize your treatment plan.

Once opioid medications are no longer needed, dispose of them properly.

Sharing medications with others can be unsafe since your doctor has selected the strength and frequency for you individually.

When the time for disposal comes, we recommend using the Drug Enforcement Administration’s Public Disposal Locator website, which is free to use. ■ Robert B. Bolash, M.D., Assistant Professor, Department of Pain Management, Cleveland Clinic; Richard W. Rosenquist, M.D., Chairman, Department of Pain Management, Cleveland Clinic

Publisher Abigail Hanania Business Developer Joelle Hernandez Managing Director Luciana Olson Lead Designer Tiffany Pryor Designer Marie Coons Lead Editor Mina Fanous Copy Editor Dustin Brennan Director of Sales Stephanie King Director of Product Faye Godfrey Cover Photo Gian Andrea di Stefano All photos are credited to Getty Images unless otherwise specifıed. This section was created by Mediaplanet and did not involve USA Today.

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How a Family-Owned Custom Medical Devices Company Is Innovating Pain Management SPONSORED

patient’s epidural space, this would cause a major problem. Arrigo reports the company has never had an issue with skiving in its 25 years.

One U.S. medical supply company, Spectra Medical Devices supplies many of the tools used during surgery — needles, scalpels, and sponges, and other surgical items — but you might not know about them.

Surgical products are in high demand. Statistics from the Centers for Disease Control and Prevention show over 48 million surgical and nonsurgical procedures were performed during 28.6 million ambulatory surgery visits to hospitals and ambulatory surgery centers.

For the past 25 years, Spectra supplied about half of the components found in procedural kit packers, such as needles, drugs, scalpels, and sponges. While they still provide those components to medical companies, Spectra is now producing their own kits and branching out with their same commitment to excellence.

“We use all quality products start-to-finish

when manufacturing,” says Anthony E. Arrigo, director of global sales and marketing for Spectra. “We also have several inspection points along the way to ensure these parts are always within specification. We strive for quality and patient safety.”

His father, Tony Arrigo, started the family run company in 1995, and serves as Spectra’s President and CEO. They’re headquartered in Massachusetts, where they engineer their medical devices. The products are then manufactured at company-owned factories using state-ofthe-art manufacturing equipment and materi-

als, including the highest grade steel available.

Needle innovations Spectra is also focused on designing and manufacturing high-quality surgical needles. The company is a world leader in the manufacture of radiofrequency (RF) needles that are used in nerve ablation procedures. The needles are designed to maximize control for the surgeon and minimize discomfort for the patient.

Spectra has been granted several U.S. patents, including patents on: Cath Slide® for epidural needles and Cath Glide® for spinal cord stimulator lead introducer needles. The

patented, proprietary processes involve eliminating sharp edges within the needle’s heel.

“When you grind a needle, you’re grinding steel and using a grinding wheel — there’s going to be small burrs, little imperfections in that bevel,” says Arrigo.

“So, it’s what you do after the grinding portion that ensures it will be comfortable and safe for the patient and won’t cause any adverse effects while being used.”

If there were sharp edges, fragments of the catheter could be cut off during insertion, or retraction of the catheter, known as skiving. If a portion of this catheter skives while inside the

Effective pain management Arrigo, his father, and the Spectra team are excited about the potential of these needles — and other products made by the company — have to help patients manage pain.

For example, a patient with shoulder pain can get a shot of medication.

The doctor can precisely insert the needle where it’s needed, using Spectra Guide echogenic technology, a needle with a tip that is extremely visible under ultrasound.

By using alternative pain management techniques, patients may not need to take prescription painkillers, such as opiates, or they may use fewer pills. That’s a winwin at a time when opiate addiction is skyrocketing.

“Rather than just kind of giving them a medication that has the potential for addiction, using some of the available, innovative techniques, you’re actually treating that one specific area that’s causing them pain,” says Arrigo. n Jeff Somers MEDIAPLANET • 3

ADVERTORIAL

Rightful Offers the Right Way to Relieve Pain Rightful is a new, plant-based pain relieving formula created by Dr. Tieraona Low Dog, who has been researching natural remedies for decades.

Dr. Tieraona Low Dog, a co-founder of the plant-based pain-relieving formula Rightful, has been promoting natural and plant-based medications for over 40 years.

“I’ve been fortunate to learn about plants from indigenous healers in Africa, midwives in Central America, and farmers in the United States,” she said. “Botanicals possess biological activities that can holistically support people with chronic pain, including anti-inflammatory, analgesic, antidepressant, anxiolytic, sedative, and stress-protecting properties.”

Herbal remedies have long been ignored by Western medicine. Dr. Low Dog created Rightful, a day-and-night formula with natural ingredients like turmeric and hemp extract to offer a natural alternative for treating pain and stress.

“Chronic pain is often accompanied by disrupted sleep, depression, anxiety, challenges with intimacy, amplified stress response, and physical deconditioning, all of which make recovery more difficult,” Dr. Low Dog said. “Our heavy reliance on prescription analgesics has been overly simplistic.”

With Rightful, Dr. Low Dog hopes to enlighten people about the benefits of plant-based natural remedies for many common ailments.

“With a few exceptions, many commonly available herbal remedies can be safely used for addressing the day-to-day problems people face; insomnia, fatigue, headaches, colds/cough, upset stomach, aches and pains, and other health challenges,” she said. Dr. Low Dog encourages patients to explore other kinds of natural remedy practices.

“Depending on the type and severity of pain, treatment options might include manual medicine, acupuncture, cognitive behavioral therapy, nutrition, mindfulness-based stress reduction, and herbal remedies,” she said.

Ross Elliott 4 • FUTUREOFPERSONALHEALTH.COM

Alternatives to Opioids Exist — Just Ask Your Pharmacist Opioid addiction (which we prefer to call opioid use disorder) continues to increase in the United States. Opioid pain relievers are certainly important for treating severe pain, but alternatives do exist.

While opioid addiction continues to dominate the news cycle, there are valuable healthcare providers who stand ready to help, including pharmacists.

Pharmacists are a reliable and accessible resource to consult about medications for pain treatment.

Numerous medications are currently being used to treat different types of pain, including certain antidepressant, anticonvulsant, and anti-inflammatory medications. Several over the counter (OTC) medications have been shown to be equally as effective as some opioid analgesics in clinical studies.

Using these alternatives with non-medication treatments, can be a safe and effective pain treatment strategy.

OTC pain medications Acetaminophen, ibuprofen, and naproxen are effective pain medications

when used as directed.

Oftentimes, these medications are overlooked because a prescription is not required, however, many types of pain respond well to these options.

Topical pain-relieving products are also safe and effective when used appropriately.

Herbals and dietary supplements are frequently used to treat pain, and include glucosamine chondroitin, kratom, turmeric, tart cherry, ginger, devil’s claw, willow, and cannabidiol (CBD). Clinical studies do not support the routine use of these agents, however, some patients do achieve meaningful pain relief.

Likely the greatest controversy among these alternatives is the routine use of kratom and CBD. While there are studies that support their use for pain management, people interested in using these agents should speak to their prescriber or pharmacist about risks, including drug interactions.

Non-opioid prescription medications No, your doctor doesn’t think your pain is caused by depression or seizures,

but they may prescribe you a medication for these conditions as they are effective for several types of pain.

Imagine pain as an electrical signal moving through your nerves. These medications may slow down that signal, thereby decreasing the severity or frequency of your pain.

Non-medication alternatives Typically, pain is best treated by a combination of both medication and non-medication therapies. Some effective non-medication treatments include electro-analgesia (devices that use low voltage electricity to provide pain relief ), acupuncture (including acupuncture only in the ear), psychotherapy (for pain-coping education), physical therapy (to maintain functionality), and formal exercise regimens (e.g., yoga and tai chi).

Chronic pain, like opioid use disorder, is a disabling condition that requires our attention. Talk to your pharmacist or prescriber for more information. ■ Chris Herndon, Pharm.D., CPE, Spokesperson, American Pharmacists Association; Professor, School of Pharmacy, Southern Illinois University Edwardsville MEDIAPLANET

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Why Cell-Based Therapies Could Be an Alternative to Opioids Although no FDA-approved therapies exist, there are high hopes for some of the nation’s pain-relieving, cell-based therapies currently undergoing clinical trials.

Patients suffering from chronic low back pain account for nearly 60 percent of prescription opioid usage in the United States.

“As the rate of opioid addiction increases, patients are seeking alternative treatment options that will relieve their pain and disability, and enable them to avoid back surgery,” said Vincent DeBono, DC, CSCS, dean of the College of Chiropractic at Logan University in Missouri.

Regenerative medicines that use the body to heal damaged muscles, tissues, and ligaments are one such option. There are currently no regenerative cell-based therapies on the market deemed safe and effective by the U.S. Food and Drug Administration (FDA) for patients with back pain.

However, there are several being investigated in regulator-allowed clinical trials across the country.

“At SPIRITT Research, we are participating in an FDA-allowed, prospective, randomized, double-blinded clinical trial of a therapy that utilizes cells originating from adult human intervertebral disc tissue to treat the root cause of degenerative disc disease,” said orthopedic surgeon Matthew F. Gornet, M.D. “If proven effective, cell-based therapies like this could have a significant impact on the way patients with chronic low back pain are treated.”

DiscGenics

Flipping the Standard for Low Back Pain Management Evidence suggests that first addressing pain with nondrug therapies like spinal manipulation, physical therapy, massage, and acupuncture could keep many people off opioids.

According to a 2010 study in the journal Addiction, as many as 1 in 4 people who receive a prescription opioid for non-cancer pain in primary care settings struggle with addiction. By exposing patients to non-drug treatments first, the hope is that some will find enough relief to reduce or even avoid their exposure to prescription pain medications.

A promising future Evidence supports that hope. A 2018 study published in the Journal of Alternative and Complementary Medicine found that patients who received services from a chiropractor for back pain — one of the most common conditions for which opioids are prescribed — were 55 per-

cent less likely to fill a prescription for an opioid medication than other patients.

Expanding access Efforts to integrate nondrug treatment alternatives for pain have been going on for more than 10 years in the U.S. military and the veterans’ healthcare systems, yielding positive outcomes. Results of a clinical trial published in 2018 in “JAMA Open Network,” featuring 750 activeduty members of the U.S. military, showed that chiropractic care combined with usual medical care — selfcare, medications, physical therapy, etc. — for low back pain provides greater pain relief and a greater reduction in disability than medical care alone.

States like Ohio, West Virginia, and Oregon also have taken steps to make non-drug pain treatments more accessible and to encourage their use as a first line of defense against pain.

In Ohio, residents with

work-related back injuries in many cases are required under a new guideline to try treatments like rest, chiropractic care, and physical therapy before taking prescription pain medications.

Attempts to increase seniors’ access to pain management alternatives have gained steam. A bill introduced this summer, H.R. 3654 (www.hr3654.org), would give Medicare beneficiaries access to more non-drug options for pain management available in their chiropractors’ clinics.

The Centers for Medicare and Medicaid Services also released a proposal this year to cover acupuncture under Medicare.

When it comes to common musculoskeletal conditions, such as back pain, neck pain, and joint pain, starting with nondrug treatments may help patients address the source of their pain rather than just mask its symptoms. n American Chiropractic Association

Revolutionizing Care for Chronic Back Pain Back pain not responding to treatment?

IDCT is an investigational, non-surgical, cell-based therapy that is being evaluated in an FDA-allowed clinical trial for the treatment of patients with degenerative disc disease in the lower back.*

Learn more at DiscGenics.com/pain 6 • FUTUREOFPERSONALHEALTH.COM

*Disclaimer: IDCT is an investigational product that is under development by DiscGenics and has not been approved by the U.S. FDA or any other regulatory agency for commercial use.

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Do You Suffer from Neck or Arm Pain?

Randy, firefighter and a M6-C disc patient

For millions of people suffering around the world, neck and/or arm pain can result from an injury or simply the wear and tear of normal life. When a roof collapsed on Randy six years ago, his constant neck and arm pain threatened to end his firefighting career.

Fortunately, the M6-C™ artificial cervical disc is an innovative next generation option for patients needing artificial disc replacement as an alternative to spinal fusion. In fact, the M6-C disc is the only disc designed to mimic your spine’s natural structure and movement.

To watch Randy’s video and find a surgeon near you, visit M6disc.com/USAToday

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People need effective and safe solutions for managing inflammatory conditions. When consumed the right way, the spice turmeric can be a great option for regular use.

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Finding A Better Way to Treat Chronic Inflammation

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Deepak Chopra on the Healing Abilities of Turmeric “Metahuman” author Deepak Chopra is a leader in the alternative medicine space. Here he explains why the spice turmeric is gaining popularity as a complementary therapy for disease management and prevention.

In the arena of alternative medicine, there’s a lot of snake oil.

But turmeric, a golden spice historically used in Ayurvedic and Chinese medicine, is one ingredient that has some real scientific backing to support its use, including for pain reduction.

The touted benefits of turmeric are due primarily to the spice’s active compound, curcumin, which Chopra said is “the most widely researched phytochemical with proven clinical benefits.”

Curcumin affects pathways in the body that enhance immunity, reduce inflammation, and lessen pain — making it one of the most effective superfoods out there, Chopra said.

Nuvothera CEO Arthur Clapp has many years of experience developing botanically based alternatives to pharmaceutical treatments.

“I’ve learned that turmeric, used as a natural anti-inflammatory and healing agent for thousands of years, works as well as some well-established, non-prescription OTC (over the counter) products to help support joint health and other inflammatory based health conditions,” Clapp said.

Harnessing the power of turmeric Turmeric is one of the most potent natural anti-inflammatory and antioxidant substances around. In the past few years, consumers have increasingly purchased turmeric supplements to support joint health, healthy inflammatory response, and proper immune system functioning.

But not all turmeric is the same.

The key to an effective turmeric supplement is having high oral absorption through the digestive tract and reaching therapeutic levels with only 1000mg per day. Having a formula that can do this without using black pepper or chemical absorption enhancers offers additional health benefits. n Bev Hope, Director of Marketing, Nuvothera, Inc.

The health benefits of turmeric What’s more, turmeric, which you can cook with or take in supplement form, neutralizes harmful free radicals, which can contribute to a plethora of ailments.

Chopra emphasized the importance of choosing curcumin over turmeric to reap the possible benefits of this spice.

“Turmeric contains 2 to 3 percent curcumin by weight; the remainder of turmeric has little pharmacological value,” Chopra said. “The curcumin is effective, while turmeric itself is not. It is therefore advisable to take curcumin rather than turmeric to achieve an effect on health, or to address a disease.”

Because of the way the body processes turmeric, it’s best absorbed when taken with black pepper (such as when cooking with turmeric) or in a supplement that is nanoformulated, he added.

“Turmeric broadly serves the dietary needs of health and wellness seekers, and addresses numerous health-related pinnacles,” Chopra said. n Melinda Carter 8 • FUTUREOFPERSONALHEALTH.COM

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Managing Pain

by Restoring Balance SPONSORED

More and more doctors are embracing CBD for pain management.

Cannabidiol, better known as CBD, is quickly entering the mainstream.

A recent Gallup poll found that 14 percent of Americans have at least tried CBD in some form — for pain management, anxiety reduction, and improved sleep. Studies have shown that CBDuse is generally safe, and the Federal Drug Administration (FDA) recently approved CBD as a treatment for seizures associated with some rare forms of epilepsy, demonstrating its growing acceptance.

In the wake of the opioid crisis, some medical professionals are beginning to embrace CBD products like the ones made by Kentucky’s Green Remedy as a safer — and more effective — pain management tool.

“CBD is more of a natural alternative with a very wide margin of safety,” says Matt Dawson, M.D. “It doesn’t have the liver

toxicity effects of Tylenol, the negative gut lining effects of ibuprofen, or the addictive potential of narcotics.”

Better for pain CBD is all-natural, one of more than a hundred compounds produced in the cannabis sativa plant.

It has no intoxicating effects but engages with the body’s endocannabinoid system (ECS), which helps to regulate a long list of bodily functions including sleep, appetite, and memory. CBD can relieve pain by binding with cell receptors that are part of the ECS. “CBD works on the receptors — tiny proteins attached to your cells,” explains Randy Barrett, M.D., founder and president of North Pittsburgh

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Pain Physicians and North Pittsburgh Anesthesia Association. “They receive signals, mostly chemical ones, from different stimuli and help your cells respond. This response creates anti-inflammatory and pain-relieving effects that help with pain management.”

Dr. Barrett’s experience with CBD has been positive. “In my practice, patients have reported significantly better sleep, less pain, less anxiety, and an overall better experience post-surgery.”

Taylor Bright, Ph.D., the co-founder and president of biotechnology startup TEC Biosciences Inc., agrees. “CBD works on pain in multiple ways,” Bright explains. “If you have an acute injury (a broken bone, for example,

or a muscle-belly tear), CBD can help by managing anxiety over the injury and promoting sleep and appetite to help with recovery. For chronic pain, CBD is more effective as this type of pain is now better understood to not be directly related to a structural defect, but a combination of perceived threat, anxiety, and learned behavior. CBD can help with all of these conditions by restoring the balance of the endocannabinoid system which regulates a host of biological functions.”

Non-addictive CBD offers a long list of benefits over traditional pain medicines, especially opioids. “Traditional medications often only work using opioids,

which can be addicting,” notes Dr. Barrett. “Traditional medications also have a host of side effects as well, including nausea, and constipation. Furthermore, these opioids do not help with anxiety, sleep, and or stress.”

In contrast, CBD offers “reduced stress and anxiety, improved sleep, less nausea, and overall better well-being.”

Dr. Bright stresses the importance of sleep in pain management. “A major benefit of CBD is that it can help manage sleep,” he says. “CBD can both help get to sleep faster and stay asleep longer. Additionally, better sleep management can help with healing, thus reducing pain.”

One more advantage that CBD has over opioids and other medicines is its holistic range of benefits. “Long-term benefits of CBD include keeping the endocannabinoid system in balance, which helps numerous biological systems including inflammation, neurological signaling, gut-health, and appetite,” notes Dr. Bright.

As some traditional pain treatments like opioids have proved to be potentially harmful, CBD is making its case as the safe, effective choice for the future of pain management. ■ Jeff Somers MEDIAPLANET

Finding 21st Century Solutions for Pain In the 20th century, doctors destroyed nerves believing it would relieve pain. In the 21st century, doctors understand destroying nervous system components often makes pain worse.

Today, advanced pain physicians modulate rather than destroy nerves, changing how the nervous system processes pain by delivering electricity or medication to nerve roots or the spinal cord.

Neurostimulation blocks pain by delivering low-voltage electrical signals to the peripheral or central nervous system. Targeted drug delivery sends small quantities of pain-relieving medications directly to the spinal cord.

Both techniques block pain at the spinal level, keeping the brain free from the mental side effects of pills and patches. Both are done on a trial basis before implanting a permanent (yet reversible) pain control system, and both allow the pain physician to eliminate or reduce opioids to the lowest possible dose.

Given the opioid crisis, more and more practitioners are reluctant to prescribe opioids, instead referring their most challenging patients to pain specialists for 21st century solutions.

David Schultz, M.D., Nura Pain Clinic

When all else fails.

How to Prepare for Conversations About Pain Management As a patient, you might find yourself needing to talk to your provider about treatment options for pain.

These conversations are as equally important as they are difficult, so here are some tips to help you get the information you need:

1

Discuss your expectations for pain management Pain is part of the healing process and different people have different thresholds for pain. It’s important to discuss the level of pain you might expect and the estimated duration of it. Talk to your provider about your goals for pain relief and resuming your regular activities, both of which will be factors in your pain management plan.

2

Understand your treatment options Using prescription opioid medications is a common

way to treat pain but there are other options. Non-opioid treatments, including prescription strength or over-the-counter analgesics, physical therapy, and mind-body therapies (like yoga and meditation), can be effective approaches to treating and managing pain.

Discuss alternatives with your provider to determine what combination of treatments might be right for you.

3

Learn about the side effects and risks Opioids can have numerous side effects, including decreased respiration, sleepiness, dizziness, and constipation. Ask your provider about possible interactions with other medications and the risk of developing a dependence that could lead to opioid use disorder. Remember that your pharmacist can also answer questions, and

For chronic pain patients who don’t respond to more conservative measures, Nura is a nationally recognized leader in treating pain with minimally invasive procedures, including: Neurostimulaton — using low-voltage electricity to block pain signals at major nerve bundles or within the spinal cord.

review instructions and warning labels included with your prescription.

4

Make it personal Tell your provider if there is a history of addiction in your family. Could your medication pose a risk to you or someone else in your household? Talk about your current circumstances, such as who lives in your home, then develop a plan for safe use, storage, and disposal.

If you are concerned about the quantity of medication in your home, ask your pharmacist about getting a partial fill to limit quantities on hand. Remember, once in your possession, it’s your responsibility to safely use, store, and dispose of the medication.

Find more tips on provider conversations at pa-foundation.org/substance-use-disorder/. n PA Foundation

Targeted Drug Delivery — delivering small doses of pain medications to the spinal cord, keeping drugs out of the brain and thereby reducing or eliminating mental side effects and risk of addiction.

Find out if either therapy is right for you: please contact us for a consultation today.

nuraclinics.com 800-775-PAIN ©2020 Nura PA

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Kristin Chenoweth’s Personal Battle With an Invisible Disorder Broadway legend Kristin Chenoweth has lit up venues across the world with her powerful singing and acting chops since she was a schoolgirl.

Now, the “Wicked” star is using her voice to raise awareness of an invisible disease she’s managed since her 20s — Meniere’s disease.

Meniere’s is an inner-ear disorder that causes vertigo, extreme dizziness, tinnitus (ringing in the ear), hearing loss, and ear pressure that comes and goes.

Chenoweth’s symptoms usually

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begin with a migraine, a condition that may cause symptoms that include pulsing headaches, nausea, and vomiting.

“Sometimes I can just wake up with vertigo,” Chenoweth said.

“The reason it stinks is because there’s no warning.”

Battling symptoms Chenoweth first knew something was wrong during a rehearsal when, even after she stopped dancing, she couldn’t stop spinning.

“My head began to pound and I threw up,” she said. “After suffer-

ing for a couple of years, I finally found a doctor who diagnosed me correctly. I went through three days of medical testing to understand I had Meniere’s.”

According to the Mayo Clinic, two vertigo episodes, each lasting between 20 minutes and 12 hours; hearing loss; and tinnitus are some of the diagnostic measures used for Meniere’s.

Because of the incurable disorder, Chenoweth is more selective about the jobs she takes.

“It’s affected my job, or me taking a job that I know I can’t physically do,” she said.

According to Genetics Home Reference, Meniere’s disease doesn’t have a clear genetic link, though some people with the disorder report having a family member with the disorder.

Usually, people begin experiencing symptoms in one ear in their 40s or 50s.

In Chenoweth’s case, her symptoms became more severe in her 40s after a freak accident on the set of “The Good Wife” led to hospitalization.

TMZ reported that while on the show’s Brooklyn set, a strong gust of wind knocked over lighting equipment, which struck Chenoweth, causing her to fall to the ground unconscious.

After that, Chenoweth said, her symptoms reached “an alltime high.”

Finding relief To prevent and lessen the severity of Meniere’s episodes, Chenoweth has turned to natural remedies.

Her arsenal includes Tiger Balm, a pain-relieving ointment that provides a cooling effect on muscle aches; Salonpas, an FDA-approved, over-the-counter topical patch; heated pads for her neck; and nasal rinse.

“We’re all just doing the best we can to get through life with any cross to bear and each person’s is different.”

Chenoweth also sleeps on an incline, rarely drinks alcohol, and adheres to a low-sodium diet. High-salt diets, along with caffeine, alcohol, and tobacco, can increase fluid retention in the ears and worsen the effects of Meniere’s, according to the Mayo Clinic. The hospital advised consuming less than 2,300 milligrams of sodium per day for optimal

health. Another way to cope, the Mayo Clinic recommends, is by finding support. That’s a measure Chenoweth also employs.

“I have several friends who have [Meniere’s],” she said, “and we talk about it and get through our pain together.”

To find support, people with Meniere’s may consider visiting the Vestibular Disorders Association website, which offers a oneon-one support tool, a directory of in-person and online support groups, and tips on starting a new support group.

Helping others like her feel less alone is ultimately why Chenoweth decided to speak up about her experience with Meniere’s.

“I wanted others to not feel shameful about their pain and just own it,” Chenoweth said. “We’re all just doing the best we can to get through life with any cross to bear and each person’s is different.” n Melinda Carter

PHOTO: GIAN ANDREA DI STEFANO

How Employers Can Take a Stand Against Opioids As the opioid epidemic continues to devastate families and communities across the United States, workplaces are also affected. A toolkit developed by the National Safety Council (NSC) is giving employers the resources to educate and empower their employees about the epidemic.

Most people living with a substance use disorder are in the workforce, so employers are well-positioned to help combat the epidemic with strong, comprehensive drug-free workplace programs (DFWPs) that rec-

ognize and address the unique challenges of the opioid crisis.

Everything you need The National Safety Council (NSC) built its Opioids at Work Employer Toolkit to assist workplaces in establishing these programs. The free toolkit includes resources designed to help educate employees, increase access to treatment, build a recovery-friendly workplace, and implement policies to keep workers safe.

For the best results, employers must commit fully to the

program and its goals, including gaining and showing support for the program from the highest level down.

Before developing new policies, work with employees to understand their unique needs and specific concerns, which can add critical perspective. For some employees, these policies may challenge deeply ingrained beliefs and practices. Giving employees a chance to voice their concerns to leadership can alleviate doubts and provide employers the opportunity to address them through conversa-

tion, leading to policies that are more helpful.

Once developed, engage supervisors, senior managers and other employees as spokespeople for the program, to answer questions and explain the benefits to other workers.

While this process may be challenging, putting in this effort can lead to workers not just understanding and accepting new policies, but actively supporting them. Employee buy-in is essential for a DFWP’s success.

No matter your industry or the size of your business, your workplace can make a difference. Be proactive, limit the risks and keep your workers safe.

Learn more and get the free toolkit at nsc.org/OpioidsAtWork. n Rachael Cooper, Senior Program Manager, Opioid Use Harm Prevention, National Safety Council (NSC) MEDIAPLANET • 15

Next-Generation Option Available for Patients Needing Artificial Disc Replacement The M6-C disc, which was approved by the U.S. Food and Drug Administration in 2019, was designed as an innovative option for patients needing artificial disc replacement as an alternative to spinal fusion.

Although Dallas-area firefighter Randy survived a roof collapse six years ago, his constant neck and arm pain after the accident threatened to end his firefighting career. Fortunately, he was a candidate for the M6-C™ artificial cervical disc and is back on the job today.

Millions of people around the world suffer from neck and/or arm pain. In the United States alone, neck pain affects up to 15 percent of the population, according to the National Institutes of Health. This type of pain is often caused by cervical disc degeneration, a common condition that can result in pain or numbness in the neck, shoulders, arms, and hands.

A new solution The M6-C disc, which was approved by the U.S. Food and Drug Administration in 2019, was designed as an innovative option for patients needing artificial disc replacement as an alternative to spinal fusion.

Featuring a shock-absorbing nucleus and fiber annulus that mimic the anatomic structure of a natural disc, the M6-C device is the only artificial cervical disc available in the country that enables compression or “shock absorption” at the implanted level. The disc also provides a controlled range of motion when the spine transitions in its combined complex movements.

The M6-C disc was designed to mimic the spine’s natural structure and movement, including backward and forward, side to side, and up and down, and to rotate left and right. By allowing the spine to move naturally, the M6-C artificial disc can minimize stress to adjacent discs and other vertebral structures.

Orthofix 16 • FUTUREOFPERSONALHEALTH.COM

Empowering People With Pain to Take Initiative If you suffer from chronic pain, it can feel like your entire life revolves around the condition. Following these steps can help you get back to normalcy.

T

he goal of pain management has always been threefold: to increase function, reduce suffering, and improve quality of life. Yet opioids and their potential for addiction have come to dominate the discussion of pain management.

This focus on opioids has increased the stigma associated with chronic pain. People with pain are often seen as drug seekers or malingerers. The truth is, most people living with pain would gladly discontinue all medications, if only the pain would stop.

Eliminating the stigma Since the mid-90s the first and, often only, line of treatment for most folks has been pain medication. We have lost sight of the fact that there is more to living a full life in spite of pain than taking medications.

Multiple governmental and academic reports cite the importance of treating pain with a multidisciplinary strategy (including medication and a combination of other treatments) in a patient-centered environment.

This means the person with pain must take an active role in the recovery process, helping to set

treatment goals and evaluate therapies, and applying self-management skills.

Making a difference Since 1980, The American Chronic Pain Association has offered education in pain management and support to people with pain. We encourage people with pain to move out of the role of a “patient” passively waiting for treatment, and to reclaim their autonomy as a person, acting together with their healthcare team to achieve their own goals.

Below is a list of tips to begin one’s journey from patient back to functional person. Know that, while it takes work, determination and support, it is well worth the effort.

Accept the pain Learn all you can about your physical condition. Understand there may be no current cure and accept that you will need to deal with the fact of pain in your life.

Get involved Take an active role in your own recovery. Follow your doctor’s advice and ask what you can do to move from a passive role into one of partnership in your healthcare.

Set priorities Look beyond your pain to the things that are important in your life. List the things that you would like to do. Setting priorities can help you find a starting point to lead you back into a more active life.

Set realistic goals We all walk before we run.

Set goals that are within your power to accomplish or break a larger goal down into manageable steps.

Take time to enjoy your successes.

Know your basic rights We all have basic rights.

Among these are the rights to be treated with respect, to say “no” without guilt, to do less than humanly possible, to make mistakes, and to not need to justify your decision with words of pain.

Recognize your emotions By acknowledging and dealing with your feelings, you can reduce stress and decrease the pain you feel.

Read the full list by checking out this story online at FutureofPersonalHealth.com. n Penney Cowan, Founder and CEO, American Chronic Pain Association

Chronic Pain: Where to Look When Nothing Works SPONSORED

ing their attention away from a strictly biomedical approach to pain and towards the role of the most powerful organ in our bodies: the brain.

Chronic pain changes the way the brain processes pain. New tools and apps can help retrain it for relief.

The brain’s role in pain From an evolutionary perspective, pain helps us to survive. As humans, we use pain to learn about our environment and to get better at avoiding anything that could potentially harm us. It acts as a sort of danger signal, telling us when we get too close to a hot burner, for example. Pain is the brain’s way of signaling something is wrong, but when pain lasts longer than a few months the brain can incorporate it more or less permanently into its predictive models — in other words, our brains can be trained to report pain regardless of circumstance.

As chronic pain persists, this cycle can have an enormous impact on pain severity and

One of the worst epidemics afflicting the world can be subtle and hard to see: chronic pain. According to the CDC, more than 50 million people in the United States experience chronic pain. For these 1 in 5 American adults, pain is more than just an inconvenience; even if it isn’t physically limiting, chronic pain can result in depression, anger, and anxiety.

What may be even more worrying than this epidemic of pain is the lack of safe, effective treatment options. As the opioid epidemic continues to grow, researchers and physicians are turn-

1

Thalamus receives input, amygdala reports input as potentially dangerous

frequency. The brain becomes hypervigilant about reporting potentially dangerous stimuli and activating a physiological pain response in the body. This is why chronic pain commonly intensifies with time, and why a patient may start to experience non-dangerous stimuli (like light touch or gentle movement) as painful.

The strangest part? This entire process is happening behind the scenes: unconsciously and through no fault of the pain sufferer themselves.

The solution While there is no “onesize-fits-all” solution for chronic pain, there are a variety of safe, science-backed strategies that can be used to retrain the way the brain processes pain. There are even apps available that offer a structured, guided program designed for this specific purpose, like Curable.

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Inputs can include: Nociceptive Input | Stress Emotion | Fear of Harm

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Brain’s “alert setting” becomes more sensitive to this input, pain response becomes more easily activated

Curable’s app, guided by its smart coach Clara, offers pain sufferers a way to directly access the tools they need to understand and modify their brain’s role in pain.

It provides hundreds of audio, visual, and text activities which work to break the cycle of pain from different angles. All of the exercises in Curable are evidence-based and were developed in partnership with a Scientific Advisory Board of physicians, researchers, and pain psychologists.

Lifestyle There is a great deal of evidence supporting the idea that the activities recommended by Curable and other leading pain experts can be effective.

Guided meditation can, for example, reduce muscle tension, stress, and anxiety, which contribute to, and exacerbate, pain.

Once the brain’s role in pain has been addressed and symptoms begin to

Activation of the brain’s pain response is triggered, creating or intensifying real physical symptoms

Outputs can include: Back Pain | Migraines Fibromyalgia| IBS

improve, it also becomes easier for chronic pain sufferers to re-incorporate the healthy habits that pain has interfered with, like exercise and sleep. These habits, in turn, can have their own inherent pain-relieving effects, creating an upward spiral of symptom reduction.

What’s increasingly clear is that while pain isn’t “in our heads,” pain is generated by the brain in response to perceived danger. Once we experience pain for a sustained period, medications can only suppress the sensation — they don’t change the pattern. To break that cycle requires behavioral changes, and new technologies are offering guidance, advice, and specific activities to achieve that. Most importantly for those suffering from chronic pain, they offer the opportunity to take control of our bodies — and minds. ■ Jeff Somers

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Experience is incorporated into the brain’s future predictive coding models

GetCurable.com/PainManagement

MEDIAPLANET • 17

Safe Storage and Disposal Can Help Prevent Prescription Opioid Abuse Misuse and abuse of prescription opioids often starts in the home, which makes safe storage and prompt disposal important parts of safely using these medicines.

Did you know that more than half of those who misused prescription opioids in the past year obtained them from a friend or relative? Prescription opioid misuse and abuse can start in the home, so practicing safe storage and disposal is essential to ensuring these medicines do not end up in the wrong hands.

Allied Against Opioid Abuse (AAOA) is a national education and awareness initiative helping to prevent the abuse and misuse of prescription opioids.

Founded by stakeholders across the healthcare and public health communities, AAOA aims to fill the education gap and raise awareness of the rights, risks, and responsibilities associated with prescription opioids, including ways to safely store and dispose of these medicines.

Safe storage Pain is a common medical issue.

If you and your healthcare provider agree on a treatment plan

18 • FUTUREOFPERSONALHEALTH.COM

any leftover pills when there is no longer a medical need for them.

Here are five things you need to know about safe disposal:

that includes prescription opioids, take the following steps to safely store these medications: • Store opioid prescriptions in the original packaging.

• Secure opioids in a lockbox or locked cabinet.

• Monitor your medicine and

know how many pills you have left.

• Keep opioids out of reach of young children.

Safe disposal Unused medicines are a main source for misuse and abuse, so it is critical to safely dispose of

• Dispose of unused medications as soon as possible.

• Ask your healthcare provider or pharmacist for information about mail-back programs, and disposal kiosks for unused medicines.

• Take advantage of law enforcement programs that accept unused medications (the next DEA Take Back Day is April 25).

• Use medication disposal bags to neutralize medicines and avoid damage to the environment.

• Alternatively, combine your medication with dirt, kitty litter, or used coffee grounds and discard in the trash.

AAOA and its partners have created a full suite of resources (AgainstOpioidAbuse.org/consumer-resources/) with reminders and tips to help underscore the importance of prescription opioid safety among patients, caregivers, and the medical community.

To learn more and access AAOA’s growing library of fact sheets, videos, and toolkits, visit AgainstOpioidAbuse.org. n Allied Against Opioid Abuse

MEDIAPLANET