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"content": "\u003cp>The explosion of deaths related to opioid misuse has underscored a pressing need for better ways of treating pain, especially chronic pain.[contextly_sidebar id=\"Lrxhc0PiaxvZNwtQRWNC315GUyNFIRBB\"]\u003c/p>\n\u003cp>Duquesne University pharmacology associate professor Jelena Janjic thinks she's on to one. It involves using a patient's own immune system to deliver non-opioid pain medication to places in the body where there's pain.\u003c/p>\n\u003cp>Janjic's idea, which draws from the field of cancer research, is to insert tiny amounts of over-the-counter pain medications into minute carriers called nanoparticles, and then inject these into pain patients. The medicines would then travel through the body to places where there is inflammation, and relieve the pain.\u003c/p>\n\u003cp>Janjic has a special reason for wanting to develop new medicines for chronic pain: She suffers from it herself.\u003c/p>\n\u003cp>\"As a patient, I want an answer,\" she says. \"I want to figure out this.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There's no question that the need for better, non-addictive medications is real and urgent. Researchers have come up with\u003ca href=\"https://www.painnewsnetwork.org/stories/2018/6/2/new-treatments-on-the-horizon-for-chronic-pain\"> some ideas\u003c/a>, but so far none has made it to market. Finding new treatments is difficult for any disease and it's proving especially difficult for chronic pain because the underlying causes are poorly understood.\u003c/p>\n\u003cp>Attempting to modulate inflammation as way to treat pain \"is an active area of research,\" says \u003ca href=\"https://www.ninds.nih.gov/node/8824\" target=\"_blank\" rel=\"noopener\">Michael L. Oshinsky\u003c/a>, Program Director, Pain and Migraine, at the National Institute of Neurological Disorders and Stroke.[contextly_sidebar id=\"wUYL0s18LxOkY4wdczUfG5sVi8cK5dSj\"]\u003c/p>\n\u003cp>Oshinsky says Janjic's idea of targeting the immune system with nanoparticles carrying pain relievers makes sense, although he cautions that the relationship between inflammation and pain is not well understood.\u003c/p>\n\u003cp>Janjic's path to this research began in 2010. She has a doctorate in medicinal chemistry, and she had recently moved to Duquesne University where she had set up a lab focused on using nanomedicine techniques to treat cancer.\u003c/p>\n\u003cp>What seemed like out of nowhere, of the blue, she started to suffer bouts of severe pain.\u003c/p>\n\u003cp>\"The one that hit me real hard was the whole body, from head to toe,\" she says. \"I've had on and off chronic pain since I was a teenager, but this was different.\"\u003c/p>\n\u003cp>In August that year, just before her students arrived back to school, she ended up in the emergency room with pain that was almost intolerable.\u003c/p>\n\u003cp>The doctors' diagnosis was discouraging. They told her she had a chronic pain syndrome. They said there wasn't much they could do about it, and they said it was for life.\u003c/p>\n\u003cp>The medicines they gave her helped with the pain somewhat, but left her feeling like she was living in a fog. She was having trouble remembering things, trouble taking notes.\u003c/p>\n\u003cp>\"Things were weird. So I decided I am going to do research on myself,\" Janjic says.\u003c/p>\n\u003cp>To control her own pain, she turned to mindfulness meditation and other non-medical interventions, including composing music and playing the piano. It's not as if the pain magically went away, she says, but she was able to carry on with her life. Some days were worse than others.\u003c/p>\n\u003cp>But she also wanted to find a medical solution.\u003c/p>\n\u003cp>She made one important treatment decision early on: She didn't want to take opioids for her pain.[contextly_sidebar id=\"QMwX3Yw6AeYbgPKNOtGQ6rPZrGu4Q9y4\"]\u003c/p>\n\u003cp>\"At the time I could have got them very easily,\" Janjic says. \"I said, 'What are you going to give me when I'm 67, or 87, if I take them now?' I knew they don't work long-term very well. So almost the refusal of opioids precipitated everything else that happened.\"\u003c/p>\n\u003cp>Looking for alternatives to opioids, she dove into the scientific literature, to learn all she could about chronic pain.\u003c/p>\n\u003cp>Chronic pain syndromes are not well understood. With acute pain, it's usually possible to identify the cause—an injury of some sort, or inflammation caused by an infection. Chronic pain may be linked to an initial mishap, but may persist long after the initial cause of the pain has disappeared. Sometimes there's no good explanation of the pain at all, a frustrating circumstance for both doctor and patients.\u003c/p>\n\u003cp>In addition to her research, Janjic started paying close attention to her own condition.\u003c/p>\n\u003cp>\"I started to understand that my body was actually inflamed,\" she says.\u003c/p>\n\u003cp>Inflammation occurs when our bodies' immune system tries to deal with some damage, maybe from an invading virus or bacteria, and sends a barrage of immune cells to the affected area. On the one hand this is a good thing, since the cells fight the infection. But on the other, it can stimulate nerve cells in a particular part of the body, causing pain.\u003c/p>\n\u003cp>Janjic also noticed something important about her pain: it varied both in intensity and in location. Sometimes it was in her knees, sometimes in her shoulders.\u003c/p>\n\u003cp>She says none of the medicines available today responded to pain's \"diversity within the body.\"\u003c/p>\n\u003cp>\"I [started] to understand the fluctuation,\" she says.\u003c/p>\n\u003cp>She realized that the fluctuation meant more immune cells were going to the part of the body where the pain was. She figured if she could get pain medicine into immune cells, that medicine would ride with those cells to where it was needed.[contextly_sidebar id=\"YRLyRHWtPrWD1BScVQCmWanq4QjZQPO0\"]\u003c/p>\n\u003cp>Before she got into pain research, Janjic was working on something called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29230567\" target=\"_blank\" rel=\"noopener\">cancer nanomedicine\u003c/a>. Cancer nanomedicines work by putting anti-cancer drugs into tiny containers called nanoparticles, and then injecting them into cancer patients, where they enter the patients' immune cells.\u003c/p>\n\u003cp>\"So what did I already know how to do? Mess with the immune system with nanomedicines,\" Janjic says. \"And that's how the idea of pain nanomedicine was born.\"\u003c/p>\n\u003cp>After many years of tinkering, she's started to get positive results. In a \u003ca href=\"https://www.jni-journal.com/article/S0165-5728(18)30012-2/fulltext\">recently published study,\u003c/a> she showed that when researchers put a nonsteroidal, anti-inflammatory drug into a nanoparticle, and then injected that into a rat, it reduced the rat's pain.\u003c/p>\n\u003cp>Janjic says her approach doesn't try to disable the immune cells.\u003c/p>\n\u003cp>\"You still want them to fight infection, you still want them to do what they're supposed to do,\" she says. \"But we almost try to stop them from going into override and causing chronic pain.\"\u003c/p>\n\u003cp>Janjic, who is also the founder and co-director of the \u003ca href=\"https://www.duq.edu/about/centers-and-institutes/chronic-pain-research-consortium\" target=\"_blank\" rel=\"noopener\">Chronic Pain Research Consortium\u003c/a> at Duquesne University, is collaborating with several labs to try pairing different pain medications with different kinds of nano-particles to see what works best. So far progress is slow. And if one of the candidates shows real promise it will be years before anything can be tested in human patients and ultimately approved by the FDA.\u003c/p>\n\u003cp>Janjic credits her own experience with pain for helping her gain a better understanding of pain and how to treat it. She thinks researchers would learn a lot from routinely talking to the people they're trying to help.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"My take home message is, 'Ask the patient first,' \" Janjic says. \"Ask the kid who's ten. Ask the grandpa with rheumatoid arthritis what that feels like. This is what I really want to see flourish. Maybe this already happening somewhere. If it is, I want to know. If you are inspiring your research this way, then I want to talk to you.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Inspired+By+Her+Own+Pain%2C+A+Researcher+Explores+Alternatives+To+Opioid+Treatments&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There's no question that the need for better, non-addictive medications is real and urgent. Researchers have come up with\u003ca href=\"https://www.painnewsnetwork.org/stories/2018/6/2/new-treatments-on-the-horizon-for-chronic-pain\"> some ideas\u003c/a>, but so far none has made it to market. Finding new treatments is difficult for any disease and it's proving especially difficult for chronic pain because the underlying causes are poorly understood.\u003c/p>\n\u003cp>Attempting to modulate inflammation as way to treat pain \"is an active area of research,\" says \u003ca href=\"https://www.ninds.nih.gov/node/8824\" target=\"_blank\" rel=\"noopener\">Michael L. Oshinsky\u003c/a>, Program Director, Pain and Migraine, at the National Institute of Neurological Disorders and Stroke.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Oshinsky says Janjic's idea of targeting the immune system with nanoparticles carrying pain relievers makes sense, although he cautions that the relationship between inflammation and pain is not well understood.\u003c/p>\n\u003cp>Janjic's path to this research began in 2010. She has a doctorate in medicinal chemistry, and she had recently moved to Duquesne University where she had set up a lab focused on using nanomedicine techniques to treat cancer.\u003c/p>\n\u003cp>What seemed like out of nowhere, of the blue, she started to suffer bouts of severe pain.\u003c/p>\n\u003cp>\"The one that hit me real hard was the whole body, from head to toe,\" she says. \"I've had on and off chronic pain since I was a teenager, but this was different.\"\u003c/p>\n\u003cp>In August that year, just before her students arrived back to school, she ended up in the emergency room with pain that was almost intolerable.\u003c/p>\n\u003cp>The doctors' diagnosis was discouraging. They told her she had a chronic pain syndrome. They said there wasn't much they could do about it, and they said it was for life.\u003c/p>\n\u003cp>The medicines they gave her helped with the pain somewhat, but left her feeling like she was living in a fog. She was having trouble remembering things, trouble taking notes.\u003c/p>\n\u003cp>\"Things were weird. So I decided I am going to do research on myself,\" Janjic says.\u003c/p>\n\u003cp>To control her own pain, she turned to mindfulness meditation and other non-medical interventions, including composing music and playing the piano. It's not as if the pain magically went away, she says, but she was able to carry on with her life. Some days were worse than others.\u003c/p>\n\u003cp>But she also wanted to find a medical solution.\u003c/p>\n\u003cp>She made one important treatment decision early on: She didn't want to take opioids for her pain.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"At the time I could have got them very easily,\" Janjic says. \"I said, 'What are you going to give me when I'm 67, or 87, if I take them now?' I knew they don't work long-term very well. So almost the refusal of opioids precipitated everything else that happened.\"\u003c/p>\n\u003cp>Looking for alternatives to opioids, she dove into the scientific literature, to learn all she could about chronic pain.\u003c/p>\n\u003cp>Chronic pain syndromes are not well understood. With acute pain, it's usually possible to identify the cause—an injury of some sort, or inflammation caused by an infection. Chronic pain may be linked to an initial mishap, but may persist long after the initial cause of the pain has disappeared. Sometimes there's no good explanation of the pain at all, a frustrating circumstance for both doctor and patients.\u003c/p>\n\u003cp>In addition to her research, Janjic started paying close attention to her own condition.\u003c/p>\n\u003cp>\"I started to understand that my body was actually inflamed,\" she says.\u003c/p>\n\u003cp>Inflammation occurs when our bodies' immune system tries to deal with some damage, maybe from an invading virus or bacteria, and sends a barrage of immune cells to the affected area. On the one hand this is a good thing, since the cells fight the infection. But on the other, it can stimulate nerve cells in a particular part of the body, causing pain.\u003c/p>\n\u003cp>Janjic also noticed something important about her pain: it varied both in intensity and in location. Sometimes it was in her knees, sometimes in her shoulders.\u003c/p>\n\u003cp>She says none of the medicines available today responded to pain's \"diversity within the body.\"\u003c/p>\n\u003cp>\"I [started] to understand the fluctuation,\" she says.\u003c/p>\n\u003cp>She realized that the fluctuation meant more immune cells were going to the part of the body where the pain was. She figured if she could get pain medicine into immune cells, that medicine would ride with those cells to where it was needed.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Before she got into pain research, Janjic was working on something called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29230567\" target=\"_blank\" rel=\"noopener\">cancer nanomedicine\u003c/a>. Cancer nanomedicines work by putting anti-cancer drugs into tiny containers called nanoparticles, and then injecting them into cancer patients, where they enter the patients' immune cells.\u003c/p>\n\u003cp>\"So what did I already know how to do? Mess with the immune system with nanomedicines,\" Janjic says. \"And that's how the idea of pain nanomedicine was born.\"\u003c/p>\n\u003cp>After many years of tinkering, she's started to get positive results. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"My take home message is, 'Ask the patient first,' \" Janjic says. \"Ask the kid who's ten. Ask the grandpa with rheumatoid arthritis what that feels like. This is what I really want to see flourish. Maybe this already happening somewhere. If it is, I want to know. If you are inspiring your research this way, then I want to talk to you.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Inspired+By+Her+Own+Pain%2C+A+Researcher+Explores+Alternatives+To+Opioid+Treatments&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>U.S. regulators have approved the first generic version of an under-the-tongue film for treating opioid addiction.[contextly_sidebar id=\"0aUmI4gi0W92FnpTgKsDzebI0XydwaN6\"]\u003c/p>\n\u003cp>The Food and Drug Administration on Thursday approved a generic version of Suboxone, a film strip that dissolves under the tongue. Used daily, it reduces withdrawal symptoms, cravings for opioids and the high from abusing them.\u003c/p>\n\u003cp>The medication combines buprenorphine and naloxone. It’s used along with counseling and other behavioral therapy.\u003c/p>\n\u003cp>The generic version will be sold by partners Mylan N.V. and Dr. Reddy’s Laboratories SA. They didn’t immediately respond to questions about when their version will be available or what it will cost.\u003c/p>\n\u003cp>Brand-name Suboxone film costs about $200 a month without insurance.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The FDA said the approval was aimed at making the treatment available to more people.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>U.S. regulators have approved the first generic version of an under-the-tongue film for treating opioid addiction.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The Food and Drug Administration on Thursday approved a generic version of Suboxone, a film strip that dissolves under the tongue. Used daily, it reduces withdrawal symptoms, cravings for opioids and the high from abusing them.\u003c/p>\n\u003cp>The medication combines buprenorphine and naloxone. It’s used along with counseling and other behavioral therapy.\u003c/p>\n\u003cp>The generic version will be sold by partners Mylan N.V. and Dr. Reddy’s Laboratories SA. They didn’t immediately respond to questions about when their version will be available or what it will cost.\u003c/p>\n\u003cp>Brand-name Suboxone film costs about $200 a month without insurance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Drug Epidemic Ensnares 25-year-old Pill for Nerve Pain",
"title": "Drug Epidemic Ensnares 25-year-old Pill for Nerve Pain",
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"content": "\u003cp>The story line sounds familiar: a popular pain drug becomes a new way to get high as prescribing by doctors soars.[contextly_sidebar id=\"nqQZEbgxZJk2YXcLkKmogofHmb5GxUKD\"]\u003c/p>\n\u003cp>But the latest drug raising red flags is not part of the opioid family at the center of the nation’s drug epidemic. It’s a 25-year-old generic pill long seen as a low risk way to treat seizures, nerve pain and other ailments.\u003c/p>\n\u003cp>The drug, called gabapentin, is one of the most prescribed medications in the U.S., ranking ninth over the last year, according to prescription tracker GoodRx. Researchers attribute the recent surge to tighter restrictions on opioid painkillers, which have left doctors searching for alternatives for their patients.\u003c/p>\n\u003cp>Those same forces are changing the drugs that Americans abuse, according to experts.\u003c/p>\n\u003cp>“We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr. Richard Dart, who tracks drug abuse through a national data network owned by the state of Colorado.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While prescriptions for opioids like Vicodin and Oxycontin have been falling since 2012, health regulators have seen increased overdoses with unexpected medications, including the over-the-counter diarrhea drug Imodium.\u003c/p>\n\u003cp>The Food and Drug Administration is now studying patterns of prescribing and illicit use of gabapentin and will soon share its findings, said Commissioner Scott Gottlieb.\u003c/p>\n\u003cp>“One of the lessons from this whole opioid crisis is that we probably were too slow to act where we saw problems emerging and we waited for more definitive conclusions,” Gottlieb said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”\u003c/p>\n\u003cp>Many doctors aren’t aware of gabapentin’s potential for abuse, particularly among those with a history of misusing drugs, said Rachel Vickers Smith of the University of Louisville.\u003c/p>\n\u003cp>People tracked in her research describe gabapentin as a “cheap high” that is almost “always available.” They report mixing the drug with opioids, marijuana and cocaine to enhance the high, with effects ranging from “increased energy” to a “mellow” numbness.[contextly_sidebar id=\"oL9ue2pfrjviaEyvbdyv9JyLxYq7wQnY\"]\u003c/p>\n\u003cp>Medical journal articles estimate that between 15 and 25 percent of opioid abusers also use gabapentin. And emerging research suggests combining gabapentin and opioids heightens the overdose risks.\u003c/p>\n\u003cp>Gabapentin, on the market since 1993, has long been considered nonaddictive and is not tracked as closely as riskier drugs like opioids. But calls to U.S. poison control centers show a stark rise in abuse and overdoses.\u003c/p>\n\u003cp>The abuse rate increased nearly 400 percent between 2006 and 2015, according to poison center data analyzed by the RADARS research group within the Denver Health and Hospital Authority, a state-owned health system. The group’s work is funded by drugmakers and government agencies, though they don’t participate in the analysis or publication of the data.\u003c/p>\n\u003cp>In some parts of the U.S., the rise in gabapentin abuse has led to new restrictions and surveillance.\u003c/p>\n\u003cp>Last year, Kentucky became the first state to classify the drug as a “scheduled substance,” placing it among other high-risk medicines subject to extra restrictions and tracking. Gabapentin was detected in a third of fatal overdose cases analyzed by Kentucky medical examiners in 2016. Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.\u003c/p>\n\u003cp>Ohio, Minnesota, West Virginia and several other states have begun tracking gabapentin through their prescription databases. Ohio took that step after gabapentin became the most dispensed drug in the state. State surveys of drug users also indicated it was “extremely easy to get” with a street price around $1.50 per capsule.\u003c/p>\n\u003cp>Alyssa Peckham, a researcher at Midwestern University in Arizona, believes a more comprehensive federal response is needed, including possibly reclassifying it nationwide. Like others, Peckham says gabapentin is not dangerous on its own, but can be when combined with opioids and other drugs that suppress breathing.[contextly_sidebar id=\"1Nyjt2T01ZS5Ppu0JX4gRyT1iBHar5yn\"]\u003c/p>\n\u003cp>Still, there is little consensus about the next steps, or even the scope of the problem.\u003c/p>\n\u003cp>Michael Polydefkis, a neurologist at John Hopkins University who primarily treats seniors with nerve pain, says he has never seen patients deliberately misuse gabapentin.\u003c/p>\n\u003cp>And given recent restrictions on opioids by hospitals, insurers and government authorities, many physicians are wary of limiting any other medicines that can help treat pain. The Center for Disease Control and Prevention’s prescribing guidelines endorse gabapentin as a good choice for nerve pain.\u003c/p>\n\u003cp>But there are questions about how much is being prescribed for proven uses — and to what extent patients are benefiting. A recent review of research by the Cochrane Group confirmed gabapentin’s benefits for several forms of nerve pain, but found little evidence of its effectiveness for more common muscle and joint pain.\u003c/p>\n\u003cp>Historically, the vast majority of prescriptions have been for uses not OK’d by the FDA as safe or effective.\u003c/p>\n\u003cp>“This drug was kind of unusual in that it was prescribed as a kind of miracle pill that could be used for anything,” said Dr. Joseph Ross, a researcher at Yale University’s school of medicine.\u003c/p>\n\u003cp>In a recent Journal of the American Medical Association, he called for new studies of gabapentin’s real-world use.\u003c/p>\n\u003cp>The freewheeling prescribing dates to years of aggressive marketing by the drug’s original manufacturer, Warner-Lambert. The company pleaded guilty and agreed to pay more than $430 million in 2004 to settle charges that it promoted gabapentin for a slew of unapproved uses, including migraines, attention deficit disorder, bipolar disorder and Lou Gehrig’s disease. While doctors are free to prescribe drugs for any use, drugmakers can only market their products for those uses approved by the FDA.\u003c/p>\n\u003cp>Warner-Lambert was bought in 2000 by Pfizer, which continues to sell gabapentin under its original brand-name Neurontin. Pfizer also sells a similar drug named Lyrica, a blockbuster medication approved for fibromyalgia, diabetic nerve pain and several other uses. Unlike gabapentin, Lyrica is a scheduled substance under federal law, in part due to reports of euphoria and other side effects suggesting “abuse potential.”\u003c/p>\n\u003cp>With tighter restrictions and a lone manufacturer, Lyrica has not seen the same problems as gabapentin.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Pfizer recognizes the importance of preventing the misuse and abuse of our medicines and will continue working with regulatory authorities and health officials to monitor the safety of these medicines,” the company said in a statement.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The story line sounds familiar: a popular pain drug becomes a new way to get high as prescribing by doctors soars.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But the latest drug raising red flags is not part of the opioid family at the center of the nation’s drug epidemic. It’s a 25-year-old generic pill long seen as a low risk way to treat seizures, nerve pain and other ailments.\u003c/p>\n\u003cp>The drug, called gabapentin, is one of the most prescribed medications in the U.S., ranking ninth over the last year, according to prescription tracker GoodRx. Researchers attribute the recent surge to tighter restrictions on opioid painkillers, which have left doctors searching for alternatives for their patients.\u003c/p>\n\u003cp>Those same forces are changing the drugs that Americans abuse, according to experts.\u003c/p>\n\u003cp>“We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr. Richard Dart, who tracks drug abuse through a national data network owned by the state of Colorado.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While prescriptions for opioids like Vicodin and Oxycontin have been falling since 2012, health regulators have seen increased overdoses with unexpected medications, including the over-the-counter diarrhea drug Imodium.\u003c/p>\n\u003cp>The Food and Drug Administration is now studying patterns of prescribing and illicit use of gabapentin and will soon share its findings, said Commissioner Scott Gottlieb.\u003c/p>\n\u003cp>“One of the lessons from this whole opioid crisis is that we probably were too slow to act where we saw problems emerging and we waited for more definitive conclusions,” Gottlieb said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”\u003c/p>\n\u003cp>Many doctors aren’t aware of gabapentin’s potential for abuse, particularly among those with a history of misusing drugs, said Rachel Vickers Smith of the University of Louisville.\u003c/p>\n\u003cp>People tracked in her research describe gabapentin as a “cheap high” that is almost “always available.” They report mixing the drug with opioids, marijuana and cocaine to enhance the high, with effects ranging from “increased energy” to a “mellow” numbness.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medical journal articles estimate that between 15 and 25 percent of opioid abusers also use gabapentin. And emerging research suggests combining gabapentin and opioids heightens the overdose risks.\u003c/p>\n\u003cp>Gabapentin, on the market since 1993, has long been considered nonaddictive and is not tracked as closely as riskier drugs like opioids. But calls to U.S. poison control centers show a stark rise in abuse and overdoses.\u003c/p>\n\u003cp>The abuse rate increased nearly 400 percent between 2006 and 2015, according to poison center data analyzed by the RADARS research group within the Denver Health and Hospital Authority, a state-owned health system. The group’s work is funded by drugmakers and government agencies, though they don’t participate in the analysis or publication of the data.\u003c/p>\n\u003cp>In some parts of the U.S., the rise in gabapentin abuse has led to new restrictions and surveillance.\u003c/p>\n\u003cp>Last year, Kentucky became the first state to classify the drug as a “scheduled substance,” placing it among other high-risk medicines subject to extra restrictions and tracking. Gabapentin was detected in a third of fatal overdose cases analyzed by Kentucky medical examiners in 2016. Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.\u003c/p>\n\u003cp>Ohio, Minnesota, West Virginia and several other states have begun tracking gabapentin through their prescription databases. Ohio took that step after gabapentin became the most dispensed drug in the state. State surveys of drug users also indicated it was “extremely easy to get” with a street price around $1.50 per capsule.\u003c/p>\n\u003cp>Alyssa Peckham, a researcher at Midwestern University in Arizona, believes a more comprehensive federal response is needed, including possibly reclassifying it nationwide. Like others, Peckham says gabapentin is not dangerous on its own, but can be when combined with opioids and other drugs that suppress breathing.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Still, there is little consensus about the next steps, or even the scope of the problem.\u003c/p>\n\u003cp>Michael Polydefkis, a neurologist at John Hopkins University who primarily treats seniors with nerve pain, says he has never seen patients deliberately misuse gabapentin.\u003c/p>\n\u003cp>And given recent restrictions on opioids by hospitals, insurers and government authorities, many physicians are wary of limiting any other medicines that can help treat pain. The Center for Disease Control and Prevention’s prescribing guidelines endorse gabapentin as a good choice for nerve pain.\u003c/p>\n\u003cp>But there are questions about how much is being prescribed for proven uses — and to what extent patients are benefiting. A recent review of research by the Cochrane Group confirmed gabapentin’s benefits for several forms of nerve pain, but found little evidence of its effectiveness for more common muscle and joint pain.\u003c/p>\n\u003cp>Historically, the vast majority of prescriptions have been for uses not OK’d by the FDA as safe or effective.\u003c/p>\n\u003cp>“This drug was kind of unusual in that it was prescribed as a kind of miracle pill that could be used for anything,” said Dr. Joseph Ross, a researcher at Yale University’s school of medicine.\u003c/p>\n\u003cp>In a recent Journal of the American Medical Association, he called for new studies of gabapentin’s real-world use.\u003c/p>\n\u003cp>The freewheeling prescribing dates to years of aggressive marketing by the drug’s original manufacturer, Warner-Lambert. The company pleaded guilty and agreed to pay more than $430 million in 2004 to settle charges that it promoted gabapentin for a slew of unapproved uses, including migraines, attention deficit disorder, bipolar disorder and Lou Gehrig’s disease. While doctors are free to prescribe drugs for any use, drugmakers can only market their products for those uses approved by the FDA.\u003c/p>\n\u003cp>Warner-Lambert was bought in 2000 by Pfizer, which continues to sell gabapentin under its original brand-name Neurontin. Pfizer also sells a similar drug named Lyrica, a blockbuster medication approved for fibromyalgia, diabetic nerve pain and several other uses. Unlike gabapentin, Lyrica is a scheduled substance under federal law, in part due to reports of euphoria and other side effects suggesting “abuse potential.”\u003c/p>\n\u003cp>With tighter restrictions and a lone manufacturer, Lyrica has not seen the same problems as gabapentin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Tylenol May Help Ease The Pain Of Hurt Feelings",
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"content": "\u003cp>Nobody likes the feeling of being left out, and when it happens, we tend to describe these experiences with the same words we use to talk about the physical pain of, say, a toothache.\u003c/p>\n\u003cp>\"People say, 'Oh, that hurts,' \" says \u003ca href=\"https://psychology.as.uky.edu/users/njdewa2\">Nathan DeWall\u003c/a>, a professor of psychology at the University of Kentucky.\u003c/p>\n\u003caside class=\"pullquote alignright\">Pain pills seemed to dim activity in regions of the brain involved in processing social pain.\u003c/aside>\n\u003cp>DeWall and his colleagues were curious about the crossover between physical pain and emotional pain, so they began a series of experiments several years back.\u003c/p>\n\u003cp>In one study, they found that acetaminophen (the active ingredient in Tylenol) seemed to reduce the sting of rejection that people experienced after they were excluded from a virtual ball-tossing game.\u003c/p>\n\u003cp>The pain pills seemed to dim activity in regions of the brain involved in processing social pain, according to brain imaging. \"People knew they were getting left out [of the game], it just didn't bother them as much,\" DeWall explains.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As part of the study, participants were given either acetaminophen or a placebo for three weeks. None of the participants knew which one they were given. Each evening, participants completed a \u003ca href=\"http://www.midss.org/content/hurt-feelings-scale\">Hurt Feelings Scale\u003c/a>, designed as a standardized measure of emotional pain. They were asked to rank themselves on statements such as: \"Today, being teased hurt my feelings.\" It turned out that the pain medicine reduced reports of social pain.\u003c/p>\n\u003cp>[contextly_sidebar id=\"I1v1EslvGhTVuAuQUjZcfhFYZvYaKLVz\"]The emotional dampening documented in these experiments is not huge, but it appears significant enough to nudge people into a less-sensitive emotional state.\u003c/p>\n\u003cp>Since that study was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20548058\">published\u003c/a> in \u003cem>Psychological Science\u003c/em> back in 2010, a body of evidence has accumulated that points to a range of subtle psychological effects attributed to acetaminophen. For instance, a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25862546?dopt=Abstract\">published\u003c/a> in 2015 found that the pain medicine seems to diminish our emotional highs and lows. Another study pointed to a \u003ca href=\"https://academic.oup.com/scan/article/11/9/1345/2224135\">reduction in empathy \u003c/a>among people taking acetaminophen.\u003c/p>\n\u003cp>And a \u003ca href=\"http://journals.sagepub.com/doi/pdf/10.1177/2167702617731374\">study \u003c/a>published in October suggests the drug may dampen the tendency to distrust in people with borderline personality disorder.\u003c/p>\n\u003cp>\"Through reducing our attention to the outside world, acetaminophen appears to nudge us into a more psychologically insulated state,\" says \u003ca href=\"https://psych.ubc.ca/persons/todd-handy/\">Todd Handy\u003c/a>, a psychology professor at the University of British Columbia in Canada.\u003c/p>\n\u003cp>Handy also studies mind-wandering. In one recent \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884318/\">experiment\u003c/a>, published in \u003cem>Social Cognitive and Affective Neuroscience\u003c/em>, he and his collaborators found that acetaminophen seemed to make people care less about the mistakes they made when they zoned out. During the experiment, participants were asked to sit in front of a computer screen and complete a repetitive task. \"Once every couple seconds, something flashes on the screen and you have to hit a button,\" Handy explains. \"We try to bore people so they will actually mind wander.\"\u003c/p>\n\u003cp>Handy found that people taking the painkiller mind-wandered at about the same rate as people on the placebo, but their reactions were different. \"When people on Tylenol mind-wander, they're shutting stuff out more effectively than people who aren't on Tylenol.\"\u003c/p>\n\u003cp>Now, whether these subtle effects are good or bad depends on the context. \u003ca href=\"http://faculty.psy.ohio-state.edu/way/\">Baldwin Way\u003c/a>, a professor of psychology at Ohio State University who has also published on the effects of acetaminophen, says that in some instances, the emotional dampening could work against us.\u003c/p>\n\u003cp>\"If you're speaking to your romantic partner and their emotions are blunted,\" Way says, \"and they react blunted and less emotional, that can probably have a negative effect.\"\u003c/p>\n\u003cp>On the other hand, say you're anxious about an upcoming medical procedure, social situation or a job interview, \"maybe having blunted emotions can help you perform more effectively,\" Way says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But no one is recommending that people start popping the over-the-counter medication regularly to protect against social pain. Though it's among the most common drugs in Americans' medicine cabinets, it can be \u003ca href=\"https://medlineplus.gov/druginfo/meds/a681004.html\">risky\u003c/a>. Taking acetaminophen can cause gastrointestinal problems and taking large doses increases the risk of liver failure. People often don't realize that acetaminophen is an ingredient in many different products, so they can inadvertently take too much.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Tylenol+May+Help+Ease+The+Pain+Of+Hurt+Feelings&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Acetaminophen, the world's most popular painkiller, doesn't just dull physical aches, it also has subtle psychological effects, researchers say. But blunting emotions isn't always a good thing.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nobody likes the feeling of being left out, and when it happens, we tend to describe these experiences with the same words we use to talk about the physical pain of, say, a toothache.\u003c/p>\n\u003cp>\"People say, 'Oh, that hurts,' \" says \u003ca href=\"https://psychology.as.uky.edu/users/njdewa2\">Nathan DeWall\u003c/a>, a professor of psychology at the University of Kentucky.\u003c/p>\n\u003caside class=\"pullquote alignright\">Pain pills seemed to dim activity in regions of the brain involved in processing social pain.\u003c/aside>\n\u003cp>DeWall and his colleagues were curious about the crossover between physical pain and emotional pain, so they began a series of experiments several years back.\u003c/p>\n\u003cp>In one study, they found that acetaminophen (the active ingredient in Tylenol) seemed to reduce the sting of rejection that people experienced after they were excluded from a virtual ball-tossing game.\u003c/p>\n\u003cp>The pain pills seemed to dim activity in regions of the brain involved in processing social pain, according to brain imaging. \"People knew they were getting left out [of the game], it just didn't bother them as much,\" DeWall explains.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As part of the study, participants were given either acetaminophen or a placebo for three weeks. None of the participants knew which one they were given. Each evening, participants completed a \u003ca href=\"http://www.midss.org/content/hurt-feelings-scale\">Hurt Feelings Scale\u003c/a>, designed as a standardized measure of emotional pain. They were asked to rank themselves on statements such as: \"Today, being teased hurt my feelings.\" It turned out that the pain medicine reduced reports of social pain.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The emotional dampening documented in these experiments is not huge, but it appears significant enough to nudge people into a less-sensitive emotional state.\u003c/p>\n\u003cp>Since that study was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20548058\">published\u003c/a> in \u003cem>Psychological Science\u003c/em> back in 2010, a body of evidence has accumulated that points to a range of subtle psychological effects attributed to acetaminophen. For instance, a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25862546?dopt=Abstract\">published\u003c/a> in 2015 found that the pain medicine seems to diminish our emotional highs and lows. Another study pointed to a \u003ca href=\"https://academic.oup.com/scan/article/11/9/1345/2224135\">reduction in empathy \u003c/a>among people taking acetaminophen.\u003c/p>\n\u003cp>And a \u003ca href=\"http://journals.sagepub.com/doi/pdf/10.1177/2167702617731374\">study \u003c/a>published in October suggests the drug may dampen the tendency to distrust in people with borderline personality disorder.\u003c/p>\n\u003cp>\"Through reducing our attention to the outside world, acetaminophen appears to nudge us into a more psychologically insulated state,\" says \u003ca href=\"https://psych.ubc.ca/persons/todd-handy/\">Todd Handy\u003c/a>, a psychology professor at the University of British Columbia in Canada.\u003c/p>\n\u003cp>Handy also studies mind-wandering. In one recent \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884318/\">experiment\u003c/a>, published in \u003cem>Social Cognitive and Affective Neuroscience\u003c/em>, he and his collaborators found that acetaminophen seemed to make people care less about the mistakes they made when they zoned out. During the experiment, participants were asked to sit in front of a computer screen and complete a repetitive task. \"Once every couple seconds, something flashes on the screen and you have to hit a button,\" Handy explains. \"We try to bore people so they will actually mind wander.\"\u003c/p>\n\u003cp>Handy found that people taking the painkiller mind-wandered at about the same rate as people on the placebo, but their reactions were different. \"When people on Tylenol mind-wander, they're shutting stuff out more effectively than people who aren't on Tylenol.\"\u003c/p>\n\u003cp>Now, whether these subtle effects are good or bad depends on the context. \u003ca href=\"http://faculty.psy.ohio-state.edu/way/\">Baldwin Way\u003c/a>, a professor of psychology at Ohio State University who has also published on the effects of acetaminophen, says that in some instances, the emotional dampening could work against us.\u003c/p>\n\u003cp>\"If you're speaking to your romantic partner and their emotions are blunted,\" Way says, \"and they react blunted and less emotional, that can probably have a negative effect.\"\u003c/p>\n\u003cp>On the other hand, say you're anxious about an upcoming medical procedure, social situation or a job interview, \"maybe having blunted emotions can help you perform more effectively,\" Way says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But no one is recommending that people start popping the over-the-counter medication regularly to protect against social pain. Though it's among the most common drugs in Americans' medicine cabinets, it can be \u003ca href=\"https://medlineplus.gov/druginfo/meds/a681004.html\">risky\u003c/a>. Taking acetaminophen can cause gastrointestinal problems and taking large doses increases the risk of liver failure. People often don't realize that acetaminophen is an ingredient in many different products, so they can inadvertently take too much.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Tylenol+May+Help+Ease+The+Pain+Of+Hurt+Feelings&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.\u003c/p>\n\u003cp>When I got home and opened the package to take a pill, I discovered that there were 42 inside.\u003c/p>\n\u003cp>Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like \u003ca href=\"https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1\" target=\"_blank\" rel=\"noopener\">Percocet\u003c/a>, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.\u003c/p>\n\u003caside class=\"pullquote alignright\">As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/aside>\n\u003cp>When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.\u003c/p>\n\u003cp>“If you had real surgery like a knee replacement you wouldn’t think it was so many,” he said, adding that the electronic prescribing system set the default at 90. So when he types in a prescription for Percocet, that’s the quantity the system orders.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Such standard orders can be overridden, but that’s an extra step for a busy physician and takes time.\u003c/p>\n\u003cp>As public health officials grapple with how to slow the growing opioid epidemic — which \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\" target=\"_blank\" rel=\"noopener\">claims 91 lives each day\u003c/a>, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/p>\n\u003cp>While patients are today often given opioids to manage post-operative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who get access to the leftovers.\u003c/p>\n\u003cp>Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” said Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.\u003c/p>\n\u003cp>Last year, the Centers for Disease Control and Prevention released a \u003ca href=\"https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf\" target=\"_blank\" rel=\"noopener\">general guideline\u003c/a> saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.\u003c/p>\n\u003cp>[contextly_sidebar id=\"IKKSKEYlRZSZtDmHEy3bAWPqrZ5UtBdX\"]But more detailed guidance is necessary, clinicians say.\u003c/p>\n\u003cp>“There really aren’t clear guidelines, especially for surgery and dentistry,” Dr. Brummett said. “It’s often based on what their chief resident taught them along the way, or an event in their career that made them prescribe a certain amount.” Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.\u003c/p>\n\u003cp>To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of 36,177 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.\u003c/p>\n\u003cp>The study, published online in \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2618383\" target=\"_blank\" rel=\"noopener\">JAMA Surgery\u003c/a> in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.\u003c/p>\n\u003cp>Some insurers and state regulators have increasingly stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who \u003ca href=\"http://chirblog.org/responding-opioid-crisis-insurers-balance-stepped-monitoring-restrictions-need-appropriate-pain-treatment/\" target=\"_blank\" rel=\"noopener\">co-authored a study\u003c/a> on insurers’ response to the opioid crisis.\u003c/p>\n\u003cp>At least two dozen states have passed laws or rules in just the past few years aimed at \u003ca href=\"http://www.painmed.org/advocacy/state-updates/\" target=\"_blank\" rel=\"noopener\">regulating the use of opioids\u003c/a>.\u003c/p>\n\u003cp>In my state of New York, Gov. Andrew Cuomo \u003ca href=\"https://www.governor.ny.gov/news/governor-cuomo-signs-legislation-combat-heroin-and-opioid-crisis\" target=\"_blank\" rel=\"noopener\">last year signed\u003c/a> legislation that \u003ca href=\"https://www.health.ny.gov/professionals/narcotic/laws_and_regulations/docs/combat_heroin_legislation_faq.pdf\" target=\"_blank\" rel=\"noopener\">reduced the initial opioid prescription\u003c/a> limit for acute pain from 30 days to no more than a seven-day supply.\u003c/p>\n\u003cp>As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, \u003ca href=\"https://khn.org/news/how-and-where-to-dump-your-leftover-drugs-responsibly/\" target=\"_blank\" rel=\"noopener\">here is the safe and proper way\u003c/a> to dispose of them.)\u003c/p>\n\u003cp>Still, some caregivers and patients worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when they’re appropriate.\u003c/p>\n\u003cp>“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” said Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston who is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.\u003c/p>\n\u003cp>But other doctors say that one of the reasons doctors call in orders for lots of pills is their convenience.\u003c/p>\n\u003cp>“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, said Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.\u003c/p>\n\u003cp>Makary is spearheading a consortium of Hopkins clinicians and patients that provides \u003ca href=\"https://www.solvethecrisis.org/best-practices\" target=\"_blank\" rel=\"noopener\">specific guidelines\u003c/a> for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.\u003c/p>\n\u003cp>The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"https://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.\u003c/p>\n\u003cp>When I got home and opened the package to take a pill, I discovered that there were 42 inside.\u003c/p>\n\u003cp>Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like \u003ca href=\"https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1\" target=\"_blank\" rel=\"noopener\">Percocet\u003c/a>, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.\u003c/p>\n\u003caside class=\"pullquote alignright\">As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/aside>\n\u003cp>When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.\u003c/p>\n\u003cp>“If you had real surgery like a knee replacement you wouldn’t think it was so many,” he said, adding that the electronic prescribing system set the default at 90. So when he types in a prescription for Percocet, that’s the quantity the system orders.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Such standard orders can be overridden, but that’s an extra step for a busy physician and takes time.\u003c/p>\n\u003cp>As public health officials grapple with how to slow the growing opioid epidemic — which \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\" target=\"_blank\" rel=\"noopener\">claims 91 lives each day\u003c/a>, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/p>\n\u003cp>While patients are today often given opioids to manage post-operative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who get access to the leftovers.\u003c/p>\n\u003cp>Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” said Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.\u003c/p>\n\u003cp>Last year, the Centers for Disease Control and Prevention released a \u003ca href=\"https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf\" target=\"_blank\" rel=\"noopener\">general guideline\u003c/a> saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But more detailed guidance is necessary, clinicians say.\u003c/p>\n\u003cp>“There really aren’t clear guidelines, especially for surgery and dentistry,” Dr. Brummett said. “It’s often based on what their chief resident taught them along the way, or an event in their career that made them prescribe a certain amount.” Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.\u003c/p>\n\u003cp>To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of 36,177 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.\u003c/p>\n\u003cp>The study, published online in \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2618383\" target=\"_blank\" rel=\"noopener\">JAMA Surgery\u003c/a> in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.\u003c/p>\n\u003cp>Some insurers and state regulators have increasingly stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who \u003ca href=\"http://chirblog.org/responding-opioid-crisis-insurers-balance-stepped-monitoring-restrictions-need-appropriate-pain-treatment/\" target=\"_blank\" rel=\"noopener\">co-authored a study\u003c/a> on insurers’ response to the opioid crisis.\u003c/p>\n\u003cp>At least two dozen states have passed laws or rules in just the past few years aimed at \u003ca href=\"http://www.painmed.org/advocacy/state-updates/\" target=\"_blank\" rel=\"noopener\">regulating the use of opioids\u003c/a>.\u003c/p>\n\u003cp>In my state of New York, Gov. Andrew Cuomo \u003ca href=\"https://www.governor.ny.gov/news/governor-cuomo-signs-legislation-combat-heroin-and-opioid-crisis\" target=\"_blank\" rel=\"noopener\">last year signed\u003c/a> legislation that \u003ca href=\"https://www.health.ny.gov/professionals/narcotic/laws_and_regulations/docs/combat_heroin_legislation_faq.pdf\" target=\"_blank\" rel=\"noopener\">reduced the initial opioid prescription\u003c/a> limit for acute pain from 30 days to no more than a seven-day supply.\u003c/p>\n\u003cp>As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, \u003ca href=\"https://khn.org/news/how-and-where-to-dump-your-leftover-drugs-responsibly/\" target=\"_blank\" rel=\"noopener\">here is the safe and proper way\u003c/a> to dispose of them.)\u003c/p>\n\u003cp>Still, some caregivers and patients worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when they’re appropriate.\u003c/p>\n\u003cp>“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” said Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston who is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.\u003c/p>\n\u003cp>But other doctors say that one of the reasons doctors call in orders for lots of pills is their convenience.\u003c/p>\n\u003cp>“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, said Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.\u003c/p>\n\u003cp>Makary is spearheading a consortium of Hopkins clinicians and patients that provides \u003ca href=\"https://www.solvethecrisis.org/best-practices\" target=\"_blank\" rel=\"noopener\">specific guidelines\u003c/a> for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.\u003c/p>\n\u003cp>The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"https://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Despite what that uncle of yours may opine every time you get stuck next to him at Thanksgiving, there is a fair amount of evidence that racism still exists in the United States. For example, we know about racial disparities in \u003ca href=\"http://www.slate.com/articles/news_and_politics/politics/2015/04/north_charleston_shooting_how_investigatory_traffic_stops_unfairly_affect.html\" target=\"_blank\">policing\u003c/a>, \u003ca href=\"http://www.npr.org/2013/05/04/181053769/fewer-jobs-persistent-racial-disparity\" target=\"_blank\">unemployment\u003c/a>, \u003ca href=\"http://www.businessinsider.com/great-recession-exacerbated-a-big-racial-disparity-in-the-housing-market-2015-6\" target=\"_blank\">housing wealth\u003c/a>, \u003ca href=\"https://www.revealnews.org/article/when-companies-hire-temp-workers-by-race-black-applicants-lose-out/\" target=\"_blank\">temp hiring\u003c/a>, \u003ca href=\"http://www.motherjones.com/mojo/2015/07/race-gender-interest-rates-mortgages\" target=\"_blank\">home loans\u003c/a>, \u003ca href=\"http://www.npr.org/sections/thesalt/2015/10/22/450863158/the-startling-racial-divide-in-pay-for-restaurant-workers\" target=\"_blank\">pay\u003c/a>, the \u003ca href=\"https://www.washingtonpost.com/news/arts-and-entertainment/wp/2016/02/28/academy-awards-presenters-black-oscar-winners-history/\" target=\"_blank\">Oscars\u003c/a> , and of course, \u003ca href=\"http://www.cbsnews.com/news/dr-damon-tweedy-race-medicine-new-book-black-man-in-a-white-coat/\" target=\"_blank\">health care\u003c/a>.\u003c/p>\n\u003cp>One way bias has manifested in the practice of medicine is in the treatment of pain. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10613935\" target=\"_blank\">study\u003c/a> published in 2000, for example, found white patients were significantly more likely than black patients to receive pain medication for bone fractures in an emergency room. Further research has borne out unequal pain treatment -- even in \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?articleid=2441797\" target=\"_blank\">children\u003c/a>.\u003c/p>\n\u003cp>So why does this happen?\u003c/p>\n\u003cp>Researchers who have published a new \u003ca href=\"http://www.pnas.org/content/early/2016/03/30/1516047113.abstract\" target=\"_blank\">study\u003c/a> in the Proceedings of the National Academy of Sciences say they may have found the answer. And it's not pretty.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[A] substantial number of white people -- laypersons with no medical training, and medical students and residents -- hold beliefs about biological differences between blacks and whites, many of which are false and even fantastical in nature.'\u003ccite>University of Virginia study\u003c/cite>\u003c/aside>\n\u003cp>Some doctors may under-treat the pain of African-Americans because they believe there are biological differences between black and white people that result in blacks feeling less pain.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Our findings show that beliefs about black-white differences in biology may contribute to this disparity,” Kelly Hoffman, a sixth-year doctoral candidate in the University of Virginia's social psychology program, said in a press release.\u003c/p>\n\u003cp>Researchers conducted two separate surveys among white, native English speakers: one group that had no medical training, and one group of medical students and residents. In both groups, they found that the more false beliefs participants held about biological differences between black and white people, the more they minimized the pain of black people.\u003c/p>\n\u003cp>The first study was conducted among 92 people with no medical training. These individuals were asked to rate the level of pain a randomly assigned black or white hypothetical patient would feel in various situations, such as getting a hand slammed in a car door.\u003c/p>\n\u003cp>The group then was asked to what extent 15 statements about biological differences between blacks and whites were true. Eleven of the statements, such as \"Black people’s skin has more collagen (i.e. it’s thicker) than White people’s skin,\" were false, and four, such as \"Whites are less susceptible to heart disease,\" were true.\u003c/p>\n\u003cp>[contextly_sidebar id=\"lRl5cKSmSexqMugwZnroQmTLXkb8QpAW\"]The researchers found that participants who believed more of these false statements rated the pain experienced by black patients lower than the pain experienced by white patients.\u003c/p>\n\u003cp>\"In other words, relative to participants low in false beliefs, they seemed to assume that the black body is stronger and that the white body is weaker,\" wrote the study's authors.\u003c/p>\n\u003cp>Now here's where it gets especially alarming. Having found that false beliefs about biological differences between blacks and whites correlates with racial bias in pain perception among laypeople, the researchers moved on to doctors in training.\u003c/p>\n\u003cp>They asked 222 medical students and residents -- again white, native English speakers -- to rate the degree of truth of the same beliefs about biological differences between black and white people.\u003c/p>\n\u003cp>The results: The doctors-in-training believed nearly 12 percent of the false statements, and half believed at least one.\u003c/p>\n\u003cp>\"These percentages are noticeably lower compared with those in study 1,\" the researchers wrote, \"however, given this sample (medical students and residents), the percentages for false beliefs are surprisingly high.\"\u003c/p>\n\u003cp>The medical students and residents were also asked to rate on a scale of zero to 10 the pain levels experienced in two mock medical cases, involving a kidney stone and a leg fracture, for both a white and a black patient.\u003c/p>\n\u003cp>And again, the participants who endorsed more false beliefs about biological differences also rated black patients as feeling less pain than white patients.\u003c/p>\n\u003cp>When asked to recommend pain medication for each scenario, the students and residents with more false beliefs underprescribed pain medication for the black patients, as determined by 10 experienced physicians. These participants recommended Tylenol, anti-inflammatory medication or an ice pack, as opposed to a narcotic like hydrocodone or morphine, which would be in line with World Health Organization guidelines, according to the researchers.\u003c/p>\n\u003cp>Interestingly enough, those medical students who either did not believe the false statements, or believed fewer of them, showed an opposite bias in terms of their perceptions of pain -- meaning they thought \u003cem>white\u003c/em> patients feel less pain. Importantly, however, this bias was not associated with insufficient treatment recommendations.\u003c/p>\n\u003cp>\"It thus seems that racial bias in pain perception has pernicious consequences for accuracy in treatment recommendations for black patients and not for white patients,\" the authors wrote.\u003c/p>\n\u003cp>Beyond that, the authors specifically remarked on the markedly outdated nature of the false beliefs in question.\u003c/p>\n\u003cp>\"(A) substantial number of white people -- laypersons with no medical training and medical students and residents -- hold beliefs about biological differences between blacks and whites, many of which are false and even fantastical in nature.\" (And which go back to the era of slavery, the authors note.)\u003c/p>\n\u003cp>\"To our knowledge, this is the first demonstration of medical personnel (students and residents) with at least some medical training) endorsing such beliefs in modern times.\"\u003c/p>\n\u003cp>I have yet to get a hold of lead researcher Kelly Hoffman on the phone. \"I apologize for the delay,\" she wrote in an email. \"I have been inundated with requests.\"\u003c/p>\n\u003cp>One can imagine.\u003c/p>\n\u003cp>And how many of \u003ca href=\"http://ww2.kqed.org/futureofyou/which-of-these-statements-about-biological-differences-between-blacks-and-whites-are-true/\" target=\"_blank\">these statements\u003c/a> about biological differences between black and white people do \u003cem>you\u003c/em> think are true?\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Despite what that uncle of yours may opine every time you get stuck next to him at Thanksgiving, there is a fair amount of evidence that racism still exists in the United States. For example, we know about racial disparities in \u003ca href=\"http://www.slate.com/articles/news_and_politics/politics/2015/04/north_charleston_shooting_how_investigatory_traffic_stops_unfairly_affect.html\" target=\"_blank\">policing\u003c/a>, \u003ca href=\"http://www.npr.org/2013/05/04/181053769/fewer-jobs-persistent-racial-disparity\" target=\"_blank\">unemployment\u003c/a>, \u003ca href=\"http://www.businessinsider.com/great-recession-exacerbated-a-big-racial-disparity-in-the-housing-market-2015-6\" target=\"_blank\">housing wealth\u003c/a>, \u003ca href=\"https://www.revealnews.org/article/when-companies-hire-temp-workers-by-race-black-applicants-lose-out/\" target=\"_blank\">temp hiring\u003c/a>, \u003ca href=\"http://www.motherjones.com/mojo/2015/07/race-gender-interest-rates-mortgages\" target=\"_blank\">home loans\u003c/a>, \u003ca href=\"http://www.npr.org/sections/thesalt/2015/10/22/450863158/the-startling-racial-divide-in-pay-for-restaurant-workers\" target=\"_blank\">pay\u003c/a>, the \u003ca href=\"https://www.washingtonpost.com/news/arts-and-entertainment/wp/2016/02/28/academy-awards-presenters-black-oscar-winners-history/\" target=\"_blank\">Oscars\u003c/a> , and of course, \u003ca href=\"http://www.cbsnews.com/news/dr-damon-tweedy-race-medicine-new-book-black-man-in-a-white-coat/\" target=\"_blank\">health care\u003c/a>.\u003c/p>\n\u003cp>One way bias has manifested in the practice of medicine is in the treatment of pain. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10613935\" target=\"_blank\">study\u003c/a> published in 2000, for example, found white patients were significantly more likely than black patients to receive pain medication for bone fractures in an emergency room. Further research has borne out unequal pain treatment -- even in \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?articleid=2441797\" target=\"_blank\">children\u003c/a>.\u003c/p>\n\u003cp>So why does this happen?\u003c/p>\n\u003cp>Researchers who have published a new \u003ca href=\"http://www.pnas.org/content/early/2016/03/30/1516047113.abstract\" target=\"_blank\">study\u003c/a> in the Proceedings of the National Academy of Sciences say they may have found the answer. And it's not pretty.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[A] substantial number of white people -- laypersons with no medical training, and medical students and residents -- hold beliefs about biological differences between blacks and whites, many of which are false and even fantastical in nature.'\u003ccite>University of Virginia study\u003c/cite>\u003c/aside>\n\u003cp>Some doctors may under-treat the pain of African-Americans because they believe there are biological differences between black and white people that result in blacks feeling less pain.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Our findings show that beliefs about black-white differences in biology may contribute to this disparity,” Kelly Hoffman, a sixth-year doctoral candidate in the University of Virginia's social psychology program, said in a press release.\u003c/p>\n\u003cp>Researchers conducted two separate surveys among white, native English speakers: one group that had no medical training, and one group of medical students and residents. In both groups, they found that the more false beliefs participants held about biological differences between black and white people, the more they minimized the pain of black people.\u003c/p>\n\u003cp>The first study was conducted among 92 people with no medical training. These individuals were asked to rate the level of pain a randomly assigned black or white hypothetical patient would feel in various situations, such as getting a hand slammed in a car door.\u003c/p>\n\u003cp>The group then was asked to what extent 15 statements about biological differences between blacks and whites were true. Eleven of the statements, such as \"Black people’s skin has more collagen (i.e. it’s thicker) than White people’s skin,\" were false, and four, such as \"Whites are less susceptible to heart disease,\" were true.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The researchers found that participants who believed more of these false statements rated the pain experienced by black patients lower than the pain experienced by white patients.\u003c/p>\n\u003cp>\"In other words, relative to participants low in false beliefs, they seemed to assume that the black body is stronger and that the white body is weaker,\" wrote the study's authors.\u003c/p>\n\u003cp>Now here's where it gets especially alarming. Having found that false beliefs about biological differences between blacks and whites correlates with racial bias in pain perception among laypeople, the researchers moved on to doctors in training.\u003c/p>\n\u003cp>They asked 222 medical students and residents -- again white, native English speakers -- to rate the degree of truth of the same beliefs about biological differences between black and white people.\u003c/p>\n\u003cp>The results: The doctors-in-training believed nearly 12 percent of the false statements, and half believed at least one.\u003c/p>\n\u003cp>\"These percentages are noticeably lower compared with those in study 1,\" the researchers wrote, \"however, given this sample (medical students and residents), the percentages for false beliefs are surprisingly high.\"\u003c/p>\n\u003cp>The medical students and residents were also asked to rate on a scale of zero to 10 the pain levels experienced in two mock medical cases, involving a kidney stone and a leg fracture, for both a white and a black patient.\u003c/p>\n\u003cp>And again, the participants who endorsed more false beliefs about biological differences also rated black patients as feeling less pain than white patients.\u003c/p>\n\u003cp>When asked to recommend pain medication for each scenario, the students and residents with more false beliefs underprescribed pain medication for the black patients, as determined by 10 experienced physicians. These participants recommended Tylenol, anti-inflammatory medication or an ice pack, as opposed to a narcotic like hydrocodone or morphine, which would be in line with World Health Organization guidelines, according to the researchers.\u003c/p>\n\u003cp>Interestingly enough, those medical students who either did not believe the false statements, or believed fewer of them, showed an opposite bias in terms of their perceptions of pain -- meaning they thought \u003cem>white\u003c/em> patients feel less pain. Importantly, however, this bias was not associated with insufficient treatment recommendations.\u003c/p>\n\u003cp>\"It thus seems that racial bias in pain perception has pernicious consequences for accuracy in treatment recommendations for black patients and not for white patients,\" the authors wrote.\u003c/p>\n\u003cp>Beyond that, the authors specifically remarked on the markedly outdated nature of the false beliefs in question.\u003c/p>\n\u003cp>\"(A) substantial number of white people -- laypersons with no medical training and medical students and residents -- hold beliefs about biological differences between blacks and whites, many of which are false and even fantastical in nature.\" (And which go back to the era of slavery, the authors note.)\u003c/p>\n\u003cp>\"To our knowledge, this is the first demonstration of medical personnel (students and residents) with at least some medical training) endorsing such beliefs in modern times.\"\u003c/p>\n\u003cp>I have yet to get a hold of lead researcher Kelly Hoffman on the phone. \"I apologize for the delay,\" she wrote in an email. \"I have been inundated with requests.\"\u003c/p>\n\u003cp>One can imagine.\u003c/p>\n\u003cp>And how many of \u003ca href=\"http://ww2.kqed.org/futureofyou/which-of-these-statements-about-biological-differences-between-blacks-and-whites-are-true/\" target=\"_blank\">these statements\u003c/a> about biological differences between black and white people do \u003cem>you\u003c/em> think are true?\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp class=\"p1\">Imagine being an otter in a virtual world where colors and landscapes unfold in endless possibilities. You engage in a game of paintball with other frisky otters. You follow a river as it travels through time and seasons, and the environment responds to your mood, calming anxiety and reinforcing relaxation.\u003c/p>\n\u003cp>This fantastical landscape is a game developed by \u003ca href=\"http://deepstreamvr.com/\">DeepStream VR\u003c/a>, a virtual reality software company based in Seattle.\u003c/p>\n\u003cp>Founded by \u003cspan class=\"s1\">Ari Hollander\u003c/span> and Howard Rose, the company aims to implement VR games for pain relief and rehabilitation. One of its earlier games, \u003ca href=\"http://www.nbcnews.com/video/rock-center/49849152#49849152\">SnowWorld\u003c/a>, has been used extensively during wound care for burn victims as well as with children undergoing painful medical procedures.\u003c/p>\n\u003cfigure id=\"attachment_3562\" class=\"wp-caption alignright\" style=\"max-width: 378px\">\u003cimg class=\" wp-image-3562\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/image003.jpg\" alt=\"This virtual reality game was developed to alleviate stress and anxiety \" width=\"378\" height=\"224\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/image003.jpg 640w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/image003-400x237.jpg 400w\" sizes=\"(max-width: 378px) 100vw, 378px\">\u003cfigcaption class=\"wp-caption-text\">This virtual reality game was developed to alleviate stress and anxiety \u003ccite>(Cool! )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The otter game, called Cool!, is built to address anxiety, pain and the helplessness or loss of control that people feel during painful experiences. These factors have a cumulative effect on pain, and can also slow recovery. That’s why Cool! was written with artificial intelligence that can detect your nerve state as you play, and evolve with you.\u003c/p>\n\u003cp>This may sound like science fiction, but it isn’t. \u003ca href=\"http://www.researchgate.net/publication/221514493_Immersive_VR_a_non-pharmacological_analgesic_for_chronic_pain\">Research shows\u003c/a> that using meditative techniques, combined with play within a virtual reality landscape, can reduce reliance on opioids.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Virtual Reality Distracts From Pain\u003c/strong>\u003c/p>\n\u003cp>Most use of virtual reality for pain management has been for acute pain. That is, VR is used to distract the patient from the pain. \u003ca href=\"https://depts.washington.edu/anesth/research/labs/sharar/sharar-bio.shtml\">Dr. Sam Sharar\u003c/a>, an anesthesiologist at University of Washington, and his team have \u003ca href=\"http://www.hitl.washington.edu/projects/vrpain/\">amassed research\u003c/a> into the analgesic effects of distraction in pain management.\u003c/p>\n\u003cp>“Cognitive distraction during a painful experience takes some of the conscious attention away from the painful stimulus,” Sharar says. If a patient’s attention can be consumed in an immersive virtual world, they experience less pain.\u003c/p>\n\u003cfigure id=\"attachment_3528\" class=\"wp-caption alignright\" style=\"max-width: 311px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/fMRI.jpg\">\u003cimg class=\" wp-image-3528\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/fMRI.jpg\" alt=\"These images from an fMRI scan show areas of the brain affected by pain, and how they shrink when the patient is immersed in a virtual reality world. (Courtesy Dr. Sam Sharar/University of Washington)\" width=\"311\" height=\"194\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/fMRI.jpg 401w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/fMRI-400x249.jpg 400w\" sizes=\"(max-width: 311px) 100vw, 311px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">These images from an fMRI scan show areas of the brain affected by pain, and how they shrink when the patient is immersed in a virtual reality world. \u003ccite>(Dr. Sam Sharar/University of Washington)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>SnowWorld, for example, was designed specifically with burn victims in mind. The environment is blue and white, with icy hues and ice cliffs. Within the arctic world, the player plays with engages with snowmen, throws snowballs, moves through snowy ravines with icicles. The design surrounds the perceptual field; music further immerses the patient in the virtual world.\u003c/p>\n\u003cp>One hypothesis as to why VR works is that immersion in the virtual world produces endorphins that help mask the pain experience.\u003c/p>\n\u003cp>Sharar’s team tested that theory using naloxone, a narcotic inhibitor. If endorphins were causing reduced pain, the naloxone would have reversed that affect and the pain would have elevated again, even during VR immersion. This wasn’t the case. Scientists still don’t know exactly why VR works the way it does to diminish the experience of pain.\u003c/p>\n\u003cp>\u003cstrong>What About Chronic Pain?\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://books.nap.edu/openbook.php?record_id=13172&page=1.\">More than 100 million Americans\u003c/a> suffer from chronic pain. It may last for months or years and is often accompanied by a cascading variety of other health issues. People suffering from chronic pain experience isolation, fear and frustration from the lack of social understanding about the severity of the condition.\u003c/p>\n\u003cp>“It is a systemic, degenerative disease,” says Dr. Diane Gromala, Canada Research Chair and Professor at the Simon Fraser University in Vancouver.\u003c/p>\n\u003cp>[Watch Dr. Gromala speak at a recent TED conference in the video below.]\u003c/p>\n\u003caside class=\"pullquote alignright\">“Pain is a more terrible lord of mankind than even death itself.”\u003cbr>\n\u003ccite>Nobel Laureate Albert Schweitzer, 1931\u003c/cite>\u003c/aside>\n\u003cp>The total \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK92521/\">financial cost of chronic pain\u003c/a> in the U.S., including lower wages, lost days of work and cost of health care, ranges from $560 to $635 billion and is higher than the annual cost of heart disease, cancer, or diabetes. People who were formerly successful, active and happy have been toppled and rendered paralyzed by this disease.\u003c/p>\n\u003cp>Yet medical treatment for chronic pain is abysmal, relying intensively on opioid prescriptions that are ineffectual for long-term pain management. Prescriptions and sales of opioids in America have \u003ca href=\"http://www.nytimes.com/interactive/2013/06/23/sunday-review/the-soaring-cost-of-the-opioid-economy.html?smid=fb-share&_r=0\">risen dramatically\u003c/a> in the last 10 years, by 33% and 110% respectively. Yet people with chronic pain have an overwhelming sense of not being in control of it, especially when they experience breakthrough pain, which can severely impact their quality of life and overall sense of well-being.\u003c/p>\n\u003cp>[youtube http://www.youtube.com/watch?v=cRdarMz--Pw&w=560&h=315]\u003c/p>\n\u003cp>\u003cstrong>New Ways To Manage Chronic Pain\u003c/strong>\u003c/p>\n\u003cp>Dr. Sean Mackey, an anesthesiologist at Stanford, experiments with perceptions of chronic pain using the fMRI scanner. His work, combined with Dr. Christopher deCharms’ efforts, has changed focus from how the nerves sense pain to how the brain processes it. Comprehending pain in this way—as a cognitive process that, like other cognitive processes, can be re-wired—is at the heart of their work.\u003c/p>\n\u003cp>With this foundation, they use the fMRI as both a diagnostic and therapeutic tool. Mackey and deCharms help patients master control over their pain by showing them real-time images of their pain digitally manifested on a screen.\u003c/p>\n\u003cp>Understanding where and how pain exists informs Gromala’s team at the \u003ca href=\"https://www.sfu.ca/vpresearch/centres/Chronic%20Pain%20Research%20Institute.html\">Chronic Pain Research Institute\u003c/a>.\u003c/p>\n\u003cp>What’s significant about Gromala’s work is that she both incorporates virtual reality as a distraction from acute pain, and also designs worlds aimed at taking advantage of the brain’s neuroplasticity. That is, she wants to interrupt the cognitive processes that make pain be experienced in a debilitating way.\u003c/p>\n\u003cp>Gromala—a chronic pain sufferer herself—and her team have developed immersive experiences that include biofeedback in order to ask people to focus on pain in order to produce thoughts about it, and better manage it. The \u003ca href=\"http://painstudieslab.com/projects/virtual-meditative-walk/\">Virtual Meditative Walk\u003c/a> uses biofeedback sensors that measure physiological symptoms like heart rate, skin temperature, or respiration along with sound, and virtual reality to enable people suffering from chronic pain to better practice \u003ca href=\"http://en.wikipedia.org/wiki/Mindfulness-based_stress_reduction\">Mindfulness-Based Stress Reduction\u003c/a>.\u003c/p>\n\u003cp>Rather than ignoring or repressing pain, the virtual environment coupled with immediate biofeedback teaches patients how much attention their pain consumes. Virtual reality doesn’t so much remove you from your world as it provides you the tools and training in which to more effectively focus and control it.\u003c/p>\n\u003cp>“It is based on a mind-body practice that scientists have studied and that humans have used for hundreds of years,” Gromala says.\u003c/p>\n\u003cp>“Technology isn’t necessary for mindful practices, but our VR system gives users immediate feedback in a number of sensory and perceptual ways. That makes it less mysterious, and users often say they feel confident that they can affect their pain, instead of feeling they are victims to it.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp class=\"p1\">\u003cem>\u003cspan class=\"s1\">Susan E. Williams is a writer and consultant who specializes in science, technology and healthcare. She provides critical research to efforts including Arizona State University's Project HoneyBee, an initiative focused on validating the clinical utility of continuous physiological monitoring with consumer wearable devices. \u003c/span>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">Imagine being an otter in a virtual world where colors and landscapes unfold in endless possibilities. You engage in a game of paintball with other frisky otters. You follow a river as it travels through time and seasons, and the environment responds to your mood, calming anxiety and reinforcing relaxation.\u003c/p>\n\u003cp>This fantastical landscape is a game developed by \u003ca href=\"http://deepstreamvr.com/\">DeepStream VR\u003c/a>, a virtual reality software company based in Seattle.\u003c/p>\n\u003cp>Founded by \u003cspan class=\"s1\">Ari Hollander\u003c/span> and Howard Rose, the company aims to implement VR games for pain relief and rehabilitation. One of its earlier games, \u003ca href=\"http://www.nbcnews.com/video/rock-center/49849152#49849152\">SnowWorld\u003c/a>, has been used extensively during wound care for burn victims as well as with children undergoing painful medical procedures.\u003c/p>\n\u003cfigure id=\"attachment_3562\" class=\"wp-caption alignright\" style=\"max-width: 378px\">\u003cimg class=\" wp-image-3562\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/image003.jpg\" alt=\"This virtual reality game was developed to alleviate stress and anxiety \" width=\"378\" height=\"224\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/image003.jpg 640w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/image003-400x237.jpg 400w\" sizes=\"(max-width: 378px) 100vw, 378px\">\u003cfigcaption class=\"wp-caption-text\">This virtual reality game was developed to alleviate stress and anxiety \u003ccite>(Cool! )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The otter game, called Cool!, is built to address anxiety, pain and the helplessness or loss of control that people feel during painful experiences. These factors have a cumulative effect on pain, and can also slow recovery. That’s why Cool! was written with artificial intelligence that can detect your nerve state as you play, and evolve with you.\u003c/p>\n\u003cp>This may sound like science fiction, but it isn’t. \u003ca href=\"http://www.researchgate.net/publication/221514493_Immersive_VR_a_non-pharmacological_analgesic_for_chronic_pain\">Research shows\u003c/a> that using meditative techniques, combined with play within a virtual reality landscape, can reduce reliance on opioids.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Virtual Reality Distracts From Pain\u003c/strong>\u003c/p>\n\u003cp>Most use of virtual reality for pain management has been for acute pain. That is, VR is used to distract the patient from the pain. \u003ca href=\"https://depts.washington.edu/anesth/research/labs/sharar/sharar-bio.shtml\">Dr. Sam Sharar\u003c/a>, an anesthesiologist at University of Washington, and his team have \u003ca href=\"http://www.hitl.washington.edu/projects/vrpain/\">amassed research\u003c/a> into the analgesic effects of distraction in pain management.\u003c/p>\n\u003cp>“Cognitive distraction during a painful experience takes some of the conscious attention away from the painful stimulus,” Sharar says. If a patient’s attention can be consumed in an immersive virtual world, they experience less pain.\u003c/p>\n\u003cfigure id=\"attachment_3528\" class=\"wp-caption alignright\" style=\"max-width: 311px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/fMRI.jpg\">\u003cimg class=\" wp-image-3528\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/fMRI.jpg\" alt=\"These images from an fMRI scan show areas of the brain affected by pain, and how they shrink when the patient is immersed in a virtual reality world. (Courtesy Dr. Sam Sharar/University of Washington)\" width=\"311\" height=\"194\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/fMRI.jpg 401w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/fMRI-400x249.jpg 400w\" sizes=\"(max-width: 311px) 100vw, 311px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">These images from an fMRI scan show areas of the brain affected by pain, and how they shrink when the patient is immersed in a virtual reality world. \u003ccite>(Dr. Sam Sharar/University of Washington)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>SnowWorld, for example, was designed specifically with burn victims in mind. The environment is blue and white, with icy hues and ice cliffs. Within the arctic world, the player plays with engages with snowmen, throws snowballs, moves through snowy ravines with icicles. The design surrounds the perceptual field; music further immerses the patient in the virtual world.\u003c/p>\n\u003cp>One hypothesis as to why VR works is that immersion in the virtual world produces endorphins that help mask the pain experience.\u003c/p>\n\u003cp>Sharar’s team tested that theory using naloxone, a narcotic inhibitor. If endorphins were causing reduced pain, the naloxone would have reversed that affect and the pain would have elevated again, even during VR immersion. This wasn’t the case. Scientists still don’t know exactly why VR works the way it does to diminish the experience of pain.\u003c/p>\n\u003cp>\u003cstrong>What About Chronic Pain?\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://books.nap.edu/openbook.php?record_id=13172&page=1.\">More than 100 million Americans\u003c/a> suffer from chronic pain. It may last for months or years and is often accompanied by a cascading variety of other health issues. People suffering from chronic pain experience isolation, fear and frustration from the lack of social understanding about the severity of the condition.\u003c/p>\n\u003cp>“It is a systemic, degenerative disease,” says Dr. Diane Gromala, Canada Research Chair and Professor at the Simon Fraser University in Vancouver.\u003c/p>\n\u003cp>[Watch Dr. Gromala speak at a recent TED conference in the video below.]\u003c/p>\n\u003caside class=\"pullquote alignright\">“Pain is a more terrible lord of mankind than even death itself.”\u003cbr>\n\u003ccite>Nobel Laureate Albert Schweitzer, 1931\u003c/cite>\u003c/aside>\n\u003cp>The total \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK92521/\">financial cost of chronic pain\u003c/a> in the U.S., including lower wages, lost days of work and cost of health care, ranges from $560 to $635 billion and is higher than the annual cost of heart disease, cancer, or diabetes. People who were formerly successful, active and happy have been toppled and rendered paralyzed by this disease.\u003c/p>\n\u003cp>Yet medical treatment for chronic pain is abysmal, relying intensively on opioid prescriptions that are ineffectual for long-term pain management. Prescriptions and sales of opioids in America have \u003ca href=\"http://www.nytimes.com/interactive/2013/06/23/sunday-review/the-soaring-cost-of-the-opioid-economy.html?smid=fb-share&_r=0\">risen dramatically\u003c/a> in the last 10 years, by 33% and 110% respectively. Yet people with chronic pain have an overwhelming sense of not being in control of it, especially when they experience breakthrough pain, which can severely impact their quality of life and overall sense of well-being.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/cRdarMz--Pw'\n title='//www.youtube.com/embed/cRdarMz--Pw'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>New Ways To Manage Chronic Pain\u003c/strong>\u003c/p>\n\u003cp>Dr. Sean Mackey, an anesthesiologist at Stanford, experiments with perceptions of chronic pain using the fMRI scanner. His work, combined with Dr. Christopher deCharms’ efforts, has changed focus from how the nerves sense pain to how the brain processes it. Comprehending pain in this way—as a cognitive process that, like other cognitive processes, can be re-wired—is at the heart of their work.\u003c/p>\n\u003cp>With this foundation, they use the fMRI as both a diagnostic and therapeutic tool. Mackey and deCharms help patients master control over their pain by showing them real-time images of their pain digitally manifested on a screen.\u003c/p>\n\u003cp>Understanding where and how pain exists informs Gromala’s team at the \u003ca href=\"https://www.sfu.ca/vpresearch/centres/Chronic%20Pain%20Research%20Institute.html\">Chronic Pain Research Institute\u003c/a>.\u003c/p>\n\u003cp>What’s significant about Gromala’s work is that she both incorporates virtual reality as a distraction from acute pain, and also designs worlds aimed at taking advantage of the brain’s neuroplasticity. That is, she wants to interrupt the cognitive processes that make pain be experienced in a debilitating way.\u003c/p>\n\u003cp>Gromala—a chronic pain sufferer herself—and her team have developed immersive experiences that include biofeedback in order to ask people to focus on pain in order to produce thoughts about it, and better manage it. The \u003ca href=\"http://painstudieslab.com/projects/virtual-meditative-walk/\">Virtual Meditative Walk\u003c/a> uses biofeedback sensors that measure physiological symptoms like heart rate, skin temperature, or respiration along with sound, and virtual reality to enable people suffering from chronic pain to better practice \u003ca href=\"http://en.wikipedia.org/wiki/Mindfulness-based_stress_reduction\">Mindfulness-Based Stress Reduction\u003c/a>.\u003c/p>\n\u003cp>Rather than ignoring or repressing pain, the virtual environment coupled with immediate biofeedback teaches patients how much attention their pain consumes. Virtual reality doesn’t so much remove you from your world as it provides you the tools and training in which to more effectively focus and control it.\u003c/p>\n\u003cp>“It is based on a mind-body practice that scientists have studied and that humans have used for hundreds of years,” Gromala says.\u003c/p>\n\u003cp>“Technology isn’t necessary for mindful practices, but our VR system gives users immediate feedback in a number of sensory and perceptual ways. That makes it less mysterious, and users often say they feel confident that they can affect their pain, instead of feeling they are victims to it.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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},
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"order": 8
},
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"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
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"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"source": "Commonwealth Club of California"
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"meta": {
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"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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},
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"id": "fresh-air",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"meta": {
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"source": "NPR"
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"how-i-built-this": {
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"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"hyphenacion": {
"id": "hyphenacion",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
},
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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