Pain Management

America’s prescription epidemic: Breaking an ancient promise

Meds
July 16, 2021

I never thought I’d ever consider disregarding my oath.

She is a strong, charismatic, caring, successful, disciplined, and reflected woman. As her significant other, I am subjected to a degree of observer bias; nevertheless, her life’s accomplishments and her friends and acquaintances would validate these characteristics all the same.

She looks nothing like a typical pill-seeking patient in clinic, if you were ever to imagine one – or do I even know …

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Merging the wisdom of pain medicine and addiction medicine to optimize outcomes

Meds
January 16, 2021

Family lore recalls that my grandfather, succumbing to stomach cancer in the mid-1960s, “died addicted to morphine.” Decades before the AIDS crisis sparked the hospice and palliative care movements, the confluences of pain, dependence, and addiction were confused and regrettably moralized. Since then, the science has excelled, but our clinical understanding of how pain and addiction intertwine remains limited by stigma, assumptions, and the separation of the underlying science …

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This is what a successful health care system looks like [PODCAST]

Podcast
December 4, 2020

“If we are serious about supporting the optimal health and well being of our nations’ patients and physicians, we need to start believing and implementing the science across the public and private sectors. We need to recognize that at its core, the practice of medicine is a human science. We need …

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Pain management’s painfully fine line [PODCAST]

Podcast
July 30, 2020

“I find that managing chronic pain can be a bit of a dance between myself and the patient. Sometimes a little bit of a compromise. I always tell my patients that pain is subjective but many things can contribute to pain — certainly stress, lack of sleep, any emotional issues can make pain worse. Your pain is different than my pain. …

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The dangers of opioid addiction in the medical industry

Meds
March 21, 2020

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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The opioid crisis is real. But so is pain.

Conditions
March 18, 2020

“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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Here’s what it’s really like to live in pain

Patient
March 11, 2020

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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Talking about opioids can lead to strong emotions

Physician
February 2, 2020

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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The pain score must go. Here’s why.

Conditions
December 23, 2019

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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What can a famous actress teach us about curing addiction?

Physician
December 18, 2019

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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Are teenagers more vulnerable to the effects of opioids?

Conditions
November 24, 2019

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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Physician-assisted suicide is a collaborative process

Conditions
November 17, 2019

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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I’ve prescribed opioids to patients. And I’m not a villain.

Conditions
November 13, 2019

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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Using low-dose naltrexone to treat pain

Meds
October 2, 2019

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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How do we manage pain in the era of the opioid crisis?

Meds
October 2, 2019

“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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How we got from 18th-century tinctures to the opioid crisis

Meds
October 2, 2019

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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A physician’s career as an opioid prescriber and addict

Physician
September 30, 2019

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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A patient predicted her tragic future

Physician
September 16, 2019

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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Does marijuana really relieve pain? Here’s what anesthesiologists say.

Meds
September 13, 2019

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 use more post-surgery opioid pain pills

Meds
September 10, 2019

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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