Pain Management

Allow patients to continue their opioid of choice while starting microdoses of buprenorphine

Meds
June 16, 2022

Twenty-six hours into the shakes, sweats, crawling anxiety, and gripping nausea of opioid withdrawal, Faye caves in and takes a couple of fentanyl tabs. She knows that she must tough out a couple of days without fentanyl to start Suboxone (buprenorphine/naloxone) through a medication-assisted treatment program, but the sickness gets the better of her. Those couple of tablets reset the clock on her withdrawal.

Starting buprenorphine – an evidence-based …

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Attorney generals are not qualified to set medical practice guidance

Physician
May 22, 2022

Eleven attorneys general (AGs) have responded to a long-awaited draft update on a nationwide opioid-prescribing guideline by asking that drafters do more to prevent prescription opioid diversion. Logically focused on law enforcement, the AGs, unfortunately, suggest reviving policies the Centers for Disease Control and Prevention (CDC) has already cited as potentially harmful to patients. In doing so, the AGs step into the practice of medicine which they are not qualified …

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I see so much of this in pain management

Physician
April 17, 2022

In 2017, the CDC rolled out a “solution” to the opioid crisis. The recommendations, which were never intended to become laws, were mostly level of evidence three or below.

To put it another way, they were not robust, nor were they based on research in any way that matters. There was also no input from the pain medicine associations.

The premise was that we would solve the problem using what those of …

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The true story of morphine milligram equivalents

Meds
March 26, 2022

They are the foundation of the CDC’s 2016 opioid guidelines, resulting in legislation limiting opioid prescribing in 36 states. Morphine milligram equivalents, or MMEs, are used to set arbitrary prescribing limits for opioids by physicians since many state legislators fail to understand — and translate into policy and law — the ’16 guidelines. If we had all known the history of MMEs, perhaps we would not have been so eager …

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Art as a tool to manage pain

Conditions
February 9, 2022

My niece and I look across the expanse of the second floor of Marshall’s Dranko Library as we take in the library’s Spring art exhibit: Creation in Confinement. We spot my moon drawings on black paper hanging on the opposite wall. As a new artist, accompanied by my niece artist, I excitedly read:­­­­ Heavenly Moon and Worldy Skies, and how they are both done with pastels, colored pencils, and gel …

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Breaking down the real cost of the opioid epidemic

Physician
January 20, 2022

I have been writing of late about recent developments in the opioid saga. My first piece talked about a fresh decision in California’s seven-year-old The People vs. opioid pharma case. The next one focused on how the middle-man, distributors, contributed to the epidemic’s picture.

Now, I wanted to write an overarching piece hitting some astounding highlights that summarize the opioid crisis through its decades-long lifespan. …

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Listening to pain in our younger patients

Conditions
January 13, 2022

As a family physician for more than 40 years, I have seen countless patients struggling to alleviate chronic pain, with far too many turning to self-destructive coping methods such as alcohol and opioids. Unfortunately, the struggle with chronic pain isn’t going away – and more alarming is the fact that those suffering from it are getting younger and younger. The latest data on chronic pain show patients between age 18 …

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How drug distributors contributed to the opioid crisis

Meds
December 28, 2021

A recent headline in my neighborhood newspaper read, “A Dentist Became a Top Opioid Buyer in W. Va. Now a Drug Firm Faces Penalty for Ignoring Red Flags.” The drug firm sent 25,400 hydrocodone pills and 3,600 Xanax to one Huntington, WV area dentist. The DEA raided the dentist’s office and shut it down. The dentist admitted to ordering the pills for personal use.

This summer, also right …

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The people vs. opioid pharma: Pharma wins again

Meds
November 14, 2021

On Monday, November 1, an Orange County California Superior Court Judge said, in a tentative decision, that the opioid pharmaceutical companies were not responsible for the opioid crisis.

This particular case, going by the name of “The People of the State of California v. Purdue Pharma,” started in 2014. The judge’s ruling noted that neither party requested a trial by jury. The trial took place before the judge between April 19, …

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What you don’t know about pain will hurt you

Conditions
November 11, 2021

Chronic pain is an epidemic, currently affecting over 100 million American adults – more than diabetes, heart disease, and cancer combined. This doesn’t include children, 1 in 3 of whom live with a chronic pain condition ranging from migraine to chronic stomachaches. Chronic pain disrupts life, impeding the ability to work, exercise, have sex, engage in hobbies, even go outside. It’s the number one cause of long-term disability in the …

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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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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 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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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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The physician who became a chronic pain patient in seconds

Physician
August 2, 2019

It took me decades of studying, training, hard work, and sleepless nights to become a doctor. In approximately five years, I became a successful writer, editor, columnist, and a whole array of other titles assigned to that type of work. In under 3 seconds, I became a chronic pain patient for the rest of my life.

Around this time last year, I was taking my two dogs outdoors when they spotted …

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If your child is ever prescribed an opioid, read this post first

Meds
May 10, 2019

What if I told you that your adolescent child could contract a disease that can never be cured, but only maintained? That it would be a lifelong struggle that could change their personality, compromise their potential and values, destroy their relationships and have a long-term detrimental effect on their overall and mental health? That this disease can even be fatal, when ineffectively maintained? What if I told you that the …

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Medical care was never intended to be daily fights against insurance companies

Conditions
March 27, 2019

Last month I saw Joan, a woman who has had low back pain for years. She’d been through the ringer like every other person in severe pain: countless procedures and medications. She continued to have daily pain that stopped her from staying focused at work, playing with her kids or being the spouse or friend she wanted to be.  After our long consultation and review of her records my prescription …

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