Are Some Medications Underutilized?

t-PA
Migraine Medications
Narcotic Pain Medications
Aspirin

t-PA

We’ve got a long way to go before we’re fully exploiting the thrombolytic effects of t-PA on ischemic strokes, according to a Duke University Medical Center physician. Dr. Mark J. Alberts, MD. noted that only two to three percent (out of a possible 35-45 percent of acute ischemic stroke victims likely to benefit from its use) are receiving this therapy. The t-PA therapy for stroke patients was approved by the FDA three years ago.

Migraine Medications

A major study concluded that treatment has not matched scientific breakthroughs in the treatment of migrain headaches. The American Migraine Study II (conducted for the National Headache Foundation (NHF) and underwritten by a grant from Glaxo Wellcome Inc. and reported at the 13^th Annual Conference of the Diamond Headache Clinic Research and Education Foundation). The study examines the current state of migraine care in the U.S. and is methodologically identical to a study by the same research team conducted 10 years ago and published in the Journal of the American Medical Association. The study featured a survey in which subjects answered a series of questions about their diagnosis and treatment history and the impact of migraine on their lives. The survey sampled a group that was determined to be representative of the U.S. population in terms of household income, ethnicity, family size and other factors. The American migraine Study II reported that---

--there is a migraine sufferer in one of every four U.S. households (13 percent of the American population);
--total U.S. migraine prevalence was virtually the same in 1999 (12.6 percent) as in 1989 (12.1 percent) current incidence (28 million) has increased since 1989 (24 million) with the growth in population;
--only 48 percent of respondents who met the clinical definition of migraine report ever having had their condition diagnosed by a physician;
--the 48 percent of sufferers who have received a diagnosis from a doctor suffer to a similar degree as those who have never had their migraines diagnosed;
--80 percent said their migraine headaches were severe or extremely severe, and 24 percent reported seeking emergency room care as a result of an attack. While sufferers with a physician diagnosis tend to have more severe migraines and report more symptoms versus the undiagnosed, there is a high level of suffering reported by both groups:
-- Throbbing pain (85 percent diagnosed vs. 85 percent undiagnosed)
-- Sensitivity to light (89 percent diagnosed vs. 72 percent undiagnosed)
-- Pain on one side of the head (64 percent diagnosed vs. 55 percent undiagnosed)
-- Nausea (80 percent diagnosed vs. 66 percent undiagnosed).—Despite advances in prescription medications designed specifically to treat migraine, 57 percent of migraine headache sufferers report still using only over-the-counter (OTC) medications for treatment, virtually the same percentage as 10 years ago (59 percent).

“In the past, narcotic medications were widely used for migraine. Narcotics relieve pain, but often produce disabling sedation. The new generation of medicines, known as triptans, relieve pain and restore people’s ability to function, allowing people to get back to their lives,” says Richard B. Lipton, M.D., Professor of Neurology, Epidemiology and Social Medicine, at Albert Einstein College of Medicine and lead researcher of the study.

In response to this study’s findings, the National Headache Foundation convened a meeting of professional and consumer medical organizations. The groups are now calling for a renewed commitment to the diagnosis and treatment of migraine from healthcare professionals and better education of patients.

Narcotic Pain Medications

Fears of addiction may be leading to underdosing and underutilization of effective narcotic pain management strategies for a variety of medical conditions.

“You will not make any patient an addict if you give them drugs to treat their pain,” says Henry Farkas, MD, MPH, Medical Director of the Northern Chesapeake Hospice and a staff physician at Union Hospital, in Elkton, MD.

Speaking at the 6^th Annual Scientific Assembly of the American Academy of Emergency Medicine, he cited a very large study done in the 1980s, which found that only four patients became addicted out of 12,000 treated with opiates for pain. “It’s just not a problem for more than 99 percent of people,” he said. He spoke of underdosed patients returning for additional medication and physicians interpreting this as a predisposition towards addiction. Also citing patient fears of addiction, Dr. Farkas spoke of needing to better educate patients and to consider time-release or concommitant administration of other pain medications focused on the specific type of pain to better address patient needs for pain relief.

Aspirin 

Despite evidence and widespread advertising stating that aspirin is an effective adjunct to managing coronary artery disease, aspirin use in such patients is low, according to a recent study from the Massachusetts General Hospital (MGH). The report, appearing in the March 14 issue of Circulation: Journal of the American Heart Association, looked at physician-reported rates of aspirin use in patients with coronary artery disease.

Analysis of 10,942 office visits of patients with coronary artery disease found that reported aspirin use had increased from 5 percent of patients in 1980 to 26 percent in 1996. The that more men than women reportedly took aspirin. Cardiologists were slightly more likely than primary care physicians to recommend aspirin to patients.

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