https://www.acsh.org/news/2018/11/21/little-state-debunks-big-lie-deas-opioid-scam-13614

 It’s more than a little ironic that the state motto for New Hampshire is:

“Live Free or Die”

Because it conflicts with a new motto I have just made up. Since we are nothing if not economical here at ACSH I figured that I could save time and energy coming up with new mottos for the CDC and DEA. But I only need one:

“Feel Free To Lie”

I’ve been writing all along (most recently Who Is Telling The Truth About Prescription Opioid Deaths? DEA? CDC? Neither?) about how the CDC and their flunkies from the Physicians Responsible for Opioid Prohibition (1) have been spinning their bogus statistics in order to tell us a story that isn’t even remotely true: That prescription opioids are killing bazillions of Americans and the way to combat this is to crack down on prescribing these drugs.

My article above catches the DEA making up the same crap – 164 pages worth of it. Somehow, despite both common sense and plenty of evidence to the contrary, the agency fell into line with the CDC and reached a similar conclusion. The graphs in the article do a pretty good job of showing you why these conclusions are nonsense.

But not as good as this one:

Source: CDC “Synthetic Opioids” means illicit fentanyl and its analogs. (2)

Well, I’ll be damned! Those numbers sure look strange. Why, if you happened to come across this graph without a calculator how could you possibly know that:

• Fentanyl was involved 83% of the overdose deaths in New Hampshire 

• Heroin was in 8% of the overdose deaths in New Hampshire 

• You can figure out the rest.

Of course, different states will have different patterns of abuse, but if 9% of OD deaths in one state came from opioid analgesic drugs like Vicodin and Percocet then it’s a pretty good bet that most of the time you’re going to see a pattern that is at least vaguely similar to that of New Hampshire, despite the fact that it has (by far) has the lowest percentage of opioid analgesic OD deaths in the country. You see this in the Northeast. The majority of OD deaths are not from pills.

• New Jersey – 30%
• Connecticut – 31%
• New Jersey – 30%
• New York – 27%
• Massachusetts – 19%

The next set of numbers is especially interesting. The Midwest is constantly described in the news as “being ravaged by the opioid crisis.” This is true, but most of the ravaging isn’t coming from prescription pills. 

• Kentucky – 43%
• Ohio – 24%
• West Virginia – 46%
• Indiana – 37%

In 19 states the percentage of deaths from pills exceeds 50% of the total. Some examples:

• Maine – 51%
• South Carolina – 61%
• Alaska – 54%
• Arkansas – 78%
• California – 58%
• Georgia – 58%

What is more interesting, however, is the slope of the (green) line between 2010 and 2016 – the time when these pill deaths supposedly skyrocketed. Here’s a close-up of New Hampshire. It is quite obvious that the number of deaths between 2010 and 2016 remained more or less constant.

New Hampshire opioid deaths 2010-2016. The green line represents prescription opioid analgesics. The black hatch line connects 2010 with 2016. It is quite level. 

The same held true for other states with a low percentage of pill deaths. The black hatch line shows that pill deaths between 2010-2016 were fairly constant in these states.

 

 

But the same also held true for the states with a high percentage of pill deaths (South Carolina being the exception).

So, here’s the obvious question:

So, where is the opioid epidemic?

Between 2010-2016, the years when everyone became hysterical about “heroin pills” there was just about no change in the number of deaths in states where pill death rates were low or where they were high. The answer is obvious. The “opioid epidemic” is due to heroin and fentanyl, not pills. As I’ve written before, we are not having an “opioid epidemic.” We are having a fentanyl epidemic. It’s been obvious all along. Yet, we keep hearing the same old garbage from our government and the press and the only “plan” our “leaders” have is to tighten up the pills.

Like this:

“Controlled Prescription Drugs (CPDs) … are still responsible for the most drug-involved overdose deaths and are the second most commonly abused substance in the United States.”

DEA Report, November 8, 2018.

Maybe they’re just high.

Or, in some cases, quite low. 

NOTES:

(1) I may have gotten the name wrong. But those guys don’t care much for accuracy, so big deal.

(2) For some reason, tramadol is classified a synthetic opioid but it has little in common with real opioids. (It has also been called a pseudo-opioid.) I don’t think it should be called an opioid at all. It is far weaker and bears little structural resemblance to either the semi-synthetics (oxycodone, hydrocodone) or the fentanyls. So, it hits a few receptors. Big deal. So do other drugs that aren’t opioids either. 

Filed under: General Problems | 1 Comment »

Ex-DEA agent gets probation for selling ARs to ‘members of a drug trafficking organization’ on border

www.guns.com/news/2019/01/11/ex-dea-agent-gets-probation-for-selling-ars-to-members-of-a-drug-trafficking-organization-on-border

 

Filed under: General Problems | Leave a Comment »

Dear Pharmacist Steve

I read your article posted on the National Pain Report website because I was searching for information regarding what to do when denied pain meds. 

I would like to share our experience with you. Please note that both my husband and I are Senior citizens and he is Disabled. 

On Tuesday Dec 18, 2018 I was  informed by our Pain Management doctor that Scripts had been sent to Martin’s Pharmacy in our hometown for both of us and were to be filled that day. Over the course of the next three days multiple attempts were made and we were always told they were not yet ready.

On Thursday December 20, I received a phone call at our home. The voice did not introduce himself, rather he rudely asked who I was and I replied and asked who was calling. He said: Martin’s Pharmacy and wanted to know who James was.I told him he was  my husband. I asked for the man’s name at this point and he replied: Thomas Harsh and then began a diatribe, first stating he questioned the fact that my husband has. been prescribed  four different Controlled Dangerous Substances from not only National Spine and Pain Center, but by two other Physicians. He stated he would not fill any of these because he questioned whether each Doctor was aware of the other’s prescriptions. He also then advised me “and I’m not filling yours either.” I also have a degenerative fractious spinal condition. 

As a result my husband was without two very crucial medications that keep his pain level to about 4 at best.He was without the medications from the date the Prescription was due to be filled, Tuesday,  December  18, until the  Prescriptions were submitted to a different local Pharmacy by National Spine and Pain Management of Cumberland; they were finally filled at 6PM the evening of  December 20, 2018.

During that lax in pain management coverage, the result of Pharmacist Thomas’s refusal to fill my husband’s prescriptions was that the coverage of the medication dwindled to none and he began withdrawal, i.e.  sweating, nausea, and vast searing pain (well over ten on the pain scale) with convulsions.  

On that Thursday evening I considered calling an Ambulance to take my husband to the local Emergency Room for pain relief. My husband is personally involved at our local NewsTalk  Radio station, where he has produced  many outspoken announcements about the fear of addiction. He is fully aware of the current Opioid  Epidemic and how seriously it has  ravaged our community. Yet, for him there are no other options, having had seven Back Surgeries and metal implanted  from his lower back to his  neck, nerve damage, diabetic Neuropathy, Parkinson’s Disease etc. 

In  short, our Martin’s Pharmacist could offer no way at all to resolve this situation to restore our medications. 

This was the day before we were to leave for Christmas Vacation in the Cleveland, Ohio area, where we had prepaid  reservations Friday through the following Wednesday at Holiday Inn Express, Mentor Ohio, and tickets to various events and other family Holiday gatherings. 

Unfortunately, after three days off of Pain Meds, receiving meds only after a switch from Martin’s to another local Pharmacy,  my husband’s pain  was soaring, severe and sharp.  He was finally able to resume pain management meds late Thursday but by Friday the 21st Dec, he was in no condition to make the trip. He stayed at home in Cumberland with my sister assisting him and we paid a friend to drive me to Cleveland, as I do not drive. 

I feel my husband and I have suffered undue pain, humiliation, and financial loss, the result of the Pharmacist’s negligence. 

Certainly, as a result of our long term customer status it would have been more prudent to advise us “Mr Drake, and Ms Melotti,  I have some serious questions about your Medications and the way they are prescribed. I am filling these Prescriptions and I am giving you notice that you must provide me proof in writing from your Prescribing Physicians BEFORE I fill such again.”

I also feel notice like  this should have been done in writing, requiring our signature of acknowledgement. This would have given us a chance to speak with each Doctor and secure such information for Martin’s Pharmacy. 

We have been customers at Martin’s Store and Pharmacy for some time now; certainly long enough that a simple review of our Pharmaceutical records should have justified any immediate question of our integrity. 

In addition to this first event I then called in a refill a week later for my husband for another one of his scripts, Clonazepam.

The auto refill system said it would be ready after 7 pm that same day. The following  morning I called Martin’s  pharmacy and spoke with a woman that said it was not yet ready but that she would take care of it and that she would send me a text message when the script was ready. After receiving three text messages advising us to come pick up my husband’s meds, I went to the  pharmacy on Park St at 5:30 pm and  was then told that the script was not ready and to wait. After waiting, the Pharmacy Clerk told me  that the pharmacist had refused to fill the clonazepam.

Again, this is a medicine that me husband cannot stop ‘cold turkey.’ We were  therefore again compelled to request that my husband’s  neurologist send a new script to a different local pharmacy. The humiliation suffered at the counter this time was witnessed by two other people.

Can this Pharmacist do this? This has been a nightmare for us. We are two solid citizens of our community and feel that we have been wrongfully discriminated against. Fortunately I have managed to switch all our meds to a different pharmacy and I do feel like I am in control again of our lives but I really feel we have been wronged and would appreciate any help of information you can provide us.

Thanking you in advance,

 

Filed under: General Problems | 9 Comments »

It has been six months since Tennessee enacted new laws to restrict the number of opioid prescriptions, but it still comes as a shock to patients.

Filed under: General Problems | Leave a Comment »

Oregon law keeps secret doctors over prescribing opioids

https://www.bluemountaineagle.com/capital_bureau/oregon-law-keeps-secret-doctors-overprescribing-opioids/article_2d7b30be-1504-11e9-88fe-d75b3dee0d05.html

State officials know of 160 doctors with suspicious prescribing patterns, but Oregon law shields those doctors from further scrutiny.

Legislators put little teeth into a 2018 law that requires doctors to register for a program that monitors drug prescriptions. Doctors, for instance, face no sanction if they don’t join, according to state officials.

Doctors identified as perhaps improperly prescribing opioids only get a letter from the state suggesting more education. Doctors can and do ignore even those mild letters with no fear of a sanction.

Under the program, retail pharmacists report prescriptions of controlled substances such as Oxycontin and Xanax to the state within 72 hours of dispensing them. The state maintains three years of prescription data.

The issue of prescriptions has been central to government efforts to reduce the number of overdose deaths attributed to opioids.

In 2016, Oregon doctors wrote 3.1 million opioid prescriptions at a rate 13 percent higher than the national average.

That year, 312 Oregonians died from an opioid overdose, a rate of about 7.6 per 100,000 people, according to the National Institute on Drug Abuse. Nationally, the rate was 13 people in 100,000.

Oregon legislators in 2017 revised the state’s prescription reporting system to flag doctors who prescribe high volumes of opioids or prescribe conflicting drugs.

State auditors examining the system found instances of Oregonians “doctor shopping.” Nearly 150 people were identified as each getting prescribed drugs from at least 30 different doctors.

That led auditors to question how the state deals with those doctors identified as improperly prescribing opioids.

“Questionable prescribing habits seen within the data, even those that are egregious, cannot be elevated to any regulatory or enforcement entities to directly look into those situations,” auditors said in their audit released in December.

Auditors recommended that a state review committee get authority to require prescribers to justify practices deemed “concerning” and to collaborate with licensing boards and police.

The state committee confidentially reviews prescriber, pharmacy and patient prescriptions, according to the Oregon Health Authority. It also developed criteria defining risky prescribing.

When the committee spots a suspicious pattern, it typically writes to the doctor. A sample letter that state auditors reviewed said it was an “invitation to explore” the state’s resources and “review your prescribing practice.”

The doctors don’t have to acknowledge the letter or take any more training or education, auditors said.

The information can’t be shared with medical licensing boards.

Those licensing boards can obtain the state’s information if they certify the information is needed for an investigation.

According to the Health Authority, state licensing boards in the last three months of 2018 requested drug monitoring information 109 times. Department officials couldn’t recall a time when they denied a request for such information from the board and said the requests are increasing.

Police can obtain the monitoring program’s data with a court order.

By the time Oregon legislators established the state’s prescription drug monitoring program in 2009, Oregon was behind dozens of other states already operating similar programs.

Rob Bovett, former Lincoln County district attorney who at the time lobbied on behalf of law enforcement groups, helped lead the charge to create the monitoring program.

The law was the result of “a lot of bargaining and compromise” between advocates and the ACLU of Oregon and the Oregon Medical Association, Bovett said.

Police and prosecutors wanted to tackle prescription drug abuse at the source, Bovett said.

“Oregon law enforcement doesn’t just want tools to go after people for drug abuse,” Bovett said. “They prefer that drug abuse drop because they’ve got plenty to keep them busy, and we just, quite frankly, don’t have enough of them.”

The Oregon District Attorneys Association plans to review the audit report at its board meeting Friday, according to the association’s executive director, Tim Colahan.

Gary Schnabel, the executive director of the state’s Board of Pharmacy from 1999 to 2014, said the board floated the idea of the state monitoring controlled substance prescriptions for years before the legislation was passed.

He got the idea while at a national conference and learned what other states were doing.

“It was the very beginnings of the opioid crisis, and it was a way to actually monitor opioid use,” Schnabel said.

The point was to identify people using more than a certain amount — whatever program administrators thought was appropriate — and let doctors know.

Pharmacists hoped that the program could prevent issues like doctor shopping by having doctors intervene when they found a patient had multiple prescriptions for the same or conflicting drugs.

But they didn’t want to share the database with police or investigators.

“The only people who (would have) access to that data were the patient themselves, or the patient’s physician,” Schnabel said. “Nobody else would have access to it.”

The state association representing doctors and the ACLU of Oregon resisted at first, Schnabel said.

The ACLU of Oregon worried the program would invade patient privacy and could be susceptible to data breaches. Some health care providers also voiced privacy concerns, legislative records show.

“They thought it was invasive,” Schnabel said of the Oregon Medical Association. “They thought it might get physicians in trouble, thought it might be punitive against the physician for prescribing. They just didn’t trust it.”

Courtni Dresser, director of government relations for the Oregon Medical Association, said the group never opposed the program.

The monitoring system was cumbersome at first, said Dr. Amy Kerfoot, an Oregon Medical Association trustee who represents the association at the governor’s Opioid Epidemic Task Force.

In recent years, the association urged reforms to make it easier for doctors to use the monitoring data, Dresser said.

In 2017, state lawmakers created the special committee to review prescribing practices of controlled substances.

The bill was sponsored by state Rep. Knute Buehler, R-Bend, a surgeon, and supported by the medical association.

The committee advises the Health Authority on interpreting prescription information and training prescribers. State law requires committee members be licensed health care practitioners with at least five years of experience prescribing controlled substances.

The following year, Gov. Kate Brown asked the Legislature to mandate registration in the prescription program.

Kerfoot testified in favor, as did other health care groups like the Oregon Primary Care Association.

“Requiring practitioners to register with the Prescription Drug Monitoring Program is another important step in the right direction,” Kerfoot told lawmakers in a letter. She said the program would be “a powerful tool to help providers rethink prescribing decisions that had been automatic in the past, but maybe should not have been for many patients.”

In an interview, Kerfoot acknowledged that the medical association was concerned that doctors would become more liable for their prescribing decisions.

“You never want to have a legislative body sending out what a physician is liable for when they don’t yet have the background on the patient, the indications, the rationale behind it,” Kerfoot said. “They want prescribing to be safe, but prescribing is a tool that should be available to the people who need to use it — qualified physicians and pharmacists.”

But that law created no consequence for not signing up and doesn’t require prescribers to access the database before prescribing a controlled substance.

State auditors cited a study from the National Bureau of Economic Research that found opioid misuse decreased in states that required health care providers to check such a database.

Dresser said requiring queries by law isn’t necessary.

“There’s no need to mandate it because it will just be part of the workflow as the integration project continues,” Dresser said.

Oregon’s program, auditors said, was “intended to be used for determining the course of treatment for a patient and should be rightfully protected,” auditors wrote. “Yet it is also intended to help ensure appropriate use of prescription medications.”

The ACLU of Oregon maintains that the monitoring program shouldn’t be used to punish or regulate doctors, but to help them improve medical care.

In 2017, roughly 40 percent of prescribers were registered with the program, according to the Oregon Health Authority. By late 2018, after state outreach efforts, 83 percent of prescribers were registered.

Additionally, only retail pharmacies must submit prescription data to the state. That leaves out pharmacies in long-term care facilities and residential treatment facilities, auditors said.

There are 143 institutional pharmacies licensed in Oregon, according to the Board of Pharmacy. Of those, 56 are pharmacies in long-term care facilities.

Those facilities often care for patients with chronic illnesses or disabilities, rather than patients with acute pain like a back injury.

Filed under: General Problems | 2 Comments »

 

 

 

The roadmap details our three- pronged approach to combating the opioid epidemic going forward: 1) prevention of new cases of opioid use disorder (OUD); 2) treatment of patients who have already become dependent on or addicted to opioids; and 3) utilization of data from across the country to better target prevention and treatment activities.

Most/all of chronic pain pts – especially those dealing with intractable chronic pain – will be DEPENDENT on their opiate therapy, according to this CMS release all of those DEPENDENT ON OPIATES are now officially considered to be suffering from a OPIOID USE DISORDER – the NEW TERM for someone who is has been “using opiates (legally/illegally)” > 90 days.

This policy will affect Medicare patients who have not filled an opioid prescription recently (for example, within the past 60 days) when they present a prescription at the pharmacy for an opioid pain medication for greater than a 7 day supply.

does this mean that chronic pain pts – such as myself – who are able to control their pain most of the time with NSAIDS are going to keep being “reclassified as opiate naive” and only able to get a 7 days supply ?

If you get caught up in this BS… and you are forced to pay cash to get your opiate medication to avoid cold turkey withdrawal… be cautious of the pharmacist telling you that they can rebill the insurance company once a PA is approved… Ask them what the days limits are for rebilling.. most will not be able to do it after 7-10 days after the Rx was filled.. and the PA process – unless you insist on an EMERGENCY PA – which should take 24 -72 hrs – otherwise it make take a couple of weeks…  and you may have to submit your receipt directly to the insurance company for reimbursement and what you get reimbursed may be substantially LESS than the pharmacy’s CASH PRICE.

Just remember that a NO from an insurance company is NOT IN CONCRETE… they all have appeal processes and they don’t have to tell you what the process is – or that they have one – unless you ask, then they have to provide you the process of filing an appeal in writing..  TODAY.. it is probably now a webpage.  Following the directions and the days limits  when an appeal has to be filed by.

Here is a excellent tutorial about filing appeals  https://www.pharmaciststeve.com/?p=27887

 

 

 

Filed under: General Problems | 1 Comment »

Judge dismisses opioid crisis lawsuits against drug makers

https://www.wtnh.com/news/connecticut/hartford/judge-dismisses-opioid-crisis-lawsuits-against-drugmakers/1694181747

HARTFORD, Conn. (AP) – A Connecticut judge has dismissed lawsuits against Purdue Pharma and other drug makers brought by 37 cities and towns in the state that blame the companies for the opioid crisis and sought to recoup millions of dollars spent responding to the crisis.

Judge Thomas Moukawsher in Hartford ruled Tuesday that the lawsuits were not allowed because they were not filed as government enforcement actions authorized by state public interest laws.

Lawyers for several municipalities said appeals are being considered. Bridgeport, New Haven and Waterbury are among the plaintiffs.

Purdue Pharma officials said the judge was right to conclude opioid manufacturers cannot be held responsible to municipalities for indirect harms from the opioid crisis.

More than 1,000 lawsuits against opioid makers by state and local governments remain pending nationwide.

 

Filed under: General Problems | 3 Comments »

My name is Mary  and I am a stage 4 cancer patient. In 2007 I was Diagnosed with a primary Pertinal cancer,Stage 3 C ,Primary colon cancer,stage3 ,2005 Back fusion L 4 L5 S1. I have had 8 lower bow Blockages,1 of them had to have surgery,,Then I had a nother open surgery and lost my spleen ,and a nother to take half of my Pancreas,I have had 7 open Abdominal cancer surgerys.I pay 1638 dollars for my helth care. In 2007 I was put on Methadone and 1 or2 Oxy Codeine for Chronic pain,I had to try 8 drugs stores when I moved down to find one that would help me.My blue cross has been paying for my meds ,I have been on methadone since 2007 as it is one of the cheapest pain pills and one that has really work.Last month I was waiting for my medicine and it never came and I only take 1 for times a day total 40 mg.I called Walgreens mail order.I told them I only had 4 left and they said that they were stopping the methadone just like that, I went to CVS and ask the Pharmacist.if I could just stop methadone and she told me no way,Now my nose was running,I had the chills, sweeting, a severe body ache, Now my hole body is going thought a great deal of pain,I went 13 days with out my Methadone.My Doctor told them that they were to order the medication and were told that it is not for a cancer pt.and try something else,so he appealed it and they said no,I was in so much pain I called a Detox unit,and two doctor looked and my Medical history and was told that they cant beleave that they did this with my medical promblem and I should call a lawer.I called my Doctor and told them that I am going thought Servira pain, Sweating Profusely,and they called and told them that I need it now.After 2 weeks I got a Prescription from Walgreens but I had to pay cash for it and it was a one time deal,I would love to start a class action suit for all the cancer patients that have to go though this.Thank you for any help that you can ghb I’ve me.If a Doctor gives a cancer medication I should not have to be look at as a drug addict,and run from one drug store to another and another,This is not right

http://www.ncpanet.org/home/find-your-local-pharmacy

 

Filed under: General Problems | 6 Comments »

Filed under: General Problems | 1 Comment »

Scientists seek ways to finally take a real measure of pain

http://www.tribtown.com/2019/01/10/us-med-measuring-pain/

WASHINGTON — Is the pain stabbing or burning? On a scale from 1 to 10, is it a 6 or an 8?

Over and over, 17-year-old Sarah Taylor struggled to make doctors understand her sometimes debilitating levels of pain, first from joint-damaging childhood arthritis and then from fibromyalgia.

“It’s really hard when people can’t see how much pain you’re in, because they have to take your word on it and sometimes, they don’t quite believe you,” she said.

Now scientists are peeking into Sarah’s eyes to track how her pupils react when she’s hurting and when she’s not — part of a quest to develop the first objective way to measure pain.

“If we can’t measure pain, we can’t fix it,” said Dr. Julia Finkel, a pediatric anesthesiologist at Children’s National Medical Center in Washington, who invented the experimental eye-tracking device.

At just about every doctor’s visit you’ll get your temperature, heart rate and blood pressure measured. But there’s no stethoscope for pain. Patients must convey how bad it is using that 10-point scale or emoji-style charts that show faces turning from smiles to frowns.

That’s problematic for lots of reasons. Doctors and nurses have to guess at babies’ pain by their cries and squirms, for example. The aching that one person rates a 7 might be a 4 to someone who’s more used to serious pain or genetically more tolerant. Patient-to-patient variability makes it hard to test if potential new painkillers really work.

Nor do self-ratings determine what kind of pain someone has — one reason for trial-and-error treatment. Are opioids necessary? Or is the pain, like Sarah’s, better suited to nerve-targeting medicines?

“It’s very frustrating to be in pain and you have to wait like six weeks, two months, to see if the drug’s working,” said Sarah, who uses a combination of medications, acupuncture and lots of exercise to counter her pain.

The National Institutes of Health is pushing for development of what its director, Dr. Francis Collins, has called a “pain-o-meter.” Spurred by the opioid crisis, the goal isn’t just to signal how much pain someone’s in. It’s also to determine what kind it is and what drug might be the most effective.

“We’re not creating a lie detector for pain,” stressed David Thomas of NIH’s National Institute on Drug Abuse, who oversees the research. “We do not want to lose the patient voice.”

Around the country, NIH-funded scientists have begun studies of brain scans, pupil reactions and other possible markers of pain in hopes of finally “seeing” the ouch so they can better treat it. It’s early-stage research, and it’s not clear how soon any of the attempts might pan out.

“There won’t be a single signature of pain,” Thomas predicted. “My vision is that someday we’ll pull these different metrics together for something of a fingerprint of pain.”

NIH estimates 25 million people in the U.S. experience daily pain. Most days Sarah Taylor is one of them. Now living in Potomac, Maryland, she was a toddler in her native Australia when the swollen, aching joints of juvenile arthritis appeared. She’s had migraines and spinal inflammation. Then two years ago, the body-wide pain of fibromyalgia struck; a flare-up last winter hospitalized her for two weeks.

One recent morning, Sarah climbed onto an acupuncture table at Children’s National, rated that day’s pain a not-too-bad 3, and opened her eyes wide for the experimental pain test.

“There’ll be a flash of light for 10 seconds. All you have to do is try not to blink,” researcher Kevin Jackson told Sarah as he lined up the pupil-tracking device, mounted on a smartphone.

The eyes offer a window to pain centers in the brain, said Finkel, who directs pain research at Children’s Sheikh Zayed Institute for Pediatric Surgical Innovation.

How? Some pain-sensing nerves transmit “ouch” signals to the brain along pathways that also alter muscles of the pupils as they react to different stimuli. Finkel’s device tracks pupillary reactions to light or to non-painful stimulation of certain nerve fibers, aiming to link different patterns to different intensities and types of pain.

Consider the shooting hip and leg pain of sciatica: “Everyone knows someone who’s been started on oxycodone for their sciatic nerve pain. And they’ll tell you that they feel it — it still hurts — and they just don’t care,” Finkel said.

What’s going on? An opioid like oxycodone brings some relief by dulling the perception of pain but not its transmission — while a different kind of drug might block the pain by targeting the culprit nerve fiber, she said.

Certain medications also can be detected by other changes in a resting pupil, she said. Last month the Food and Drug Administration announced it would help AlgometRx, a biotech company Finkel founded, speed development of the device as a rapid drug screen.

Looking deeper than the eyes, scientists at Harvard and Massachusetts General Hospital found MRI scans revealed patterns of inflammation in the brain that identified either fibromyalgia or chronic back pain.

Other researchers have found changes in brain activity — where different areas “light up” on scans — that signal certain types of pain. Still others are using electrodes on the scalp to measure pain through brain waves.

Ultimately, NIH wants to uncover biological markers that explain why some people recover from acute pain while others develop hard-to-treat chronic pain.

“Your brain changes with pain,” Thomas explained. “A zero-to-10 scale or a happy-face scale doesn’t capture anywhere near the totality of the pain experience.”

Filed under: General Problems | 5 Comments »