The abuse of dextromethorphan—a cough suppressant ingredient in more than 140 over-the-counter cold- and cough-medications—has nearly doubled among adolescents in the past few years. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 12,584 emergency department visits involved DXM use in 2004, of which 5,581 visits were caused by nonmedical use of the substance. From these cases, 48% involved adolescents between the ages of 12 and 20. SAMHSA estimates that an average of 7.1 emergency department visits per 100,000 caused by the nonmedical use of DXM involve patients between 12 and 20 years of age. In comparison, the rate of DXM misuse among Americans of other age groups will cause an average of 2.6 emergency department visits per 100,000.

For that same year, the FDA estimates that 4,634 emergency department visits involved DXM overdose; by 2008, this figure had risen to 7,988 cases of overdose. In 2008, SAMHSA found that almost 1 million Americans between the ages of 12 to 25 had misused DXM that year: 30.5% had abused NyQuil, 18.1% had abused Coricidin, and 17.8% had abused Robitussin. Approximately 3.1 million Americans ages 12–25 have abused over-the-counter medications at some point during their lifetime. Over a third of DXM overdose cases among older adolescents also involve alcohol.

In light of these figures, the FDA’s Advisory Committee issued its first public warning regarding adolescents’ abuse of DXM, also known as "robo-tripping," by 2005. As of today, the incidences of DXM abuse and overdose have continued to escalate. In their upcoming meeting, the FDA will determine whether it should implement restrictions on the sale of over-the-counter medications containing DXM. The Advisory Committee will consider reclassifying DXM products as a controlled substance, making these medications available by prescription only. Most manufacturers of the over-the-counter medications disagree with this movement, suggesting that the restrictions will impede upon the public’s right to use DXM products, which when taken in regular dosages is quite safe. Some experts suggest restricting the sale of these products to minors to combat their misuse among adolescents, while still making them accessible to adults. Furthermore, parents should be better informed of DXM’s potential for abuse when they make their purchases.

The rate of DXM abuse among adolescents and young adults now greatly exceeds their rate of methamphetamine abuse. SAMHSA has found that adolescents who abuse DXM also have a high tendency to regularly abuse other substances, including marijuana (89.1%), hallucinogens like LSD, PCP, or ecstasy (44.2%), and inhalants (49.3%). When taken in large quantities that exceed normal dosage, DXM can produce euphoria, heightened awareness, dissociative experiences, and hallucinations, similar to PCP or ketamine abuse. When overdose occurs, DXM can cause severe adverse effects including loss of physical coordination, severe abdominal pain, nausea/vomiting, blurred vision, violent uncontrolled muscle spasms, delirium, heart arrhythmia, and death.

Source: Los Angeles Times, FDA weighs how to stop abuse of over-the-counter cough and cold drugs, August 31, 2010

Erica Weintraub Austin, director of the Murrow Center for Media and Health Promotion at Washington State University and lead author of the study, and her colleagues found that a two-week course helped third, fourth, and fifth graders reduce their intentions to try alcohol and tobacco, and increased their belief that they could resist the substances. 

Austin said that people underestimate children’s ability to understand advertising messages, as well as the fact that marketing methods can affect their decisions later in life. If children associate smoking with popularity and maturity, they might want to try cigarettes when they’re older. Marketing specialists tend to make their messages appealing to young people, so it’s important that children understand that some of these messages may not be in their best interest.

The researchers found that people internalize or reject advertising messages through a partly logical, partly emotional process. By teaching children that advertisers want them to react emotionally, they can learn to react more logically.

North Carolina-based Innovation Research Training, Inc. conducted the study, in which elementary schools either received the Media Detective program or were part of a control group. The 344 children who received Media Detective lessons were less interested in alcohol merchandise than the 335 children in the control group. Students in the Media Detective group who had already used alcohol or tobacco said their intentions to use the substances were lower, and they believed they had a better ability to refuse the substances than children in the control group. The researchers found that the lessons were most helpful to boys.

Prior studies by Austin and researchers with The Edward R. Murrow College of Communication’s Center for Media & Health Promotion found that programs such as Media Detective can help prevent substance abuse, teach sex education, and instill an interest in voting and public affairs among teens. The new study is the first to show that these programs can be helpful for children, as well.

Source: Science Daily, ‘Media Detective’ Tool Empowers Children to Skirt Alcohol and Tobacco Marketing Messages, August 24, 2010
 

The problem is pervasive. Over one-half of all high school students will have taken a drink of alcohol during any given one-month period. Most get the alcohol from home or from someone they know. Almost one-third of high school seniors will engage in binge drinking (five or more drinks in any given period) in any two-week period. Given the major role that parents play in shaping the actions of their children, they are in the best position to regulate drinking behavior and prevent tragedy.

State officials seek to remind parents that tragedy resulting from teen drinking at parties can be avoided. Most importantly, minors under the age of 21 should not be permitted to drink alcohol, whether they are under the supervision of an adult or not. However, even the most well-intentioned adult host can quickly land him or herself in hot water if underage guests get their hands on alcohol. Even when hosts notify underage participants that they are not permitted to drink at the party, failure to actually supervise the possession of alcohol by party guests often leads to tragedy, as many teens are likely to disregard the warning and drink anyway. Like waiving a red flag in front of a bull, placing alcohol within reach of teen party participants is just asking for trouble.

Given that teens often prefer to keep to themselves at functions, largely to avoid having to hang with the boring adults, a host may not realize that minors have been drinking alcohol until it is too late. The consequences can, indeed, be tragic.
Younger people are typically smaller in size than an average adult and become intoxicated much more quickly than the normal of-age party-goer. Alcohol poisoning (the inability of the body to safely process alcohol as it is ingested) among teen drinkers is very common, as they do not have the experience with alcohol to know when to stop drinking. Alcohol poisoning, or overdose, can lead to permanent organ damage or death.

Another risk for hosting parties where teens will be in attendance is motor vehicle incidents. The most obvious consequence of teen drinking at parties is that one will get behind the wheel and cause an accident. Another consequence is that he or she will be driving one or more friends, thus subjecting others to serious injury or death.
While state authorities have little control over whether parents and guardians will allow teens to drink at parties, a behavior that could subject the adults to criminal and civil liability, the state can take steps to ensure that law enforcement is prepared to handle the ramifications of teen drinking.

New York’s OASAS has aggressively implemented the Party Patrol and Controlled Party Dispersal training program with an eye toward reducing alcohol abuse, driving under the influence, and underage drinking. Using prevention professionals, the PPCPD has trained over one thousand law enforcement officers on how to safely break up underage drinking gatherings at parties, in college dorms and frat houses, in residential settings, during outdoor parties, and in large concert arenas. Law enforcement agencies use intelligence gathering, work with community leaders, and disseminate information through media outlets in order to stop teen drinking. Officials believe, and research has shown, that young people are less likely to engage in underage drinking if they think there is a possibility that they will be caught doing so by police. Research has also shown that parents will be more likely to adopt a zero-tolerance policy for teen drinking at parties and at home if they believe that they could be held accountable, either criminally or civilly, for underage drinking.

Lawmakers in New York have also started holding social hosts accountable for teen drinking incidents. Nearly fifty local governments across New York have “social host” laws that impose liability for serving alcohol or drugs to teens at home. There are also penalties for those supply alcohol to minors for a fee.

For party planning, officials recommend that adults establish firm regulations and expectations prior to party day and to make sure they are clearly understood by attendees, especially teen children and their friends. Obviously, the most important rule is that teen guests cannot ingest alcohol or other drugs before, during or after the party. Hosts should have a plan in place to monitor the grounds during the event, and to ensure that off-limit areas cannot be accessed. In addition, teens who arrive at the event driving their own vehicles should turn in keys to the host and be expected to interact with the host prior to key return, to ensure that he or she is ok to drive. Hosts are also reminded to have plenty of non-alcoholic beverages available.

This question was posted to a panel of presenters during the American Pain Society’s 29th Annual Scientific Session. The challenge in addressing this question is that routes of administration vary by agent which can make it difficult to determine the best way to deter abuse.

A database used to capture routes of administration of prescription opioids found that hydrocodone was mostly taken orally, while fentayl was primarily smoked. A study in this field found that a subset of people who abuse opioids often begin taking the drug orally, but tamper with the medication so it can be snorted.

The U.S. Food and Drug Administration issued a memo recently that cautioned, “that language in a product’s label for a claim of abuse resistance would require long-term epidemiological data from community-based observational studies that document changes in abuse and addiction and the consequences of those behaviors.”

At the same time, populations exposed to opioids happen to be very broad and human abuse liability studies, which are required for all opioid agents, must increasingly serve as surrogates for “real world” behaviors. This observation was made by Lynn Webster, MD, of Lifetree Clinical Research & Pain Clinic in Salt Lake City, Utah.

Robert Bianchi, of the Prescription Drug Research Center, Fairfax, Va., noted that the more difficult it is to extract an active ingredient from an opioid, the less likely people are to do so. One unpublished study found that 80 percent of subjects would spend a maximum of 3 to 10 minutes tampering with an agent with abuse as the goal.
 

The Monitoring the Future survey is a research project carried out every year by the University of Michigan. The survey examines 50,000 middle and high school youth throughout the nation and then prints a report on drug use by America’s young people.

The behavior and attitudes that are captured in the survey and then printed in the report provide critical advance notice of adult drug use and addition that is likely to occur a few years down the road. Changes in trends provide information as to the effectiveness of the message.

The latest report was released in December 2009 and showed that overall drug use has risen slightly, mainly due to the rise in marijuana use. At the same time, the high rate of prescription drug abuse remained stable among students in their senior year of high school.

Figures show that the rate of narcotic use other than heroin has more than doubled since 1992. For every 100 students, 13 of them have abused prescription medications such as OxyContin, Vicodin, Lortab or methadone.

Teens are also abusing prescription drugs such as amphetamines, sedatives and tranquilizers. While Ritalin was once the drug of choice among abusers, the shift has moved more toward Adderall.

Perhaps even more disturbing is how teens are able to get their hands on their drug of choice. More than half are able to get their drugs for free from a friend or relative. Another third purchased the drug from a friend or relative and 20 percent took it without asking.
 

Does a rural setting provide protection for children from the pressures of experimentation with dangerous behaviors? A recent study looked specifically at alcohol use and its effects on the ability of youth to later sustain regular employment.

Mink, Wang, Bennett, Moore, Powell and Probst examined in 2008 whether alcohol use in youth and early adulthood was related to employment as an adult for both rural and urban youth. The authors of the study wanted to see whether the rural environment insulated youth from the effects of drinking on their employment outcomes.

The researchers used data from the National Longitudinal Survey of Youth 1979. The survey was a 20-year panel survey and was used to establish whether there may an association between alcohol use between the ages of 17 and 26 and employment in adulthood.

Early drinking behaviors and misuse symptoms were used to identify drinking behavior measures. Rural was defined as living outside a Metropolitan Statistical Area, and employment was defined using employment status and employment quality.

The results of the study indicated that drinking behaviors were not affected by residence. The researchers found that alcohol consumption during youth was associated with working over 40 hours per week and earning irregular compensation.

The study also found that rural youth were more likely to encounter negative employment situations as a result of drinking during youth.

The study’s findings have important implications for understanding how drinking behaviors during youth impact future employment and how those factors are affected by rural or urban environments.

Rural residence does not appear to protect youth from the effects of the consumption of alcohol as a youth and adult employment outcomes. This may be surprising to those who have historically identified rural residence with a protected environment for children and teenagers.

Further research is necessary to determine whether the results stem from a limitation of services available in rural areas when compared with urban areas. It is important to understand also how the availability of certain types of employment may affect the employment outcomes of those in rural areas.
 

Acute vs. Chronic Pain

First, however, it’s important to differentiate between acute and chronic pain. According to WebMD, acute pain begins suddenly and is sharp in quality. It may serve as a warning sign of disease or some kind of threat to the body. Acute pain may be mild and last only a short time, or it can be severe, lasting many weeks or months. Usually, acute pain lasts less than six months – disappearing when the underlying condition is treated or heals. Examples of incidents causing acute pain include childbirth, dental work, broken bones, cuts and burns, and surgery. If the underlying condition remains untreated, however, acute pain can become chronic pain.

Chronic pain, on the other hand, is pain that persists even after an injury has healed. WebMD advises that pain signals remain active in the body’s nervous system for varying lengths of time: weeks, months, or even years. Chronic pain has numerous physical effects, including limited mobility, changes in appetite, lack of energy and muscle tenseness. It also has several emotional effects, including anger, anxiety, depression, and fear of re-injury. All of these effects may serve to prevent the chronic pain sufferer from returning to work or normal activities.

People complaining of chronic pain may have one or more of the following pain causes: arthritis, cancer, headache, low back problem, nerve damage, or psychogenic pain (pain not caused by past injury, disease or visible sign of damage).

Methods to Treat Pain

Numerous methods exist to treat pain. These include non-prescription or over-the-counter (OTC) and prescription drugs, nerve blocking, alternative treatments, electrical stimulation, exercise and physical therapy, spinal decompression therapy, surgery, psychological counseling, and behavior modification. Some of these are more effective when combined with other forms of treatment. In addition, pain sufferers often need to try several different methods in order to obtain the needed relief. We’ll examine each of the pain treatment methods separately.

Non-Prescription Medication

The quickest pain relief for many individuals is to reach for a bottle of aspirin, Motrin, Aleve, or Tylenol. Pain relievers and fever reducers are safe when used as directed, but do pose risks for people with certain conditions or who are taking specific medicines. Acetaminophen products include Tylenol and Panadol. Non-steroidal-anti-inflammatory drugs (NSAIDs) include such OTC products as aspirin, ibuprofen (Advil and Motrin), naproxen sodium (Aleve) and ketoprofen (Orudis KT). These products can cause stomach bleeding with an increased risk for consumers over the age of 60, those who take prescription blood thinners, steroids, or who have a history of stomach bleeding. They may also cause reversible kidney problems in those who have a preexisting kidney disease or are taking a water pill (diuretic).

Prescription Drugs

Depending on the severity and duration of the pain, some patients turn to stronger prescription painkillers (opioids) to ease their suffering. Medications commonly prescribed for pain include codeine, morphine, and anesthesia.

According to the National Institute on Drug Abuse (NIDA), opioids include hydrocodone (Vicodin), oxycodone (OxyContin), propoxyphene (Darvon), hydromorphone (Dilaudid), meperidine (Demerol), and diphenoxylate (Lomotil). The chief caution about long-term use of opioids is that they can lead to physical dependence and addiction. Opioids, according to NIDA, can produce constipation, drowsiness, and, depending on the amount taken, may even depress breathing.

When taken as prescribed by a physician, and not abused, alone or in combination with other prescription and/or OTC drugs, illegal drugs or alcohol, most painkilling medications are safe. They are meant to be taken as a short-term pain remedy, however, and are not appropriate for long-term use. In addition, certain opioids, as well as other prescription drugs such as stimulants, sedatives and tranquilizers, have side effects.

Elderly people are particularly vulnerable to prescription drug abuse, since they are more often prescribed several medications for a number of different health conditions.

Nerve Blocking

Chronic pain such as that caused by herniated discs may be alleviated by nerve blocking. This involves using local anesthetics to block a group of nerves. Since the pain of herniated discs is aggravated by inflammation, temporary nerve blocking with anesthetics allows the inflammation to decrease, thus reducing pain. For severe chronic pain, the pain management physician may order a series of nerve-blocking injections, spaced a week or more apart.

SpineUniverse lists the various types of spinal injections/nerve block therapies that help reduce and stop back pain. Injections deliver pain reducing medicine directly to the source of the pain. The types of injections include:

• Epidural
• Diagnostic
• Nerve Block
• Spinal Joint Blocks and Injections
• Cervical: Specific Injection Therapies
• Lumbar: Specific Injection Therapies
• Thoracic: Specific Injection Therapies
• Soft Tissue Injections – also called trigger point injections

It is important to note that spinal injections to alleviate pain are considered an adjunct treatment. It is used to facilitate participation in active exercise programs. Practitioners say it may help the patient with chronic pain to avoid surgical intervention.

Alternative Treatments

Acupuncture, yoga, relaxation and biofeedback are examples of alternative methods to safely combat pain.

• Acupuncture – WebMD indicates that acupuncture is thought to decrease pain by increasing the release of endorphins that block pain. The practice of acupuncture involves the use of disposable, stainless steel needles that are inserted into the body’s 14 major meridians (also known as energy-carrying channels), in order to correct imbalances in the body and overcome or resist illnesses and conditions. Acupuncture is most effective in treating chronic pain such as low back, neck or muscle pain, headaches, and menstrual cramps. It is also used to treat pain caused by arthritis, shingles, spastic colon and colitis, among other conditions. After the needles are inserted, they are twirled to produce electricity, or electricity flows through them. The needles remain in place for a few minutes. If the tingling from the electricity is too strong, the patient can ask the acupuncturist to reduce the intensity. In typical sessions and over the course of treatment, different combinations of needles and techniques are used to help stimulate new sources of healing. Acupuncture appears to be safe, with relatively few side effects. Go to a well-trained and experienced acupuncturist.

• Yoga, Tai Chi and Pilates – As reported in an L.A. Times story, a three-year study of 90 chronic low back pain funded by the National Institutes of Health found that twice-weekly yoga sessions for a period of 24 weeks appeared to relieve pain and improve mood. Six months after the study ended, those in the yoga group reported significantly more improvement in pain and functionality as compared to a control group. The yoga classes were taught by an instructor certified in Iyengar yoga, a type of yoga that emphasizes posture. Tai Chi is a gentle program of exercise shown by scientific studies to relieve pain, strengthen muscles, and improve blood circulation, stamina, balance and relaxation. While there are many different Tai Chi programs, special emphasis is placed on strengthening the deep stabilizing muscles of the back. Strengthening these muscles improves pain and improves physical function. Pilates, on the other hand, according to AltMD, is an ideal and easy way to alleviate neck pain by stretching and elongating muscles, aligning posture and improving strength, balance and flexibility. Like yoga, Pilates pays close attention to form and sustained stretches. Pilates uses eight guiding principles: relaxation, concentration, alignment, centering, breathing, coordination, flowing movements and stamina. Pilates should only be practiced under the guidance of a well-trained and certified Pilates instructor.

• Hypnosis – Scientists believe that hypnosis helps relieve pain by blocking nerve pain receptors in the brain. In the brain, these receptors control sensations of anxiety, discomfort and pain. Studies have shown that cancer-related pain and pain from back injuries, surgeries, and migraine headaches, appear to respond well to hypnosis. You learn the skill from a trained therapist and then are able to self-hypnotize. In general, you learn to focus your attention to achieve a desired purpose – such as alleviating pain. In essence, you focus your attention on an image, and your mind seizes on that image, blocking the perception you have of pain. As a result, you feel less pain. With practice, your subconscious mind replays that image again and again, effectively blocking pain.

• Relaxation – Pain can also be relieved by relaxation techniques. Some of these techniques include rhythmic breathing, deep breathing, visualized breathing, relaxing to music, mental imagery relaxation (also called guided imagery), and massage.

• Meditation – Research has shown that meditation helps lower blood pressure and improves heart rate, brain waves, and breathing. Tightness and tension melt away from muscles as the body receives gentle, quiet messages to relax. Traditionally, a single word or phrase is repeated, the “mantra,” all the while focusing on breath and ignoring thoughts. Practitioners of meditation report feeling soothing warmth, calmness, and a sense of heaviness (groundedness) while they meditate. You can learn meditation from a teacher or you can pick up the skills on your own. Meditation classes are a good start.

• Biofeedback – The American Pain Foundation says that biofeedback is a “time-tested methodology for using the power of the mind to treat pain.” Biofeedback is a spectrum of techniques that may involve using different machines and electrical technology to help patients receive information about their bodies react to the way they think. Through biofeedback training, patients gain control over their pain, and may also be able to control high blood pressure and depression. WebMD says biofeedback has been used to help control migraine pain, epilepsy seizures, and other common problems. Other mind-body therapies include mindfulness meditation, cognitive behavioral techniques, and hypnosis, although this is not an all-inclusive list.

Electrical Stimulation

Minimally invasive, cervical facet radiofrequency neurotomy, also called radiofrequency (RF) rhizotomy, reduces or eliminates pain of damaged facet joints by disrupting medial branch nerves that carry pain signals. The procedure, carried out under local anesthetic, takes about 1-2 hours and requires two sessions. The patient usually experiences relief from the pain within one month. Studies have found that successful RF neurotomies can last longer than steroid block injections.

Other electrical stimulation therapies include transcutaneous electrical nerve stimulation (TENS), radiofrequency ablation and spinal cord stimulation. Neurostimulation treatment involves using painless electrical impulses to interrupt pain signals. There are two types of neurostimulation systems – one is powered by a battery that is surgically implanted beneath the skin, and the other system uses a battery that is worn outside the body.

Exercise and Physical Therapy

For most back pain conditions, active back exercises and stretching – and not rest – are typically better at reducing pain and encouraging healing, according to Spine-Health. Stretching benefits everyone, whether getting ready to go on a hike or brisk walk, or to engage in modest exercises, or physical therapy regimen. In fact, stretching exercises should always precede any of these activities.

Back pain exercises and rehabilitation programs will differ according to the patient’s condition and level of pain. For this reason, it is important that individuals see a spine specialist who can tailor a personalized program of back exercises and give instruction on how to correctly perform the exercises. The specialist will give the patient a prescription for physical therapy. Insurance may cover some of the cost of the physical therapy or rehabilitation. A balanced workout includes stretching, strengthening and low-impact aerobic conditioning. Typical physical therapy sessions begin with relaxing heat followed by a therapeutic massage of the affected area. Stretching of the loosened muscles then takes place, followed by a series of exercises, graduating in repetitions and complexity as the patient is able to do them without pain. The session concludes with icing of the affected area.

Those with chronic back pain may find that they require months of stretching in order to gain the mobility in their spine and soft tissues. After months of stretching, however, most chronic back pain sufferers find their pain levels have decreased and they are able to experience increased range of motion.

Benefits of low-aerobic exercise for persons with low back pain include an increased production of endorphins, the body’s natural painkillers, that can reduce pain after 30 to 40 minutes of exercise; an elevation of mood as a result of the endorphins (persons with back pain often suffer from depression); fewer episodes of back pain, and less pain when it does occur. Endorphins can also reduce the need for pain medication – a substantial benefit in order to safely combat pain.

Low-aerobic conditioning exercises include:

• Walking – 2 to 3 miles, three times a week
• Stationary bicycling or “spinning” classes
• Elliptical trainer or step machine
• Water therapy

Maintenance programs of vigorous physical exercise are also helpful once patients have reached an optimum stage of mobility and pain reduction. Any form of strenuous exercise will suffice, from brisk walking in the canyon trails, to participation in sports, working out at the gym, swimming, and others. To be effective, however, the maintenance exercise program should involve 30 minutes to one hour, four days a week.

Spinal Decompression Therapy

Instead of opting for surgery to correct back problems (and the resulting pain), many chronic back pain sufferers are opting to find relief with spinal decompression therapy. In this type of non-surgical therapy, vertebrae in the patient’s back are put into traction. In the procedure, the vertebrae are slowly pulled away from each other so that healing nutrients can flow into the damaged area, allowing healing to begin.

Treatments usually start off with several sessions the first week, followed by follow-up treatments that are spaced further apart. Decompression therapy has been successfully used to treat herniated discs.

Surgery

Spine-Health identifies certain structural spine conditions (degenerative disc disease, spinal stenosis and spondylolisthesis) as examples of chronic pain that can result in ongoing pain until the diagnosable anatomical problem is successfully treated. After several weeks or a few months of more conservative treatments (see above), spinal surgery may be considered as a treatment option.

Some surgeries to alleviate chronic pain include joint replacement, tumor excision, and discectomy. In severe cases of chronic pain where all other methods have proven ineffective, cordotomy may be performed. This involves severing nerve fibers on one or both sides of the spinal cord, eliminating sensations of temperature and pain.

Due to lengthy recuperation time and potential need for physical therapy and rehabilitation, as well as the risks associated with any such procedure, surgery should only be considered as a last resort option in most cases.

Psychological Counseling

Pain is a “whole person experience,” according to the Stanford School of Medicine Pain Management Center. Chronic pain can lead to profound psychological effects such as feelings of depression, sadness, anger, hopelessness and despair. Psychological counseling can help many pain sufferers to develop specific skills that both relieve pain and increase quality of life.

Individual and group psychological therapy is available, and both use a variety of techniques. Psychophysiological techniques include biofeedback and relaxation. Other techniques include behavioral (self-monitoring and paced, progressive increases in activity levels), cognitive (self-hypnosis and visual imagery, and emotional management), and home treatment aids.

Behavior Modification

This type of treatment involves training the patient incrementally to alter or change their specific behaviors and is often used in conjunction with other pain management or treatment modalities. Biofeedback and relaxation training, for example, are two types of behavior modification treatment for pain.

How to Choose the Right Method to Combat Pain Safely

Before deciding on any specific course of pain treatment, see your doctor for a complete physical examination. If the problem requires it, your doctor will refer you to a specialist, often a spine specialist, for further tests and evaluation. From there, a comprehensive and minimally invasive or nonsurgical treatment program can be personally designed to fit your circumstances and wishes. Some patients who have chronic pain may be candidates for surgery but may not wish such an invasive procedure with all its attendant risks. Others may have a condition that surgery cannot fix. In any case, only proceed under a doctor’s guidance. In addition, many of the procedures to eliminate pain require a prescription or referral from a physician (such as physical therapy, nerve blocking, electrical stimulation, etc.).

Remember that it takes time for any procedure or treatment to work. Be patient, follow your doctor’s or therapist’s advice, and look forward to the day when your pain will be reduced or eliminated – as safely as possible.

Article Written by Suzanne Kane

But what if the patient is not you, but your child? While any parent readily describes a seriously sick child as their worst nightmare, does that nightmare translate to stress for the parent?

A recent study by Jurgergs, Long, Ticona and Phipps of the Division of Behavioral Medicine at St. Jude Children’s Research Hospital looked at the posttraumatic stress symptoms (PTSS) of parents of children with cancer. The researchers examined stress levels as a function of time since diagnosis, treatment status, and relapse history, compared with parents of healthy children.

The participants of the study were a group of parents of 199 children with cancer. The sample was cross-sectional and included parents of children at various diagnoses and treatment phases. The children ranged from those currently involved in therapy to those who were long-term survivors of cancer.

The parents of children with cancer were compared with a group of parents of 108 healthy children, obtained using acquaintance control methods. The parents all completed a standardized self-report questionnaire that measured PTSS.

Within the group of parents of children with cancer, the results showed that parental PTSS varied dependent on treatment status and time since diagnosis. The parents of children undergoing treatment showed the same levels of PTSS as those parents in the control group.

Parents of children who had finished treatment showed a significantly lower level of PTSS than did parents of healthy children. Also, parents of long-term survivors showed lower levels of PTSS than did controls, while parents of recently diagnosed children had similar levels of PTSS as the control group.

Parents whose children had suffered a relapse reported significantly higher levels of PTSS and were much more often found to be suffering from posttraumatic stress disorder.

The study’s results indicate that in general, parents of children with cancer did not show elevated levels of PTSS as compared to parents of healthy children; but time since diagnosis, child treatment status and relapse history are significant factors in parent PTSS.

Only parents of children who were experiencing a relapse were at an increased risk of PTSD.

The results of this study indicate that enduring the trauma of a child’ diagnosis of cancer does not necessarily guarantee a PTSS diagnosis for the parent. The study’s results are different, however, from existing information about how a child’s illness affects a parent. Further studies need to be done to examine the relationship between a child’s illness and PTSS in the parent.
 

Halley Lamberson, 17, and Monica Reed, 16, juniors at San Francisco University High School, recently made a pact to help each other avoid addiction. “We decided we spent way too much time obsessing over Facebook and it would be better if we took a break from it,” Halley said. The two friends decided to only log on to Facebook the first Saturday of every month, and they are holding each other accountable.

Halley and Monica are among many teenagers, especially girls, who are recognizing the addictive potential of Facebook and the time it consumes that could be spent studying or hanging out with friends.

Kimberly Young, a psychologist who is the director of the Center for Internet Addiction Recovery in Bradford, Pa., said she had spoken with dozens of teenagers trying to break their Facebook habit.

“It’s like any other addiction,” Dr. Young said. “It’s hard to wean yourself.” She said she admired teenagers who came up with their own strategies for taking Facebook breaks in the absence of computer-addiction programs aimed at them.

“A lot of them are finding their own balance,” she said. “It’s like an eating disorder. You can’t eliminate food. You just have to make better choices about what you eat…and what you do online.”

In October, Facebook reached 54.7 percent of people in the United States ages 12 to 17, up from 28.3 percent in October last year, according to the Nielsen Company, the market research firm.

In her coming book, “Alone Together,” Sherry Turkle, a psychologist who is director of the Initiative on Technology and Self at the Massachusetts Institute of Technology, discusses teenagers who take breaks from Facebook.

For one 18-year-old boy completing a college application, Professor Turkle said, “Facebook wasn’t merely a distraction, but it was really confusing him about who he was,” and he opted to spend his senior year off the service. He was burned out, she said, trying to live up to his own descriptions of himself.

Walter Mischel, a professor of psychology at Columbia University who studies self-control and willpower, performed a now-famous set of experiments at Stanford University in the late 1960s in which he tested young children’s ability to delay gratification when presented with what he called “hot” temptations, like marshmallows. Some managed to stop themselves, while others could not. “Facebook is the marshmallow for these teenagers,” Professor Mischel said. In his follow-up work, Mischel said he found that some of the children who delayed gratification with the marshmallows turned out to be higher achievers as adults.

Rachel Simmons, an educator and the author of “The Curse of the Good Girl: Raising Authentic Girls with Courage and Confidence,” said Facebook’s new live feed format makes the site particularly difficult to tear oneself away from.

“You’re getting a feed of everything everyone is doing and saying,” Simmons said. “You’re literally watching the social landscape on the screen, and if you’re obsessed with your position in that landscape, it’s very hard to look away.”

This addictive quality makes having a partner who knows you well especially helpful. Monica said that when she was recently in bed sick for several days, she broke down and went on Facebook. “At first I lied,” she said. “But we’re such good friends she could read my facial expression, so I ’fessed up.” As punishment, the friend who breaks the pact has to write something embarrassing on a near-stranger’s Facebook wall.

Neeka Salmasi, 15, a sophomore at Greenhills School in Ann Arbor, Mich., asked her sister, Negin, 25, to change her Facebook password every Sunday night and give it back to her the following Friday night. As a result, Neeka quickly saw an improvement in her grades.

Last year, Magellan Yadao, 18, a senior at Northside College Preparatory High School in Chicago, went on a 40-day Facebook fast for Lent. “In my years as a Catholic, I hadn’t really chosen something to give up that was very important to me,” Magellan said. “Apparently, Facebook was just that.”

Flash forward to a situation where your teen, in the company of other teens, has a discussion about drugs, availability of drugs, quick highs, and easy access. The conversation will inevitably get around to who’s parents have what kinds of drugs at home and can the teens get some. Think this doesn’t happen? You’d be wrong. Results from the 2008 Monitoring the Future Survey, sponsored by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) show that 15.4 percent of 12th graders reported using a prescription drug nonmedically within the past year. Vicodin, according to the 2008 report, continues to be abused at “unacceptably high levels.” The category of drugs abused includes amphetamines, sedatives/barbiturates, tranquilizers and opiates (other than heroin). Many of the drugs abused by teens are prescription (for someone else) or available over-the-counter (OTC).

Where do teens get their drugs? You guessed it. They’re readily available in homes. Let’s take a look at some of the kinds of drugs teens most commonly abuse.

Classes of Prescription Medications Abused by Teens

According to NIDA, commonly abused classes of prescription medications include opioids (prescribed for pain), central nervous system (CNS) depressants for anxiety and sleep disorders, and stimulants for attention-deficit-hyperactivity-disorder (ADHD) and narcolepsy.

Opiods – These include hydrocodone (Vicodin), oxycodone (OxyContin), propoxyphene (Darvon), hydromorphone (Dilaudid), meperidine (Demerol), and diphenoxylate (Lomotil).

CNS Depressants – The list includes barbiturates such as pentobarbital sodium (Nembutal), and benzodiazepines such as alprazolam (Zanax) and diazepam (Valium).

Stimulants – Popular stimulants include amphetamines (Adderall), dextroamphetamine (Dexedrine), and methylphenidate (Concerta and Ritalin).

Note that this list is not all-inclusive. For a more complete listing of prescription drugs, including category and name, commercial and street names, DEA schedule and how administered, and intoxication effects and potential consequences, see the NIDA Prescription Drug Abuse Chart.

According to the Partnership for a Drug-Free America, every day, 2500 teenagers use a prescription drug to get high – for the first time. Why do they do it? According to the Partnership, their desire to get high outweighs their perception of any potential risks. Some 60 percent of teens who have abused prescription painkillers started before age 15. Another frightening statistic is that 12 to 17 year olds abuse prescription drugs more than they abuse crack/cocaine, ecstasy, heroin, and methamphetamine combined. And while marijuana is the illegal drug of choice for many teens, there are as many new abusers aged 12 to 17 of prescription drugs as there are of marijuana.

Tips to Prevent Teen Prescription Drug Abuse

Other than completely purging the household of all prescription and OTC medications, what other ways are there to safeguard your teens and help prevent prescription drug abuse? Here are several ideas:

• Lock ‘em up. – In the housing market, the axiom is “location, location, location.” The same could be said for prescription medications. In this case, however, the tip is to keep all prescriptions secure in the home. Once they’re not readily available, easy to surreptitiously filch and pocket, the problem of immediate access is solved. Keep all prescription medications in one location, and make sure to secure it with a lock. No, this isn’t too extreme. Remember, you are the parent. You need to control all the medications in the home. Period.

• Inventory and count everything. – Start now and take a complete inventory of every medication in the home. Write down what the medication is and what condition it’s for, who takes it, how often, brand and generic names, expiration dates, and so on. Then, count every pill in each of the containers. This inventory and counting is a practice you should repeat weekly. The idea is to stay on top of quantities. When and if you notice some missing, it’s a sign that something’s not right and needs addressing further.

• Check expiration dates and discard old prescriptions. – Using your handy inventory sheet, go through and check the prescriptions with expired dates. Discard all those prescriptions safely. Do not flush them down the toilet or drain unless you are specifically instructed to do so. Guidelines from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the White House Office of National Drug Control Policy have the following recommendations for proper disposal of prescription drugs:

o Take the prescription drugs out of their original containers. Conceal or remove any personally-identifiable information from the container labels, including prescription number. Use black indelible marker or scratch off information. Place the empty drug containers, now devoid of personal identification, in the trash receptacle.

o Mix with coffee grounds, kitty litter or other undesirable substances and place in a sealed container before dumping in the trash receptacle.

o Inquire about community prescription take-back programs. These are an excellent and safe way to dispose of expired or unwanted prescription drugs.

o Many communities hold hazardous waste collection events that collect drugs at a central location and dispose of them safely. Make use of these services.

o Contact your pharmacist for proper disposal methods and locations.

• Be informed about drugs of abuse. – Before you can have intelligent conversations with your teens (and adolescents) about the dangers of prescription drug abuse, you need to educate yourself on the types of drugs that are currently being abused in this population. Know the latest drug abuse trends and be mindful of the kinds of drug-related incidents going on in your community and your teen’s school.

• Talk to your teens. – Get in the practice of having candid and open discussions with your teens (and adolescents) about prescription and OTC medications. Let them know the rules and what you expect from them. Keep dialog open, especially if the subject of drug abuse comes up after a television news report, public service announcement, or your teens mention a drug incident involving their friends or at school. Don’t limit the discussion to just prescription drugs, since street or illegal drugs are also highly addictive – and nearly as readily available. Make sure you mention how dangerous abuse of prescription medication can be, as well as abuse of OTC medicines. Let them know that abusing prescription narcotic painkillers can be as dangerous as abusing heroin. Also, and this is very important, instill the point that prescription medications taken as directed by the person for whom they are prescribed can be very beneficial, but when taken as a means to get high, they have very unpredictable and potentially harmful effects. Research shows that teenagers mistakenly believe that taking prescription medications for nonmedical purposes is safe. They believe that experimentation with such drugs is safer than trying street drugs. Since abuse of medications can be lethal, set clear expectations with your teenagers, letting them know that they are not to take medications under any circumstances without your knowledge and/or permission.

• Lead by example. – Our children are sponges, soaking up impressions about appropriate behavior, habits, beliefs and expectations. One of the most effective tools in parents’ arsenal to prevent abuse of drugs (prescription, OTC, and illegal) is to lead by example. Don’t let your teens see you pop a pill every time you have a slight headache, sore back, or your “nerves” are getting to you. That sends the wrong message: that it’s okay to use a prescription drug to make everything feel better. In fact, many prescription opioids are only intended for short-term use, and they’re not supposed to take all the pain away, just to ease the most severe pain. But, back to the lead by example recommendation – let your teens see that you are responsible about taking prescription medications. Keeping careful inventory, disposing of expired and/or unwanted medications, only taking prescription medications as prescribed, and “walking the talk” shows your teens important modeling behavior.

What to Do If Your Teen Gets in Trouble

Despite following all the precautions, having open and candid dialog, there may be situations where your teen gets in over his or her head regarding prescription drugs. It may be that they were at a party and someone slipped something into a soda or bottle of water. It could be that they followed the rest of the group and experimented with someone’s mother’s tranquilizer or a relative’s ADHD medication.

You may get a phone call from a concerned friend. Or, you may see warning signs in your teen such as lethargy, inability to concentrate, poor motor movement, glazed eyes, vomiting, increased heartbeat, increased body temperature, or other symptoms. Remain calm. Ask your teen, if he or she is coherent, what they took, if they know it. If not, ask what was going on in general, including whether or not others took something in a pill form. If you’ve kept an open line of communication with your teen, you’re likely to get an honest answer. The first thing to do, depending on the substance ingested and the severity of the symptoms, is to contact your doctor, Poison Control Center, or take your teen to the hospital. The prescription and/or street drug and alcohol needs to get out of your teen’s system – and the sooner, the better.

After the drug(s) have been purged, take steps to trace the incident back to the source. Who is responsible for the drugs being at the scene? Was it covert or overt? When you have the names, contact the parents of the individual(s) who supplied the drugs. Chances are your teen isn’t the only one affected. One suggestion is to band together with other concerned parents to present a united front on the issue. It’s also a good idea to insist that your teen stay away from the teen or teens involved in supplying the drugs. Be prepared for a little resistance on this, however, especially if the teen(s) are popular. Once again, you are the parent. It’s up to you to be the one in charge.

If the prevalence, use and abuse of prescription and/or street drugs and alcohol continue, get professional help in the form of counseling for your teen. Prescription drug abuse, if caught early, can be treated successfully. Residential treatment centers or outpatient facilities should be carefully screened to ensure that they specialize in treating teen addictions. Check all credentials and licensing, and inquire about insurance coverage, length of stay or duration of treatment, and any special financing, grants or scholarships available.

To locate a treatment facility for substance abuse (including prescription drug abuse), visit the SAMHSA Substance Abuse Treatment Facility Locator, or call them at 1-800-662-HELP.

Finally, never give up on your teens. They look to you for guidance and need you when things get tough (and when they’re fine). As parents, use your unconditional love for your teens to give them the best possible preparation for life. Be a good example, and be there for them always.