12 OPIOID ALTERNATIVES

12 OPIOID ALTERNATIVES BEING PUSHED ON PAIN PATIENTS... INSTEAD OF THE OPIOID PRESCRIPTION THAT ONCE MANAGED THEIR PAIN

1.   RADIOFREQUENCY ABLATION

INFO & BENEFITS:   Radio-frequency ablation disrupts nerve conduction, specifically interrupting the conduction of pain signals. In turn, this may reduce pain, and other related symptoms. Approximately 70 percent of patients will get a good block of the intended nerve. This should help relieve that part of the pain that the blocked nerve controls. Sometimes after a nerve is blocked, it becomes clear that there is pain from the other areas as well* (*In other words wrong spot, another injection, another time)

OUTCOME:   The nerves are usually blocked for 6-9 months, although it may last as short as 3 months or as long at 18 months or longer.

SUCCESS RATE:  about 30% to 50% of patients that undergo this procedure for low back pain experience significant pain relief for up to two years. Out of the remaining 50-70%, about 50% of those patients will get some pain relief for a shorter period.

DISADVANTAGES/RISKS:   Nerves regenerate over time, causing the alleviated pain to return.

The nerves to be ablated may be near blood vessels or other nerves that can be potentially damaged.

COST*:   Cervical--  $ 4,000.00      Lumbar or Thoracic--  $ 4,650.00

Links:  http://www.medcentral.org/Main/RadiofrequencyAblation.aspx

 2.   NERVE BLOCK AKA EPIDURAL INJECTION (BANDAID?)

INFO & BENEFITS:   An epidural steroid injection (ESI) treats inflammation associated with back pain, as well as related pain in the neck, legs, or arms. An epidural procedure delivers powerful anti-inflammatory medicine directly into the epidural space. The steroid (cortisone) will usually begin working within 1-3 days, but in some cases it can take up to a week to feel the benefits. Although steroids do not change the underlying condition, they can break the cycle of pain and inflammation, allowing the body to compensate for the condition.

OUTCOME:   Although steroids do not change the underlying condition, they can break the cycle of pain and inflammation, allowing the body to compensate for the condition. While the effects of an epidural steroid injection tend to be temporary (lasting from a week to up to a year)

SUCCESS RATE:  50% of patients receive some pain relief as a result of lumbar epidural steroid injections. Depending on the study these rates are highly debatable. Some state 80-90% however that was in comparison to Placebo. It is very important that you research and know what type of steroid is being injected. See Dr. Oz’s In-Depth Investigation of Epidural Steroid Injections, be sure to read, do some research, and judge for yourself.

http://www.doctoroz.com/article/depth-investigation-epidural-steroid-injections?page=1

http://nationalpainreport.com/study-finds-nerve-blocks-risky-8823030.html

http://nationalpainreport.com/the-dark-side-of-epidurals-8816252.html

DISADVANTAGES/RISKS:   Steroid injections do not change the underlying condition. Most doctors limit patients to two or three injections per year, as having injections too often may weaken spinal bones or nearby muscles. Receiving higher doses of the steroids in these injections may cause similar problems. Overall we suggest you do your homework, be choosy, and do not get too many or you may be causing more damage.

COST*:   Epidural Injection* Cervical, Lumbar, or Thoracic, w/ general anesthesia $2,750 - $ 3,550, Sacroiliac (SI) Joint* $ 1,850-$ 2,650, Facet Injection* Cervical, Lumbar, or Thoracic with general anesthesia $3,050.00

* You can expect to pay about $800.00 less for local anesthesia vs. general

LINKS: http://www.spine-health.com/treatment/injections/epidural-steroid-injection-pain-relief-success-rates

https://www.epainassist.com/pain-management/intrathecal-pain-pump-the-cost-of-surgery-and-refill

 3.   SPINAL STIMULATOR or INTRATHECAL PAIN PUMP:

INFO & BENEFITS:   (aka neurostimulators or drug pumps) These devices are meant for chronic pain or severe spasticity that isn't responding to medication, or the side effects. The implantable device may help to manage nerve or chronic pain, and restore one’s ability to do everyday activities.

OUTCOME:   Provide pain relief around the clock with less side effects. They decrease the need for oral pain medications, and improve quality of life

SUCCESS RATE:  If you are selected and can get through the entire process studies show approximately 50% reduction in chronic pain. Multiple types of opioid medications are available for the device. Many report a much better quality of life however don’t get too excited until you read all the information and the links at the bottom.

http://professional.medtronic.com/pt/neuro/scs/eff/data-clinical-outcomes/index.htm#.WNY2kjvsLIU

DISADVANTAGES/RISKS:  PRICE! Very costly! The process is absolutely tedious. Two surgeries one minor for trial (outpatient) the other more involved for the insertion. There is a 1 in 20 chance of death from overdose. After researching you will probably be scared and should be, the stories from patient complications are nothing short of a nightmare… while awake. Complications are not uncommon. The pumps do not last forever so you can expect to go through this multiple times. There is only one company that makes the pumps and there are very few if any long term studies.

COST*:   The newer devices can cost $20,000. That is just the device. One report showed over two years the expense would run $60-85,000.00

http://www.medtronic.com/us-en/patients/treatments-therapies/drug-pump-chronic-pain/getting-a-device/drug-pumps-questions-answers.html#question8

http://www.healthcentral.com/chronic-pain/c/915283/142528/intrathecal/

http://nationalpainreport.com/medtronic-pain-pump-blamed-for-14-deaths-8820647.html

https://www.epainassist.com/pain-management/intrathecal-pain-pump-trial-and-its-contraindications

https://www.epainassist.com/opioid-treatment/interventional-treatment/pump-implant-pain-medications

https://www.ncbi.nlm.nih.gov/pubmed/9932882

https://www.ncbi.nlm.nih.gov/pubmed/9083712

4.   ACUPUNCTURE:

INFO & BENEFITS:   Acupuncture involves the insertion of extremely fine needles into the skin at specific "acupoints." This may relieve pain by releasing endorphins, the body's natural pain-killing chemicals, and by affecting the part of the brain that governs serotonin, a brain chemical involved with mood. No drugs. Natural. Many pain management offices are now including this option within their own practice.

OUTCOME:   Varies widely. I remember years ago doctors and surgeons alike would dismiss any discussions or thoughts of using an acupuncturist and chiropractor. Today, we often wonder if the new acupuncture option at pain management is money driven. The procedure is now FDA approved.

SUCCESS RATE:  Success stories vary, some say it helps others say it doesn’t do a thing. Studies are the same with nothing concrete.

DISADVANTAGES/RISKS:  Although FDA approved, some states do not have any licensing requirements for acupuncturist so do your homework. Many patients will need to pay out of pocket. Ouch, for chronic pain 12-20 sessions are generally recommended.

COST*:   Generally $60.-$120.00 per treatment. Not covered by Medicare and many insurances

LINKS:             http://www.health.harvard.edu/healthbeat/relieving-pain-with-acupuncture

https://www.painscience.com/articles/acupuncture-for-pain.php

https://acupuncturenowfoundation.org/2016/03/one-two-three-four-how-many-sessions-more/

5.   CHIROPRACTIC CARE:

INFO & BENEFITS:   Chiropractors use hands-on spinal manipulation and other alternative treatments, the theory being that proper alignment of the body's musculoskeletal structure, particularly the spine, will enable the body to heal itself without surgery or medication. Years ago Surgeons would dismiss any thoughts or questions regarding a chiropractic care. I personally received my first diagnosis of scoliosis and leg length inequality at 17 from a chiropractor. Doctors and the schools missed this so

OUTCOME:   Considered a safe, effective treatment for acute low back pain, the type of sudden injury that results from moving furniture or getting tackled.  Many have also had success in relieving headaches. Many get relief but once things get severe there is only so much they can do to help. They can help keep your pain minimal especially those with basic pains.

It is not for everyone, people who have osteoporosis, spinal cord compression, or inflammatory arthritis, or who take blood-thinning medications should not undergo spinal manipulation.

SUCCESS RATE:  Success for those with acute pain shows a good amount of happy patients. Acute meaning pain from getting tackled or from a of sudden injury that results from moving furniture   Because there’s such a broad range of reasons one may see a chiropractor here are some of the medical research and studies regarding the therapeutic benefits of chiropractic.

https://draxe.com/10-researched-benefits-chiropractic-adjustments/

Unfortunately that’s not great news for those patients with lifelong chronic pain.

DISADVANTAGES/RISKS:  Not covered by many insurances and those that do have a cap. It is not for everyone.

COST*:   $30-$200.00- with the average session being about $65.00

LINKS:             http://www.webmd.com/pain-management/guide/chiropractic-pain-relief#1

https://draxe.com/10-researched-benefits-chiropractic-adjustments/

 6.   PHYSICAL THERAPY

INFO & BENEFITS:   The goals of physical therapy are to decrease pain, increase function, and teach the patient a maintenance program to prevent future problems. ... Passive physical therapy (modalities), which includes things done to the patient, such as heat application, ice packs and electrical stimulation.

OUTCOME:   You will learn how to properly do exercises and what at home treatments will help with the pain you are having and relieve that pain. After a surgery physical therapy is used to get you moving again.

SUCCESS RATE:   It really depends on the patient’s issue, on average 50% is a safe estimate. Here’s an interesting and recent article.

www.thegoodbody.com/physical-therapy-statistics-and-facts/

DISADVANTAGES/RISKS:  Some patients spend a lot of time doing therapy when they really should have had an MRI and surgery first. Many insurances are very picky about the order doctors are dealing with pain, requiring this before that and so on, which can be very frustrating to patients in a lot of pain.

COST*:   Most insurances will cover some physical therapy and HMOs are required to cover it. http://www.thegoodbody.com/physical-therapy-statistics-and-facts/

LINKS: http://www.spine-health.com/treatment/physical-therapy/physical-therapy-low-back-pain-relief

7.   NSAIDS ASPIRIN & IBUPROPHEN

INFO & BENEFITS:   OTC, Non-steroidal anti-inflammatory drugs, known as NSAIDs, are more than just pain relievers. They also reduce inflammation and lower fevers. A recent study published in Lancet found that NSAIDs are effective in relieving pain, but prevent blood from clotting. So using them can put patients at an increased risk for heart attack and stroke, as well as gastrointestinal problems and ulcers.

OUTCOME & DISADVANTAGES/RISKS:  Many of the pain patients I spoke to consider this option “laughable” and feel insulted at the provider’s suggestion. I agree, these patients are very familiar with these OTC drugs and will never get nearly the amount of pain relief needed. They may not have a stomach left if they tried. Patients do use this when needed for certain types of pain but not for chronic pain.

COST*:   Minimal, OTC, out of pocket

 8.   ACETAMINOPHEN:

INFO & BENEFITS:   OTC, The generic version of Tylenol is easily obtained over the counter and is often used for patients who don't take NSAIDs because of stomach irritation or worries about heart attacks. Like NSAIDs, acetaminophen is useful in relieving pain, but more than 4000 mg should not be taken in 24 hours or acute liver failure may occur.

OUTCOME & DISADVANTAGES/RISKS:  Many of the pain patients I spoke to consider this option “laughable” and feel insulted at the provider’s suggestion. I agree, these patients are very familiar with these OTC drugs and will never get nearly the amount of pain relief needed. They may not have a stomach left if they tried. Patients do use this when needed for certain types of pain but not for chronic pain.

COST*:   Minimal, OTC, out of pocket

9.   ANTICONVULSANTS:

INFO & BENEFITS:   Anticonvulsant medications are effective in treating neuropathic pain conditions, which can cause burning and shooting sensations, according to the American Chronic Pain Association. Gabapentin (Neurontin) has been shown to be effective in high dosages, according to the American Academy of Family Physicians, but can cause dizziness, headache, diarrhea and confusion. Although anticonvulsants are not habit-forming, the American Chronic Pain Association advises against abrupt discontinued use. The medication is intended to be taken every day, whether or not the patient is experiencing pain.

OUTCOME:   Some relief from nerve pain and the unpredictable sensations they cause. Please research this drug prior to long term use and high doses.

SUCCESS RATE:   Rated fairly low for pain on drugs.com 6.5 out of 10 for pain, some patients love it and others are ready to scream and have no relief at all. Neuropathy (nerve pain) gets a 6.3 and restless leg was the highest of these at 6.7 out of 10 when this was written.

DISADVANTAGES/RISKS:  Gabapentin is not approved by the FDA for many of the conditions patients are reporting it is being prescribed for. The drug is only approved to treat a handful of conditions such as Epilepsy, Postherpetic Neuralgia, and

Restless Legs Syndrome. Also nerve pain caused by herpes virus or shingles. Certain brands can treat something the other can’t so be careful with this one and look it up.

https://www.drugs.com/gabapentin.html

COST*:   Should be covered by most insurances.

LINKS:  PLEASE READ THIS ONE         https://www.peoplespharmacy.com/2012/05/26/gabapentin-side-effects/

http://www.medicaldaily.com/gabapentin-side-effects-dangers-label-prescriptions-surprising-side-effects-403998

 10.        ANTIDEPRESSANTS:

An increasing number of providers are suggesting antidepressants for those with chronic pain even if they are not depressed. Many are pointing to Cymbalta. In adults it is used to treat major depressive disorder, general fibromyalgia (a chronic pain disorder), and chronic muscle or joint pain (such as low back pain and osteoarthritis pain). Cymbalta is also used to treat pain caused by nerve damage from diabetic neuropathy. There are a host of side effects, some make it much less appealing. For those fortunate enough to also have the option and access to medical marijuana, you are envied by many and may prefer it as an effective alternative to all the side effects of the antidepressants and nerve issues. Tricyclic antidepressants, such as Amitriptyline, Imipramine and Clomipramine, are particularly effective in treating neuropathic pain. But a study published in Psychiatry (Edgmont) found that tricyclic antidepressants can cause a host of side effects, including weight gain and cardiovascular problems. Cymbalta is FDA approved to treat chronic and musculoskeletal pain.

BENEFITS:   Cymbalta is FDA approved to treat many chronic pain and chronic musculoskeletal pain disorders.

OUTCOME:   Patients vote this a 6.7 out of 10, some are saying risks outweigh the benefits.

SUCCESS RATE:  Overall patients vote this a 6.7 out of 10, the link below breaks them down by condition.  https://www.drugs.com/comments/duloxetine/cymbalta.html

DISADVANTAGES/RISKS:  Very difficult to discontinue, when you do it must be managed by a physician. Cymbalta comes a long list of not so appealing side effects and unfortunately there are very few long term studies.  I found one from patients with over 2500 reviews, you may want to check this out. http://www.askapatient.com/viewrating.asp?drug=21427&name=CYMBALTA

If you are not opposed to Medical Marijuana those that live in approved states may want to read up on it.            https://www.painnewsnetwork.org/stories/2017/2/27/pain-patients-prefer-marijuana-over-opioids

COST*:   Should be covered by most insurances.

LINKS: https://www.drugs.com/cymbalta.html

https://www.bostonglobe.com/metro/2016/09/17/rejecting-opioids-pain-patients-find-relief-with-marijuana/WGJlr7Q5TEh4XDp6N4vZQJ/story.html

https://www.theatlantic.com/health/archive/2017/02/marijuana-cannabinoids-opioids/515358/

http://www.webmd.com/pain-management/news/20151007/medical-marijuana-seems-safe-for-chronic-pain-patients-study-finds#1

11.COGNITIVE BEHAVIORAL THERAPY:

Seeing a mental health counselor (psychotherapist or therapist) because they say “Many people with unrelenting chronic pain can feel hopeless”. Cognitive behavioral therapy can help them practice “acceptance theory," which can lead to changed behaviors and perceptions.

BENEFITS:  CBT works by enhancing coping skills, increasing confidence and self-efficacy for managing pain and dealing with emotional problems.
SUCCESS RATE:  Minimal at best for pain, but may give some patients a better outlook on how to handle it. Possibly they will meet others or have a support system in place for bad days.

DISADVANTAGES/RISKS:  Cost, and Can be time consuming. Outpatient therapy can last 5-10 months, with one 50 minute session per week. Partial Inpatient 3-4 weeks (daily for 8 hours, then home in evenings)

Inpatient varies from 30-90days depending on diagnosis and if addiction is involved.

The biggest disadvantage is the pain that sent you there.

COST*:   Medicare will only cover a few visits under certain situations and only for certain reasons or disorders. Some addiction is covered but not many basic mental health. You would need to check with your insurance company, some do and some don’t, but most have limitations.

LINKS:             https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/

https://www.apa.org/pubs/journals/releases/amp-a0035747.pdf

http://my.clevelandclinic.org/health/articles/chronic-pain-rehabilitation

https://patient.info/health/cognitive-behavioural-therapy-cbt-leaflet

12.        QUELL:

We’re adding this one since maybe some of you haven’t heard of it yet. Quell is a TENS unit worn below the knee that stimulates nerves, blocks pain signals from reaching your brain, and claims drug free relief in as little as 15 minutes. Quell claims to provide intensive nerve stimulation technology and to be 5x more powerful than other leading over-the-counter pain relief devices. It can be customized and automatically adjusts therapy so that you receive optimal pain relief. Quell can be used alone but was designed to be used in conjunction with other therapies. Quell is used for the following… Nerve Pain, Arthritic & Joint Pain, Leg & Foot Pain, Lower Back, and Widespread Pain.

BENEFITS:   No Prescription, 60 day trial period w/ a money back guarantee. 100% drug free.

OUTCOME:   Some patients are getting relief.

SUCCESS RATE:  We’ve included links so you can see if success stories include your condition.

DISADVANTAGES/RISKS:  PRICE, OTC, not covered by Medicare or insurance. Those with severe pain may incur higher monthly costs and may need other therapies to use in conjunction. At this time there were 2-3 of the monthly electrode products out of stock.

COST*:   All costs will be out of pocket, it is over the counter and not covered by insurances. $250.00 for the unit plus monthly maintenance of about $30.00 for electrodes which may increase as you become accustomed to it. There are also other accessories which may increase costs.

LINKS:             https://www.quellrelief.com/

There are a lot of reviews on amazon you can see for yourself here…

https://www.amazon.com/Quell-Wearable-Pain-Relief-Starter/dp/B01GLHM9NG/ref=sr_1_1_a_it?ie=UTF8&qid=1490427495&sr=8-1&keywords=quell+device

Here are some additional links definitely worthwhile reading:

-          http://drugabuse.com/opiate-alternatives-doctors-got-a-brand-new-bag/

-          https://www.painnewsnetwork.org/stories/2016/10/25/unwilling-to-suffer-in-silence-over-cdc-opioid-guidelines

-          https://pricinghealthcare.com/healthServices/

Can Chronic Pain Cause Suicidal Thoughts?

-          https://www.epainassist.com/pain-management/can-chronic-pain-cause-suicidal-thoughts

We hope that you have found some information and answers so that you can make better decisions and so that have access to information other than what may have been discussed or provided to you. Many of these alternatives are being offered to opioid pain patients instead of the opioids that once managed their pain. Many providers are not offering a choice to the patient. So the patient hears “we will not write you any narcotic opioid prescriptions, so now you have these options. We try to show you the basic Benefits, cost and Risks and provide you with links to the information/studies we found online. They will provide full details and/or study results.

www.Opioidpainpatients.com/12-opioid-alternatives-being-pushed-on-pain-patients

Visit us on Facebook: www.facebook.com/opioidpainpatients/

 

3 thoughts on “12 Opioid Alternatives Being Pushed On Pain Patients”

  1. I believe everything wrote made a ton of sense. However, what about this?
    what if you were to create a awesome title? I am not
    saying your content is not solid, but suppose you added a headline that grabbed a person’s attention? I mean 12 Opioid Alternatives Being Pushed On Pain Patients –
    Pain Patients UNITE is kinda vanilla. You should peek at Yahoo’s front page and note how they create post headlines to get viewers
    interested. You might add a video or a picture or two to get readers interested about everything’ve got to say.
    In my opinion, it could make your posts a little livelier.

  2. Excellent blog! Do you have any helpful hints for aspiring writers?

    I’m planning to start my own website soon but I’m a little lost
    on everything. Would you suggest starting
    with a free platform like WordPress or go for a paid option? There are so many options out there
    that I’m totally overwhelmed .. Any ideas? Thanks a
    lot!

  3. I like the valuable info you provide in your articles.
    I’ll bookmark your weblog and check again here regularly.
    I am quite certain I will learn a lot of new stuff right here!
    Good luck for the next!

  4. Practice Exam Software:
    The practice software comes in multiple various verified mock exams that are constantly updated with
    relevant questions to simulate the real exam scenarios. The practice software can keep all your
    previous exam attempts as history and display the changes/improvements at the end of each exam attempt.

    Customers will be able to customize the practice software by time
    or question types. company designed the practice software to be supported on all Windows-based platforms

  5. I think that everything said was actually very reasonable.
    However, think on this, what if you added a little information? I mean, I don’t want to tell you how to run your website,
    but suppose you added a post title that grabbed people’s attention? I mean 12 Opioid Alternatives Being Pushed
    On Pain Patients – Pain Patients UNITE is a little boring.
    You should glance at Yahoo’s home page and note how they create post titles to get viewers interested.

    You might try adding a video or a picture or two to get readers excited about everything’ve got
    to say. Just my opinion, it would make your posts a little bit
    more interesting.

  6. Hey There. I found your blog using msn. This is a really well written article.
    I will make sure to bookmark it and return to read more of
    your useful information. Thanks for the post. I’ll definitely return.

  7. I think that what you said made a great deal of
    sense. But, consider this, what if you wrote a catchier title?

    I am not saying your information isn’t good., however
    what if you added a headline that grabbed folk’s attention? I mean 12 Opioid
    Alternatives Being Pushed On Pain Patients – Pain Patients UNITE
    is kinda boring. You ought to glance at Yahoo’s home page and note
    how they create news headlines to get viewers to click. You might
    try adding a video or a related picture or two to grab people excited about everything’ve got to say.

    In my opinion, it could make your blog a
    little bit more interesting.

  8. Hey! Someone in my Myspace group shared this site with us
    so I came to look it over. I’m definitely loving the information. I’m book-marking and will be tweeting this to my followers!
    Outstanding blog and terrific design and style.

  9. Pingback: LostFilm HD 720
  10. Pingback: kinosmotretonline
  11. Pingback: HDrezka
  12. Pingback: movies hdrezka
  13. Pingback: dorama hdrezka
  14. I think that is among the most significant info for me.
    And i’m satisfied studying your article. But should commentary on some common things, The web site style is perfect, the articles is truly nice : D.
    Good job, cheers

  15. Wonderful article! That is the kind of info that are supposed to be shared across the
    internet. Shame on the seek engines for now not positioning this post higher!
    Come on over and seek advice from my web site . Thanks =)

  16. I cherished as much as you will receive carried out right here.

    The comic strip is tasteful, your authored subject matter stylish.
    nonetheless, you command get bought an nervousness over that you want be turning in the following.
    in poor health no doubt come more before again since
    exactly the same just about very frequently inside case you defend this increase.

  17. Great article! That is the type of info that are meant to be shared around the internet.
    Shame on Google for no longer positioning this put up
    higher! Come on over and visit my web site . Thanks =)

  18. Pingback: cerialest.ru
  19. I liked up to you will obtain carried out proper here.
    The sketch is tasteful, your authored material stylish.
    nevertheless, you command get got an nervousness over that you would like be delivering the following.
    sick surely come more previously once more as exactly the same nearly a lot incessantly inside case you shield this hike.

  20. Keep up the wonderful piece of work, I read few articles
    on this website and I think that your web blog is really interesting and has got sets
    of wonderful info.

  21. Hello There. I found your blog using msn. This is a
    really well written article. I will make sure to bookmark it and come back to read more of your useful information. Thanks for the post.
    I’ll certainly comeback.

  22. Undeniably imagine that that you stated. Your favorite justification seemed to be on the
    net the easiest thing to remember of. I say to you, I definitely get annoyed even as folks consider worries that they plainly don’t understand about.
    You controlled to hit the nail upon the top as well as outlined out the entire thing without having side-effects ,
    folks can take a signal. Will likely be back to get more.
    Thanks

  23. I beloved as much as you’ll obtain performed proper here.
    The comic strip is tasteful, your authored subject matter stylish.

    however, you command get got an nervousness over
    that you would like be delivering the following.
    unwell undoubtedly come further until now once more since exactly the same nearly a
    lot incessantly inside case you shield this hike.

  24. Pingback: serial
  25. Pingback: kinokrad-2019
  26. Pingback: filmy-kinokrad
  27. Pingback: casino
  28. Have you ever considered creating an ebook or guest authoring on other websites?
    I have a blog centered on the same ideas you discuss and
    would love to have you share some stories/information. I know my visitors would enjoy
    your work. If you’re even remotely interested, feel free
    to send me an email.

  29. Do you mind if I quote a few of your articles as long as I provide credit and
    sources back to your blog? My website is in the exact same niche as yours and my
    users would truly benefit from some of the information you present here.
    Please let me know if this ok with you. Thanks a lot!

  30. Pingback: Watch TV Shows
  31. Having read this I thought it was very enlightening.
    I appreciate you spending some time and energy to put this short article together.
    I once again find myself spending a significant amount of time both reading and posting comments.

    But so what, it was still worth it!

  32. I think what you published was very logical. However, what about this?
    what if you typed a catchier post title? I ain’t suggesting your information is not good, however suppose you added a
    title to maybe grab folk’s attention? I mean 12 Opioid Alternatives Being Pushed On Pain Patients – Pain Patients UNITE is kinda vanilla.
    You should peek at Yahoo’s front page and see how they write news titles to get people interested.
    You might try adding a video or a related pic or two to grab readers interested about everything’ve got to
    say. In my opinion, it would bring your blog a little livelier.

  33. Hello There. I found your blog using msn. This is a very well written article.
    I’ll make sure to bookmark it and return to read
    more of your useful info. Thanks for the post.

    I will definitely comeback.

  34. Pingback: kinokrad 2020
  35. Pingback: kinokrad
  36. Pingback: Serial smotret
  37. Hello very nice blog!! Guy .. Beautiful .. Superb ..
    I’ll bookmark your website and take the feeds also? I am satisfied to find so many
    helpful info right here within the publish, we want develop more techniques on this regard, thanks for sharing.
    . . . . .

  38. I was just searching for this info for a while.
    After six hours of continuous Googleing, finally I got it in your site.
    I wonder what’s the lack of Google strategy that do not rank
    this kind of informative web sites in top of the list.
    Normally the top websites are full of garbage.

  39. I was just seeking this information for a while. After 6 hours of continuous Googleing, finally I
    got it in your site. I wonder what is the lack of Google strategy that do not rank this type
    of informative web sites in top of the list.

    Normally the top web sites are full of garbage.

  40. I was just searching for this info for a while. After 6 hours of continuous Googleing, finally I got it in your website.

    I wonder what’s the lack of Google strategy that do not rank this kind of informative web sites in top of the list.
    Normally the top web sites are full of garbage.

  41. I was just seeking this info for a while. After 6 hours of continuous Googleing,
    finally I got it in your web site. I wonder what is the lack of Google strategy that do not rank this type of informative websites
    in top of the list. Usually the top web sites are full of garbage.

  42. Pingback: 11 10 2019
  43. I believe this is among the such a lot vital info for me.
    And i am satisfied studying your article. But want to commentary on few common issues,
    The site taste is ideal, the articles is truly nice :
    D. Good process, cheers

  44. Pingback: Movies1
  45. Pingback: Top Movies
  46. Pingback: karan johar
  47. Pingback: movies online
  48. Pingback: movies
  49. Howdy very cool website!! Guy .. Excellent .. Superb .. I’ll
    bookmark your blog and take the feeds additionally?

    I’m glad to search out numerous useful information here in the submit, we’d
    like develop more strategies on this regard, thanks for sharing.
    . . . . .

  50. Sweet blog! I found it while searching on Yahoo News. Do
    you have any suggestions on how to get listed in Yahoo News?
    I’ve been trying for a while but I never seem to get
    there! Cheers

  51. I was just seeking this information for some time.
    After 6 hours of continuous Googleing, at last I got it in your web site.

    I wonder what is the lack of Google strategy that don’t rank this kind of informative web sites in top of the list.
    Generally the top websites are full of garbage.

  52. Hiya very cool web site!! Guy .. Beautiful .. Superb
    .. I’ll bookmark your web site and take the
    feeds additionally? I’m glad to find so many helpful info here in the submit,
    we want work out more techniques in this regard, thank you
    for sharing. . . . . .

  53. Hi there very nice web site!! Man .. Beautiful .. Superb
    .. I will bookmark your website and take the feeds additionally?
    I am glad to search out a lot of helpful information here in the publish, we
    want work out extra techniques in this regard, thanks for sharing.
    . . . . .

  54. I believe what you posted was actually very logical.
    But, consider this, what if you typed a catchier title? I
    am not suggesting your information is not solid., however what if you added a title that grabbed a person’s attention? I
    mean 12 Opioid Alternatives Being Pushed On Pain Patients – Pain Patients UNITE is kinda
    boring. You should peek at Yahoo’s front page and see how they
    create news titles to grab viewers to open the links.
    You might add a video or a related picture or two to
    get readers excited about what you’ve written. Just my
    opinion, it might make your posts a little bit more interesting.

  55. I like what you guys are up also. Such clever work and reporting!
    Keep up the superb works guys I have incorporated you guys to my blogroll.
    I think it’ll improve the value of my web site :).

  56. As I site possessor I believe the content material here is rattling wonderful
    , appreciate it for your hard work. You should keep it up forever!
    Good Luck.

  57. Heya i’m for the first time here. I found this
    board and I find It really useful & it helped me out much.
    I hope to give something back and help others like you
    aided me.

  58. I don’t even know the way I finished up right here,
    but I thought this put up was once good. I don’t know who
    you are but definitely you are going to a famous blogger in case you are not
    already. Cheers!

  59. Superb blog! Do you have any suggestions for aspiring writers?
    I’m planning to start my own blog soon but I’m a little lost on everything.
    Would you recommend starting with a free platform like WordPress or go for a paid option?
    There are so many choices out there that I’m totally overwhelmed
    .. Any suggestions? Appreciate it!

  60. I like what you guys are up too. Such smart work and reporting!
    Carry on the superb works guys I’ve incorporated you guys
    to my blogroll. I think it’ll improve the value of my website
    :).

  61. Hey there! I could have sworn I’ve been to this site before
    but after reading through some of the post
    I realized it’s new to me. Anyways, I’m definitely delighted I found it
    and I’ll be bookmarking and checking back frequently!

  62. I like the valuable info you supply on your articles.
    I’ll bookmark your blog and test again right here regularly.
    I’m rather sure I’ll be informed many new stuff proper right here!
    Best of luck for the following!

  63. Hi there very nice site!! Man .. Beautiful .. Superb ..
    I will bookmark your site and take the feeds also? I’m
    satisfied to search out numerous useful info right here within the submit, we’d like work out more techniques in this regard, thank you for sharing.
    . . . . .

  64. Hi, Neat post. There is a problem along with your website
    in web explorer, could test this? IE nonetheless is the market leader and a
    big element of folks will omit your magnificent writing due to this problem.

  65. Hello! Someone in my Facebook group shared this site with us so I came to check it out.

    I’m definitely loving the information. I’m book-marking and will
    be tweeting this to my followers! Great blog and outstanding style and design.

  66. I like the valuable info you supply on your articles.
    I will bookmark your weblog and check once more right here
    frequently. I am moderately sure I’ll learn plenty of new stuff proper right
    here! Good luck for the next!

  67. I like what you guys are up too. Such intelligent work and reporting!
    Carry on the excellent works guys I’ve incorporated you guys to my blogroll.
    I think it’ll improve the value of my web site :).

  68. I beloved up to you’ll obtain performed right here.
    The cartoon is attractive, your authored subject matter stylish.

    nevertheless, you command get got an shakiness over that
    you want be handing over the following. sick indisputably come more previously once
    more since precisely the same nearly a lot often inside case you shield this
    increase.

  69. Terrific work! That is the type of info that are meant to be shared around the web.
    Shame on the search engines for now not positioning this
    submit higher! Come on over and talk over with my site .
    Thank you =)

  70. Hey would you mind stating which blog platform you’re using?
    I’m looking to start my own blog soon but I’m having a difficult time deciding between BlogEngine/Wordpress/B2evolution and Drupal.
    The reason I ask is because your design seems different then most blogs and I’m looking for something completely unique.
    P.S My apologies for being off-topic but I had to ask!

  71. I know this web site provides quality dependent articles or reviews and other data, is there any other web site which offers these kinds of things in quality?

  72. I think everything said made a bunch of sense.
    But, what about this? suppose you were to create a killer title?

    I mean, I don’t want to tell you how to run your website,
    but suppose you added a title to possibly get folk’s attention? I mean 12 Opioid Alternatives Being Pushed On Pain Patients –
    Pain Patients UNITE is kinda vanilla. You ought to peek at Yahoo’s home page and watch
    how they create post titles to get viewers to open the
    links. You might add a video or a pic or two to grab people excited about everything’ve
    written. Just my opinion, it would bring your posts
    a little bit more interesting.

  73. I believe everything said made a bunch of sense. But, consider this, what if you were to write a awesome headline?

    I am not suggesting your information isn’t good., but suppose
    you added a title that makes people desire more? I mean 12 Opioid Alternatives Being Pushed On Pain Patients – Pain Patients
    UNITE is kinda vanilla. You could peek at Yahoo’s front page
    and see how they create news headlines to grab people
    to open the links. You might add a related video
    or a picture or two to get people interested about everything’ve got to say.
    In my opinion, it might bring your posts a little livelier.

  74. I loved as much as you will receive performed proper
    here. The sketch is attractive, your authored subject matter stylish.
    nevertheless, you command get got an nervousness over that you would like be delivering the following.
    ill indisputably come more in the past again as precisely the similar nearly very often inside case you
    shield this increase.

  75. I was just seeking this info for a while. After six hours
    of continuous Googleing, finally I got it in your
    website. I wonder what’s the lack of Google strategy that do not rank this kind of
    informative sites in top of the list. Usually the top web sites are full of garbage.

  76. I believe what you published was actually very reasonable.

    But, consider this, what if you typed a catchier
    title? I ain’t suggesting your information is
    not solid., however suppose you added a post title to maybe get people’s
    attention? I mean 12 Opioid Alternatives Being Pushed On Pain Patients – Pain Patients UNITE is kinda plain. You could peek at Yahoo’s front page and watch how they create news titles to grab viewers to click.
    You might add a video or a pic or two to get people excited about
    everything’ve written. Just my opinion, it might make your blog
    a little livelier.

  77. Hi! Someone in my Myspace group shared this website with
    us so I came to check it out. I’m definitely loving the information. I’m book-marking and
    will be tweeting this to my followers! Terrific blog and great
    design.

  78. Great article! That is the kind of information that
    are meant to be shared around the web. Disgrace on Google for now not positioning this post upper!
    Come on over and visit my website . Thanks =)

  79. I loved up to you will receive carried out right here. The caricature is tasteful, your authored material stylish.
    nonetheless, you command get bought an nervousness over that you
    want be delivering the following. sick undoubtedly come further formerly once more
    as precisely the similar nearly a lot continuously inside case you defend
    this hike.

  80. Hi there, i read your blog occasionally and i own a similar one and i was just curious if you get a lot of spam
    comments? If so how do you protect against it, any plugin or anything you can recommend?

    I get so much lately it’s driving me crazy so any assistance is very much appreciated.

  81. Hi! This post could not be written any better! Reading through this post reminds
    me of my good old room mate! He always kept talking about this.
    I will forward this article to him. Pretty sure he
    will have a good read. Thank you for sharing!

  82. I was just looking for this information for a while.

    After six hours of continuous Googleing, finally
    I got it in your site. I wonder what’s the lack of Google strategy that don’t rank this kind of informative sites in top of the list.
    Normally the top websites are full of garbage.

  83. Hey! Someone in my Facebook group shared
    this website with us so I came to check it out. I’m definitely enjoying the information. I’m book-marking and will be tweeting
    this to my followers! Superb blog and amazing
    style and design.

  84. I blog frequently and I really appreciate your information. This article has truly peaked my interest.
    I will bookmark your site and keep checking for new details about once per week.
    I subscribed to your RSS feed too.

  85. Hey very nice website!! Man .. Excellent .. Wonderful ..

    I’ll bookmark your site and take the feeds additionally?
    I’m happy to find numerous useful information right here within the put up, we want work out more techniques on this regard, thanks for sharing.
    . . . . .

  86. Magnificent goods from you, man. I have understand your stuff previous
    to and you are just extremely magnificent. I really like what you’ve
    acquired here, really like what you’re saying and the way in which you say it.
    You make it entertaining and you still care for to
    keep it wise. I can’t wait to read much more from you.
    This is actually a great site.

  87. Nice blog right here! Additionally your website
    so much up fast! What web host are you the use of? Can I
    get your affiliate link for your host? I want my site
    loaded up as quickly as yours lol

  88. I cherished up to you will receive performed proper here.

    The sketch is attractive, your authored material stylish.

    nonetheless, you command get bought an edginess over
    that you want be delivering the following.
    sick indisputably come further beforehand again since precisely
    the same nearly a lot steadily within case you shield this increase.

  89. I was just searching for this info for some time.
    After six hours of continuous Googleing, finally I got it in your
    website. I wonder what is the lack of Google strategy that do
    not rank this kind of informative web sites in top of the list.

    Normally the top sites are full of garbage.

  90. Hello! Someone in my Facebook group shared this site with us so I came to look it over.

    I’m definitely loving the information. I’m book-marking and will be tweeting this to my followers!
    Fantastic blog and terrific design.

  91. It’s a shame you don’t have a donate button! I’d most certainly donate
    to this brilliant blog! I suppose for now i’ll settle for bookmarking and adding
    your RSS feed to my Google account. I look forward to new updates and will
    talk about this site with my Facebook group. Talk soon!

  92. Howdy! I know this is kind of off topic but I was wondering which blog platform are you using for this website?
    I’m getting fed up of WordPress because I’ve had issues with hackers and I’m looking at options for another platform.
    I would be awesome if you could point me
    in the direction of a good platform.

  93. A person necessarily assist to make seriously articles I would state.

    That is the first time I frequented your web page and so far?

    I surprised with the analysis you made to create this particular
    post incredible. Wonderful activity!

  94. Just want to say your article is as surprising. The clarity for
    your submit is simply nice and that i could suppose you’re
    knowledgeable in this subject. Fine with your permission let me to snatch your feed
    to stay updated with imminent post. Thank you 1,000,000
    and please carry on the gratifying work.

  95. Pingback: wwin-tv.com
  96. Pingback: Video
  97. Pingback: 2020
  98. Pingback: HD-720
  99. Pingback: ++++++
  100. Pingback: watch
  101. Pingback: +1+
  102. Pingback: 00-tv.com
  103. Pingback: tureckie_serialy
  104. Pingback: hs;br
  105. Pingback: we-b-tv.com
  106. Hello! Someone in my Facebook group shared this website with us so
    I came to take a look. I’m definitely enjoying the information. I’m book-marking
    and will be tweeting this to my followers! Excellent
    blog and wonderful design and style.

  107. Good day very nice web site!! Guy .. Excellent ..
    Amazing .. I’ll bookmark your web site and take
    the feeds additionally? I am satisfied to search out so
    many useful information right here within the publish, we’d like develop extra techniques on this regard,
    thank you for sharing. . . . . .

  108. What you published was actually very logical.
    However, think on this, what if you added a little content?
    I ain’t suggesting your information is not solid, however suppose you added a post title that makes people want more?
    I mean 12 Opioid Alternatives Being Pushed On Pain Patients –
    Pain Patients UNITE is a little vanilla. You ought to
    peek at Yahoo’s home page and note how they create post headlines to get viewers to
    open the links. You might try adding a video or a pic or
    two to get people excited about what you’ve got to say. In my opinion, it could bring your
    blog a little livelier.

  109. you’re actually a excellent webmaster. The website loading velocity is incredible.
    It sort of feels that you are doing any distinctive trick.
    Moreover, The contents are masterwork. you have done a magnificent activity in this subject!

  110. This design is spectacular! You most certainly know how to keep a reader entertained.
    Between your wit and your videos, I was almost moved to start my own blog (well, almost…HaHa!) Fantastic job.
    I really loved what you had to say, and more than that, how you presented it.
    Too cool!

  111. I like what you guys are up also. Such clever work and
    reporting! Keep up the superb works guys I’ve incorporated you guys to my blogroll.
    I think it’ll improve the value of my site :).

  112. Hey there! This post could not be written any better!
    Reading this post reminds me of my good old room mate!
    He always kept chatting about this. I will forward this
    page to him. Pretty sure he will have a good read. Many thanks for sharing!

  113. We stumbled over here from a different web page and thought I may as well check
    things out. I like what I see so i am just following you.
    Look forward to exploring your web page yet again.

  114. I like what you guys are up also. Such intelligent work and reporting!
    Keep up the excellent works guys I have incorporated you guys
    to my blogroll. I think it’ll improve the value of my website :).

  115. obviously like your website however you have to test the spelling on quite a few of your posts.

    Many of them are rife with spelling problems
    and I to find it very troublesome to inform the truth on the
    other hand I’ll certainly come again again.

  116. Hello! This is kind of off topic but I need some help from an established blog.
    Is it tough to set up your own blog? I’m not very techincal but I can figure things out pretty fast.
    I’m thinking about making my own but I’m not sure where to
    start. Do you have any ideas or suggestions?
    Appreciate it

  117. Admiring the time and effort you put into your website and detailed information you offer.
    It’s nice to come across a blog every once in a while that isn’t
    the same unwanted rehashed material. Wonderful read! I’ve saved your site and I’m including your RSS feeds to my Google account.
    pof natalielise

  118. Simply want to say your article is as amazing. The clarity in your post is simply great and
    i could assume you’re an expert on this subject.

    Well with your permission allow me to grab your feed to keep
    updated with forthcoming post. Thanks a million and please keep up the gratifying work.

  119. My brother recommended I may like this blog. He used to be totally
    right. This post actually made my day. You can not consider simply how
    so much time I had spent for this info! Thanks!

  120. Wonderful beat ! I would like to apprentice while you amend your
    website, how can i subscribe for a blog website?
    The account helped me a appropriate deal.
    I were tiny bit familiar of this your broadcast offered vivid clear concept