Pain Management

The Joint Commission of Hospital Accreditation requires hospitals to ask the patient for their level of pain, just subjectively. They require we use a 10-point scale, from 0 for no pain to 10 being the worst pain ever. I knew instinctively that this was a bad thing and would lead to more narcotic addiction, as it did eventually. But in our patients, the pain scores went down as we detoxified patients ...

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"I'm not impressed with his pain." "I only give Norco if I see a bone sticking out." "She says her pain is a 10/10 but ..."

On any given shift in the emergency room, I hear some version of these said by residents or fellow attendings. And whenever I hear these phrases, I think to myself, "When did we stop treating pain?"

I'm not talking about chronic pain. I feel terribly for ...

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I am a retired union plumber with the state of Illinois. I've had laparoscopic surgery on both knees, a lower back surgery that required two stainless rods, and I'm not sure how many screws, and three cervical fusions. I now suffer from neuropathy (nerve dysfunction) in my feet. They're painfully numb: A shoe could come off, and I wouldn't know it. I find it difficult to get around — not to ...

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About three years ago, I was chatting about pain with a friend at a social function, and she told me she was taking a prescribed opioid for her chronic pain. I quickly got the uncomfortable feeling in my stomach that comes from discussing and prescribing opioids in clinical practice. I responded with my concerns, based on solid scientific evidence: “Opioids aren’t really effective for the treatment of fibromyalgia, or chronic ...

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One of the most important purposes of a physician is to alleviate pain and suffering. Pain is the most common symptom prompting an emergency department (ED) visit. Emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad array of illnesses and injuries. It has been shown that emergency medicine providers are not necessarily good at treating patients uniformly. Since the 1990s, numerous ...

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I recently had the pleasure of interviewing famous television and film actress, Claudia Christian. She has played significant roles in many notable movies and shows, including lead roles in the long-running sci-fi series Babylon 5 and the Disney film, Atlantis: The Lost Empire. In our podcast interview, we discussed treating alcoholism using the FDA-approved drug, naltrexone. Why listen to an actress about medical treatment for addiction? First of all, doctors generally ...

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The younger you are when you are exposed to opioids, the higher the likelihood of addiction later in life. The prefrontal cortex is not fully formed until the age of 25. This means that alterations in the “feel-good” neurotransmitters, specifically dopamine (released by opioids), can have an effect that predisposes the person towards future opioid use. Because teenagers have an overactive impulse to seek pleasure and less ability to consider the ...

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Who remembers Jack Kevorkian, Doctor Death? He was found guilty in 1998 of second-degree murder. Still, it was because of his advocacy that the terminally ill patient's right to die by physician-assisted suicide was propelled into the public arena. And who can forget Brittany Maynard? It was her advocacy for physician-assisted suicide that reignited the debate on its legality in 2014 — ...

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You’ve probably heard this one in one format or another: kid gets wisdom teeth yanked, dentist prescribes a handful of Vicodin, next thing you know, he’s on the street busking for change to pay the man for the big H. Meanwhile, the dentist is on cruises paid by Big Pharma and taking kickbacks from his local drug dealers. This author is here to tell you that such yarns have probably been verified, ...

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Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15. She has had countless disappointing visits with doctors. Some said they couldn’t help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome. Pinkley has taken opioids a few times after surgeries, but they never helped her underlying pain, she said. “I hate ...

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“6 in 10 Kids Got Opioids After Tonsil Surgery, Study Says.” So screams the headline from The Daily Beast. "In the midst of the opioid crisis, doctors sent many kids home with oxycodone and hydrocodone," it goes on to say. Another example of scaremongering and sensational headlines, or is this something we should still be concerned about? Well, according to the actual article, there was no greater risks of complications ...

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Americans have always loved their medicines and sought them out actively to cure whatever ailed them. Their interest ranged all the way from "staying well" to "feeling better." Productivity in this hard-charging, pull yourself up by the bootstraps society required activity, and it's hard to be active when you're sick. In the 18th-century in Germany, England, France, and Switzerland, men practicing pharmacy saw their retail operations as the ...

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I sat in the back seat of a police patrol car handcuffed with a mind imprisoned by addiction. My day had finally arrived after months of a manhunt by state detectives for operating a fraudulent prescription enterprise to support my obsession and compulsion with cocaine. No more unmarked police cars staked outside the crack houses that I frequented or my mother’s home or in pharmacy parking lots waiting to capture ...

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I'd been told in my hospital sign-out that Melanie was transgender, but I stumbled on the first day and referred to her as "he" in front of my medical team. "She!" she said immediately. "Oh, man," I thought to myself. I was a hospitalist teaching medical students at one of the most liberal medical schools in the country — University of California, San Francisco. I should have known better. When I ...

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Marijuana is made from the dried flowers of the cannabis plant. Made of more than 500 chemicals, including over 100 compounds called cannabinoids, the primary active compounds in the plant are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC acts on specific brain cell receptors that ...

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Americans and Canadians are seven times more likely to fill a prescription for opioid pain pills in the week after surgery than Swedes, says a study published Wednesday, one of the first to quantify international differences. More than 75% of patients in the U.S. and Canada filled a prescription for opioids following four common surgeries, compared with 11% of Swedes, researchers report in JAMA Network Open. Americans also ...

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The judgment in the Oklahoma trial against Johnson & Johnson for their role in the opioid crisis is a good start to what deserves to be an ongoing pursuit of justice for the victims, their families, and the states. Any financial settlement is only a Pyrrhic victory unless the following non-negotiable conditions are met: 1. Every single penny must go toward treatment. There are not nearly enough inpatient ...

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I’ve been living with chronic pain for more than a decade. It began in 2009 with nerve damage after emergency groin surgery. Four years later, I fell and hit my head. That fall led to a constant headache, a whistling sound in my ear, back and hip pain, tingling and numbness in my hands and feet, electrical shocks ...

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When they started practicing medicine, most surgeons say, there was little or no information about just how many pain pills patients needed after specific procedures. As a result, patients often were sent home with the equivalent of handfuls of powerful and addictive medications. Then the opioid crisis hit, along with studies showing one possible side effect of surgery is long-term dependence on pain pills. These findings prompted some medical ...

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