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Part 3: Expanding the options

The alternatives to opioids we have now don’t work for everyone’s pain. More non-opioid, non-addictive treatment options could help reduce the number of opioids prescribed each year.

Healthy Living LifePath winterThe Healthy Living program at LifePath is offering several workshops during the 2019 winter season, including a free Chronic Pain Self-Management workshop that helps people build self-confidence to assume an active role in managing their chronic pain. Particpants explore the cause of pain; distraction and relaxation techniques; dealing with difficult emotions, stress, fatigue, isolation, and poor sleep; appropriate exercise; strategies on healthy eating, weight management, and nutrition; pacing activity and rest; and more. The next six-week Chonric Pain Self-Management workshop series starts on February 14 at North Quabbin Recovery Center. Learn more about this and other Healthy Living workshops.Recently, the National Institutes of Health (NIH) launched the Helping to End Addiction Long-Term (HEAL) Initiative to address the shortage of effective medications for chronic pain and other issues contributing to the opioid crisis.

Some of the research funded by HEAL will focus on understanding how chronic pain develops. A better understanding of how acute pain becomes chronic could reveal new treatment targets.

Researchers funded by HEAL also hope to learn how to predict who will develop chronic pain from acute pain. This information could be used to guide early pain management, Oshinsky explains. HEAL will fund research into new treatments for opioid misuse and addiction as well.

More options for pain management could help doctors better personalize pain treatment. “It could be a little more like precision medicine, where you try to identify what flavor of pain the patient has, and then match the treatments we have available to the needs of that patient,” explains Dr. David Williams, an NIH-funded pain researcher at the University of Michigan.

Read Part 1 of this series.

Read Part 2 of this series.

Learn about the Chronic Pain Self-Management Program at LifePath.

Article adapted from the NIH October 2018 News in Health.

 

Pam OddyAttorney Pamela OddyThe topic of funerals is not the most pleasant one to discuss; however, the idea of a prepaid funeral is gaining more prominence especially when it comes to spending down one’s assets in order to become eligible for MassHealth. To not count toward the asset limit for these programs, the prepaid funeral arrangement must be “irrevocable,” that is, it cannot be changed. There is no “lookback” period for the purchase of a prepaid funeral.

It is always a wise choice to prepay a loved one’s funeral if that loved one (for example, a spouse or a parent) enters a nursing home for permanent placement. If a spouse is the one who must enter the nursing home on a permanent basis, it makes good sense to prepay the funerals of both spouses (i.e. the one who is in the nursing home as well as the spouse who remains in the home). Prepaying both funerals may become part of the spend down for MassHealth eligibility. Although it is a sensitive topic, I have found the area funeral directors to be quite helpful in guiding people in choosing funeral arrangements. I counsel my clients to be sure to have the funeral director include in the prepaid funeral the cost of minister/priest/rabbi as well as the cost of multiple death certificates.

In addition to prepaying the funeral, one may establish a burial fund account with a local bank. The total amount that can be deposited into this account is $1500. This expenditure is also an allowable one for MassHealth eligibility and may become part of the spend down. One may ask the question: why set up a burial fund account if the funeral is already prepaid? Theoretically, the burial fund account may be used to pay for a funeral luncheon and flowers and various extras that fall outside the parameters of a funeral. This account may not be touched until the person’s passing or else all of the money in the account becomes countable toward the MassHealth asset limit.

Prepaying a funeral will serve to take the burden off your loved ones because you will be the one making the decision as to what you want as well as which funeral home directs the arrangements. It will also settle any disagreement as to what you want and what your family members want for you; for example, you may want to be buried, but your family, if the decision were left to them, might have you cremated. If the funeral is prepaid, then the choice is already made, you have covered the expense and saved your family the financial burden and you will receive the funeral that you paid for.

The topic of funerals is not one any of us look forward to discussing but it is becoming increasingly important in any advanced planning.

The views expressed in this column represent general information. To address your particular and specific needs consult your own attorney. If you need help with referral to an attorney, contact the Franklin County Bar Association at (413) 773-9839 or the Worcester County Bar Association at (978) 752-1311. Elder law resources may be found through the National Academy of Elder Law Attorneys, Massachusetts Chapter, at massnaela.com or 617-566-5640.

Community Legal Aid (CLA) provides legal services free to people age 60 and older for civil legal matters with an emphasis on access to health care coverage (MassHealth and Medicare) and public benefits as well as tenants’ rights. A request for legal assistance can be made by phone at 413-774-3747 or toll-free 1-855-252-5342 during their intake hours (Monday, Tuesday, Thursday, and Friday from 9:30 a.m. to 12:15 p.m. and Wednesday from 1:30 p.m. to 4:15 p.m.) or any time online by visiting www.communitylegal.org.

Part 2: Opioids are not always needed

Opioids are often prescribed for acute pain. Acute pain is short-term pain, the kind experienced after an accident or an operation. But other drugs may be just as effective for acute pain, even after surgery, explains Dr. Dena Fischer, a dental health expert at the National Institutes of Health (NIH). Some of these drugs, like acetaminophen or ibuprofen, don’t require a prescription.

People may think that prescription drugs work better for acute pain. But that’s often not the case, Fischer says. Using something other than an opioid first can be especially important to manage acute pain in fields such as dentistry, she adds.

Many people receiving opioid prescriptions from dentists are teens or young adults who have never been prescribed an opioid before.

“Research is starting to tell us that people who receive an opioid prescription as a teenager have a tendency to continue to take opioids for non-medical purposes in the long term,” Fischer says.

Healthcare providers who decide their patient needs an opioid are now being encouraged to give only a few pills at a time. People who receive shorter prescriptions are less likely to misuse their pills by taking more than prescribed or taking them after the pain is gone. This also cuts down the chance that the pills could be taken by others.

When pain is chronic

Managing chronic pain is more complicated than treating acute pain. More than 25 million people in the U.S. alone live with chronic pain, which is pain that lasts more than three months.

Many things can cause chronic pain. For example, Oshinsky says, a muscle that was damaged in an accident may heal relatively quickly. But if a nerve was also hurt, it can continue to send pain signals long after the body has repaired the muscle.

Other types of chronic pain are driven by brain changes, explains Dr. David Williams, an NIH-funded pain researcher at the University of Michigan. When these changes happen, the brain continues to perceive pain even though the injury has healed.

For people with this type of chronic pain, sometimes called central pain, opioids and some other kinds of pain medications can actually make the pain worse.

CounselingTalk therapy may be able to help people with chronic pain.Research has shown that talk therapies, such as cognitive behavioral therapy, can help many people with chronic central pain. These types of therapies “emphasize behaving in different ways or thinking in different ways that alter the perception of pain,” Williams explains. “Pain is a combination of a sensory and an emotional experience.”

Cognitive behavioral therapy can also help people with chronic pain manage related health problems, such as problems sleeping, feeling tired, or trouble concentrating. This can increase quality of life for people with chronic pain. It can also have overlapping effects.

“Pain processing and sleep and thinking and mood all share the same neurotransmitters in the brain,” Williams says. “So, by improving something like sleep, you’re also improving pain.”

Non-opioid drugs can help some people with chronic pain too, Oshinsky says. Many of these drugs were first developed to treat different health conditions, such as seizures, depression, or anxiety. But they can also change the way the brain processes pain.

Some people benefit from devices that stimulate the nerves directly to block pain signals from reaching the brain, Oshinsky adds. Different devices can work on different parts of the nervous system, from the nerves in the skin to the spinal cord.

People with certain types of pain have also been shown to benefit from exercise, acupuncture, massage therapy, or yoga.

Read Part 1 of this series.

Learn more about research into additional pain treatment alternatives to opioids in Part 3.

Learn about the Chronic Pain Self-Management Program at LifePath.

Article adapted from the NIH October 2018 News in Health.

Thriving in place with smart technology

The United States is a graying nation. With it has come a new conversation about aging, namely, the difference between simply getting older versus thriving as you age.

Important work related to the research and development of technologies to help elders thrive in place is taking place worldwide. Falls are a leading cause of injury-related death among older adults and a major reason why many elders become unable to live independently. In response, the University of Maine’s Center on Aging is working to develop clothing that would provide hip protection to help prevent a fracture upon a fall. The University is also working to develop a device to be mounted on an individual’s glasses to help detect edges, such as stairs, curbs, or benches, which could create falling hazards.

Aging in place with smart technology in the home

“Smart” technology can enhance the livability of one’s home too. For example, motion-sensor lighting is not only convenient, but can prevent falls when walking into a room. If you forget to lock the door, your home can remind you and even take care of it for you. With one touch or voice control, you can control just about everything in the home. As you age, your connected smart home can help you continue to live independently, safely, and comfortably.

Health-monitoring and tracking smart devices

Devices that monitor and track your health are becoming more popular among all age populations. Telemedicine and Telehealth capabilities and communications are particularly valuable in rural communities and enable long-distance patient and clinician contact and care, advice, reminders, education, intervention, and monitoring. Health data can be collected through wearable technologies like smartwatches and relayed to your care providers. Activity sensors through the house monitor loved ones who are living unassisted at home. These sensors can be placed in discreet locations: doors, cabinets, windows, beds, etc., to track movement around the house and report back to a caregiver or a loved one. 

“Smart” pill counters alert and properly dispense medications for you. Stovetop technologies will turn the stove off if left unattended for a predetermined amount of time. “Smart” doors that don't require fumbling with a handle – and in some cases, don't swing out, but slide side to side – can assist elders who struggle to get around. “Smart” doorbells help ensure one’s safety at home by allowing a homeowner to see, hear, and speak to someone at their door without having to open it.

Smart technology for inviduals with dementia

Of note is the positive effect technology is having on improving the quality of life and easing safety concerns for individuals with dementia. Assistive technology is also impactful in lifting some of the responsibilities and anxieties experienced by caregivers.

Sept 2017 World Alzheimers Day photo webThe Alzheimer's Music Project provides iPods with custom playlists to individuals with dementia. You can donate your gently-used iPod Shuffle or iPod Touch by mailing it to: Alzheimer's Music Project, Inc., 138 Harkness Rd., Pelham, MA 01002. Visit The Alzheimer's Music Project website for more information. Photo by Sabri Tuzcu on Unsplash.com.Recorded reminder messages can prompt a person not to open the door or to go back to bed. Those who may confuse day and night can experience altered sleep patterns, which may be disruptive to the household. Clocks designed specifically for those with dementia can hold set routines. GPS tracking and location devices can significantly increase the safety of individuals who may wander. These systems, which can be attached to the person or may be built into clothing or shoes, will alert a caregiver if their loved one has left the home. These tracking devices can also provide emergency personnel with the location of an individual to ensure a timely and safe recovery. For those who cannot remember or identify phone numbers, picture phones with clear buttons where photos can be placed enable the person to simply press the button to quickly call their loved one or first responders.

Music technology through the use of ipods or mp3 players can have a marked impact on quality of life. According to Peter Acker, director of The Alzheimer's Music Project, “Research has shown that familiar and beloved music helps to calm chaotic brain activity in people with Alzheimer’s and they’re more able to focus on the present moment and regain a sense of his/her connection to others. We work with families and caregivers in Massachusetts to create music playlists that are ‘tailored’ for each person – enabling those struggling with cognitive challenges to reconnect with the world through music-triggered memories.”

While no cure exists yet for Alzheimer’s disease and other related dementias, emerging technologies can alleviate anxieties, help establish routines, and offer vehicles for sustaining joyful relationships as well as enable dignity and independence. These investments, and others like them, can transform the aging in place experience. In this season of giving, consider introducing some of these remarkable technologies to a loved one aging in their home. For more information, contact us.

Additional “Seniorgram” articles can be found here.

Part 1: Moving beyond opioids

Most people experience some kind of pain during their lives. Pain serves an important purpose: it warns the body when it’s in danger. Think of when your hand touches a hot stove. But ongoing pain causes distress and affects quality of life. Pain is the number one reason people see a doctor.

Healthy Living Pain Management photo WEBThe Healthy Living program at LifePath offers a free Chronic Pain Self-Management workshop that helps people build self-confidence to assume an active role in managing their chronic pain. Participants explore the cause of pain; distraction and relaxation techniques; dealing with difficult emotions, stress, fatigue, isolation, and poor sleep; appropriate exercise; strategies on healthy eating, weight management, and nutrition; pacing activity and rest; and more. The next six-week workshop series starts on February 14, 2019, at North Quabbin Recovery Center. Learn more or register here.A class of drugs called opioids is often used to treat pain. One reason, explains National Institutes of Health (NIH) pain expert Dr. Michael Oshinsky, is that opioids work well for many people. Opioids can stop the body from processing pain on many levels, from the skin to the brain. Because they work throughout the body, he says, “Opioids can be very effective for multiple types of pain.”

But opioids also produce feelings of happiness and well-being. And they’re reinforcing: the more people take them, the more they crave them. This can lead to addiction, or continuing to take opioids despite negative consequences. Scientists have not yet been able to develop opioids that reduce pain without producing these addicting effects, Oshinsky explains.

The longer someone takes opioids, the more they may need to take to get the same effect. This is called tolerance. Having a high tolerance doesn’t always mean you’ll become addicted. But taking higher doses of opioids increases the risk for both addiction and overdose.

The U.S. is now in the grip of an opioid crisis. Every day, more than 100 Americans die from an opioid overdose. This number includes deaths from prescription opioids.

“We don’t need ‘better’ opioids. We need to move away from the reliance on opioids for developing pain treatments,” Oshinsky says.

NIH is funding research into new and more precise ways to treat pain. It’s also working to develop new treatments to combat opioid misuse and addiction.

Learn more about pain treatment alternatives to opioids in Part 2.

Article adapted from the NIH October 2018 News in Health.