FDA Orders Suicide Risk Warning for Common Back Pain and Migraine Drugs, and Others

The FDA issued a public health alert today based on their review of 199 clinical trials. Specific drugs for epilepsy and psychiatric disorders are often prescribed to patients with migraine, back and body pain. The FDA review was released last January, and showed that patients taking those drugs had "almost twice the risk of suicidal behavior or thoughts than patients taking a placebo."

One of the drugs on the warning list is Neurontin (Gabapentin). Patients with back and various nerve and diabetic pain are commonly prescribed this drug. More drugs on the list are frequently prescribed for fibromyalgia and other pain: Lyrica (Pregabalin), Topamax (Topiramate), Celontin (Methosuximide), Felbatol (Felbamate), Zarontin (Ethosuximide) and others.

Here is a list of the medications required to add the warning:

* Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)
* Clonazepam (marketed as Klonopin)
* Clorazepate (marketed as Tranxene)
* Divalproex sodium (marketed as Depakote, Depakote ER, Depakene)
* Ethosuximide (marketed as Zarontin)
* Ethotoin (marketed as Peganone)
* Felbamate (marketed as Felbatol)
* Gabapentin (marketed as Neurontin)
* Lamotrigine (marketed as Lamictal)
* Lacosamide (marketed as Vimpat)
* Levetiracetam (marketed as Keppra)
* Mephenytoin (marketed as Mesantoin)
* Methosuximide (marketed as Celontin)
* Oxcarbazepine (marketed as Trileptal)
* Phenytoin (marketed as Dilantin Suspension)
* Pregabalin (marketed as Lyrica)
* Primidone (marketed as Mysoline)
* Tiagabine (marketed as Gabitril)
* Topiramate (marketed as Topamax)
* Trimethadione (marketed as Tridione)
* Zonisamide (marketed as Zonegran)
Some of these drugs are also sold generically.

I will be covering migraine and other headache in the future. Instead of drugs to mask back pain, neck pain and various musculoskeletal and nerve pain, fixing the cause is healthier than drugs. By no longer injuring the area, the pain will stop and the area can heal. It is not matter of choosing between pain and often worse problems from the treatment.

To stop common causes of pain, and the need for drugs, start with these:

• Disc Pain - Not a Mystery, Easy to Fix
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
• The Cause of Disc and Back Pain
• Fix Disc Pain Without Surgery
• How Much Inward Curve Space Should There Be In The Lower Back?
• Fast Fitness - Prevent Back Pain When Rowing
• Fix Scoliosis and Arthritis Pain, Fix New Orleans
• Prevent Knee Pain When Rowing
• Prevent Main Factor in Back Pain After Running and Walking
• Prevent Back Surgery
• Gaze Perseid Meteors Without Neck Pain
• Prevent Neck Pain and Get Upper Back Exercise Carrying Backpacks
• Upper Back Exercise and Neck Pain Prevention Too
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part I
  
• Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II
• Cauda Equina - Result Not Cause
• Healthy Mother's Day
• Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
  
  

Also recommended, available from my BOOKS page - www.DrBookspan.com/books:

• Fix Your Own Pain Without Drugs or Surgery
• Health&Fitness - How To Be Healthy Happy and Fit For The Rest of Your Life. THIRD edition.
• The Ab Revolution - No More Crunches No More Back Pain THIRD edition.

Labels: diabetes, drugs, fibromyalgia, fix pain, headache/migraine, injury, lower back, practice of medicine, stenosis, upper back

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Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II

In Part I of this post on Monday, photographer Bernie tells of fixing years of pain that doctors told him only surgery would fix, even after three surgeries. Here is a look "behind the scenes."

10 March 2005, Bernie e-mailed me:

"I've had this persistent paresthesias for 4+ years. I just learned about you yesterday. Where are your back & spine classes held. Tomorrow, I'm having lumbar myelogram & CT at (top name deleted here) Hospital. Before I consider anything else, I want to learn about your methods."

I wrote back with class information. I had two classes coming up. One was the next month. The second would be in early May and only a few blocks from where he lived. I told how we work to see change in pain right in class. I asked him to let me know the test results and that I hoped to see him in class.

20 March 2005 he wrote back:

"Thanks for asking, I never expected you to keep in touch. The myelogram and CT showed moderate central spinal stenosis at L4-L5. Severe facet joint arthropy & hypertrophy of ligamentum flaxa causing compression of the lateral recesses stenosis of L5 on both sides, kinking of L5 nerve root sleeves on both sides. I have a copy of the xray, showing the "hourglass" at L4-L5

"(name deleted) is the attending, 3-B Orthopaedics. He said the next step is surgery, by ( ), at ( ) Hosp. I asked if strengthening of my upper body would help support my spine. He said "try it" so I'll be at physical therapy next week to start.

"I have a commitment for the weekend of April 2-3 so can't attend that class, much as I'd like to. Since I live at (close to) your class at Temple CC is my best chance of attending. Cordially, Bernie Cleff"

I checked back in to make sure he was signed up for the May class and to ask what he was doing in Physical therapy. He wrote:

29March 2005
"The phys therapy that I'm getting concentrates on my core muscles. Thanks for getting in touch...very kind of you."

I wrote back saying that conventional core exercises were not the best thing. Usually they are forward bending actions that will further compress the discs, the nerves, and also do not retrain the abdominal muscles in the way they work when you go about daily life. Strengthening does not automatically support the spine. I wanted to make sure that he had my Ab Revolution book, which was then out in a training manual version. He said he had it with him for PT. I found out two years later that they had the book, but they were not using it, and were doing traditional forward bending abdominal exercises.

10 May 2005, the day after the Fix Your Own Back Pain workshop was held, Bernie wrote me,

"Hello, I did sign-up for your class at TUCC on Monday 5/9, but I was too tired to attend. On top of that, I am scheduled for spine surgery at ( ) on Wed 5/11/05, with ( ). After having 2 epidurals and physical therapy I decided to go for the surgery. My nerve that is pinched is in the shape of an hourglass (at L4- L5) and (the doctors told him) that no body position or exercise changes are going to help at this time. Both legs are numb and I am walking like a drunk. It is kind of you to keep in touch. I hope to meet you at your fall class."

Days later, Bernie had the surgery. He tells about it, and his next two years, in Part I of this story. The doctors all considered his surgery a "complete success." They said the surgery went completely according to plan, with no complications. His recovery was in line with expected results. The fact that his pain returned, was worse, and complicated by limited movement from his plates and screws and other surgical hardware not a factor to them. They felt the limited movement was beneficial and a goal of the surgery. The commonly held idea is to stop motion in the area to stop the pain.

In late October of 2007. I arrived to teach the Fix Your Own Back and Neck Pain Workshop. I had 16 people waiting for me. One was Mr. Bernie Cleff, a funny white-haired muscular man of 80, who was in much pain.

We had a fun, energetic class. One of the students was a young man from India. He sat unsmiling as I mentioned various yoga poses that can injure discs in the neck. I explained that I am not against all yoga, and studied years to become a teacher myself. He sat unsmiling. We did three specific techniques to stop the neck pain process and a beautiful smile radiated from the young man from India. He had three herniated discs in his neck from his yoga practice of the specific moves I had mentioned, together with sitting badly at a computer for his work. He already knew those yoga moves hurt his neck. He had just been worried the pain would never stop. When the pain stopped right there in class, he smiled.

Another of the students was a golf pro, who I consulted with afterward to test out my work on lower back pain and golf. More on this in Lower Back Pain and Golf.

Mr. Cleff did great in the first class. This class was done over two weeks. I gave the students things to try during the week before the second (last) class.

Oct 25 2007, he wrote me:

"Today (Thursday) is my class day at The Clay Studio, working over the wheel for 5 hours. I felt good with very little noticeable pain. Usually after walking the 5 blocks from my home to the studio both my legs would tingle badly and I would stop to rest halfway. Not today. When I told my classmates about you phoning me to ask how I was doing with your exercises & stretching, they could not get over your caring. None of us had ever had a Dr. call to check-up. You are one hellova person and I'm thankful that I've met you.

"I've had my spine problems with the pinched nerves for a long time - roughly 4-5 years - and I'm slowly getting better since you came into my life. There is no other way to say it. Thanks Jolie."

He was improved in one class, and he felt that he was "slowly" getting better. I like an empowered student who does not want to dawdle to get better. The day after the second of the two sessions, Bernie wrote:

28 Oct 2007

"Last night, I walked about 7 blocks to restaurant AQUA (great value, low cost & delicious) and back home another 7 blocks.

"Upper back extension causes no pain, lower back does. I can do plank on elbows, holding for 60 seconds now, no pain.

"If you want to make photos of a geriatric doing your things, it's OK with me. as you've seen, I'm not bashful or delicate. I will work at getting better, my daughter is getting married January 5 and I want to be able to dance with her and my wife."

Bernie went back to his doctors to ask about a small amount of remaining pain. They told him he should have more surgery and gave him prescriptions. He wrote to ask me:

"On Nov. 2 I have a follow up with the spine surgeon (same guy) and on Nov 14 a consult with a Neurologist ( ). Do you have any suggestions about a pain med FENTANYL, which was suggested by a doc at the V.A."

I wrote back that Fentanyl is a surgical grade narcotic. It is used "off-label" for back pain and there have been deaths. I asked him to tell me more about what hurt, and when, so we could stop it without any harmful medicine, and also what the neurologist said.

14 Nov 2007, he wrote:

"I had an office visit with the neurologist at ( ), he said my twisted nerve at L5 will never get better and I will always have pain."

They told him to have another spine surgery, and take Fentanyl, and he will always have pain? Then why did they put him though all that surgery?

He wrote:

"Hello, I still have some tingling in both knees...but much better than 2 weeks ago! There has always been pain in my left flank between spine & hip, never told you because the knees were my greatest problem… The lower back pain persists, but only left side. When I do the trap stretch leaning to left--puts much pressure on that pain. Leaning to the right feels like a good stretch. Any additional suggestions?"

I found that that he was still doing "their" exercises. Conventional exercises of bending forward to stretch the hamstrings are often prescribed for back pain. The assumption is that tight hamstrings have something to do with back pain. However, bending forward is one major contributor of this kind of back pain. I changed how he stretched his hamstrings to one of the ways we did in class.

He was also continuing to overarch his lower back when walking, which was a large source of the tingling pain. When he used the Trapezius stretch, he was also overarching, which makes pain when bending to that side. This kind of pain is often confused for spinal stenosis. One classic sign of stenosis is pain when bending toward one side. However, the narrowing is not true stenosis, but just overarching which narrows and pinches the area. For someone who has stenosis, not pinching the area further with overarching is frequently enough to stop pain.

What was complicating everything was his surgeries. They were considered "completely successful." The two knee replacements were "completely rehabbed" meaning he could bend his knees enough to sit in a chair. He could no longer stretch the front of his hip enough to prevent the kind of tightness that encourages standing and moving in overarched position. The back surgery put a plate in his back to prevent much movement. That meant that even small overarching movements were enough to pressure the newly immovable area. The back hurt, and the tight back and hip were compressing nerves going down both legs.

After we fixed these issues he wrote two mails:

"Jolie You hit on the spot. I will keep at it gently."

and

"Jolie, a quick note to tell you today I walked 12 blocks, stopping to stretch hamstrings.. often on steps or fireplug....as you suggested...also lunge stretch. I will dance at my daughter's wedding. Much thanks.

"There will not ever be more surgery on my body."

For the flank pain, he had been for many tests, and was even scheduled for a kidney evaluation. The muscles in the area were so tight, that I biked over to his home to do a sports medicine technique to stretch it out for him, and checked his other stretches. I went over how to stretch the front of the hip without overarching his lower back. His sweet funny wife made me lunch. We got some fun photos of things as gifts for you, of fun stretches and activities.

He wrote:

"I've had x-rays, MRI, bloodwork, surgery, injections, no Dr. had any solution.
YOU HAD THE ANSWER. No wonder so many people have thanked you."

He did the work and gave me the credit. That's a good man.



Next:

• Bernie dances at his daughter's wedding in Cauda Equina - Result Not Cause.

Related:

• Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part I
• Overhead Lifting, Reaching, and Throwing - More Part I
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
  
• Prevent Back Surgery
  

See Mr. Cleff Demonstrate:

• Fast Fitness - Quick Relaxing Hip Stretch
• Fast Fitness - Relaxing Hip, Leg, and Groin Stretch
• and Dynamic Partner Balance Challenge.
  
  

Labels: drugs, facet joints, fix pain, hamstring, impingement, injury, knee, lordosis, lower back, neck, practice of medicine, readers inspiring story, side, stenosis, stretch, surgery, yoga

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Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part I

In this post, Bernie, an 80 year old retired photographer tells how he was signed up to take my "fix your back pain" workshop in 2005, but was convinced by his doctors that nothing but surgery would help. After "completely successful" surgery, his pain returned and worsened. He returned two years later to me. December 2007, Bernie wrote:

"I was a professional photographer for over 53 years-freelance-meaning go any place, any where- for many varied clients and I am now 80 years old and retired from photography.

"Much of the time I carried a 40-pound camera bag on my shoulder when climbing a 75 ft radio tower, walking on railroad construction sites or climbing The Great Wall in China.

"When I was at my vacation home, I climbed ladders to paint, replace cedar shingles and install new windows.

"Both my knee joints were replaced (5/93 & 6/01). Sometime in 2003 I was aware of tingling in both of my lower limbs from the knees downward. That started my medical testing with EMG’s, MRI, CT Scan and X-rays. The diagnosis was spinal stenosis caused by age-related changes in my spine. Physical therapy was started and I had an epidural, which helped for about a year. Then a second epidural lasted for only 3 months.

"I had been volunteering in an E.R. for 7 years helping patients and I had to stop as it was impossible to walk or stand on my feet because of the strong tingling in both limbs. Then I was told that spine surgery was the answer, but continue P.T. with some changes of the therapy. So, two years later, with some relief… but not enough to continue, I stopped the P.T., had an MRI scan which showed further degeneration of L4 & L5 with kinking of nerve roots. All along there was a pain in my left flank, but that was overshadowed by the strong tingling in the knees. There had been suspicion of kidney stones or liver function but x-rays & all blood work proved negative. I was hurting more in both knees.

"The spring passed at my vacation home near Barnegat Bay with much pain and with me looking at my kayak that had remained in storage. I called for surgery to be scheduled.

"The lumbar myelogram & CT was done at Pennsylvania Hospital and surgery date was set.

"On March 10,2005 I found the website of Jolie Bookspan and e-mailed her with my “story” of pain. Her class to fix back pain was going to be held soon a few blocks from where I lived. She asked me to try the class first, (it was being held a week before the schedule surgery) but I told her that both legs are numb and I am walking like a drunk, the doctors said no amount of exercise or body mechanics would fix such structural problems, and am going thru with the surgery on May 11, 2005.

"Post-op recovery was hell. The summer was hell with pain killers and sleeping pills. At the follow-up exams, I was told “the surgery went well, no infection, you’ll be better in 6 to 8 months”. The laminectomy used a metal plate & 4 screws and a bone graft from my hip for the fusion of L4 & L5. The pain in my left flank remained throughout 77 physical therapy treatments. The surgeon prescribed Elavil and when I took it, I felt like a zombie. After I told him, I was told to try a half tablet. That made me feel like a half-zombie.

"No doctor had a solution except “try Tylenol, Advil, Fentanyl, and more”…a consult with a neurologist said that my twisted nerve would never get better. (So why all the surgery?) The pain in my left flank remained.

"Then I took Jolie's class on October 20, 2007 and she had the answer. My left flank pain was not a medical condition (I was put through every test including kidney function), but a muscle in spasm. I was doing the wrong exercises that I had learned in PT and they were making it worse. She taught me to do the exercises the correct way as shown in her books and articles in her websites.

"Five days later I reported to Jolie that I had been working at The Clay Studio, throwing clay on a wheel making pottery for 4 hours and felt good. Usually after walking the 5 blocks from my home to the studio both legs would tingle badly and I had to stop halfway to rest. Not today. When I told my classmates about you phoning me to ask how I was doing with your exercises & stretching, they could not get over your caring. None of us had ever had a Dr. call to checkup. You are one hellova person and I’m thankful that I’ve met you.

"I’ve had my back problems with the muscle spasm and damaged nerve for a long time…roughly 4-5 years…and I’m getting better since you came into my life. There is no other way to say it. Thanks Dr. Jolie for your passion for helping others.

"On your questionnaire in the first class I wrote that I wanted to be able to dance with my daughter at her wedding in January 2008. You have made it happen for me.

"I will dance."

Next - Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II - a look behind the scenes.

Follow-up Note - the wedding on the 4th of January was great and Bernie danced and danced. Here is a photo.

Labels: fix pain, impingement, knee, lower back, practice of medicine, readers inspiring story, side, stenosis, surgery

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