Under-use of prescribed opioid medications

Reasons for under-use of prescribed opioid medications by patients in pain. [Pain Med. 2010] – PubMed – NCBI

BACKGROUND: With the growth in opioid therapy for the treatment of chronic pain, health care providers have focused their attention on avoiding over-use of opioid medications, specifically to avoid addiction, dependency, and other misuse. Qualitative and quantitative reviews of medication adherence, in contrast, focus primarily on why patients under-use or do not take their medications as prescribed and find nonadherence rates of approximately 25%.

RESULTS: Under-use of opioids (20%) was more common than over-use (9%), consistent with research on medication adherence. Patients who under-used their opioids offered the same reasons for under-use that patients report for other medications. However, while under-users reported more pain than other opioid users they filled only slightly fewer opioid prescriptions. Communication problems between patients and providers about opioids were common.  

 

 

Pain Patients Say Drugs Don’t Work

Pain Patients Say Drugs Don’t Work – National Pain Report

Nearly nine out of 10 Americans with chronic pain say they are not satisfied with the drugs they take, according to the results of a new survey that also found that half of pain patients on opioid painkillers have had suicidal thoughts.

One of the more dramatic findings of the survey is that 97% of chronic pain sufferers had at least one instance of physical or emotional trauma prior to the onset of their pain.

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Does Bad Posture Cause Back Pain?

Does Bad Posture Cause Back Pain? | Better Movement

Although you wouldn’t know it from reading most books or articles, there are many studies looking for associations between pain and measures of postural alignment. And most of them find none.

This is in direct opposition to the previous post, which points out how bad posture can exacerbate pain.  Instead of right and wrong, we can assume both points of view are valid. Whether posture increases pain or not depends on the specific pain syndrome and individual response.  The great variety of pain symptoms, their causes and cures, and the individual’s responses show how little can be generalized about pain.

Although the results from these studies aren’t completely clear, most do not support the claim that bad posture causes back pain.

Here are some representative findings: Continue reading

The Role of Body Posture In Musculoskeletal Pain Syndromes

The Role of Body Posture In Musculoskeletal Pain Syndromes

Better pain relief may be achieved if patients do exercises and use devices that elongate the spine and promote normal posture.

The observation of the influence of postural mechanics on physiologic functions and pain has led researchers to conclude that posture plays a significant role in the development of pain and is critical to pain management.

The most significant influences of posture are upon respiration, oxygenation, and sympathetic function, which is a major component of perceived pain. Ultimately, it appears that homeostasis and autonomic regulation are intimately connected with posture

Review of the Literature Continue reading

Seven Things You Should Know About Pain Science

Seven Things You Should Know About Pain Science | Better Movement

If you have pain, this is stuff you should know.

  1.  Pain is a Survival Mechanism whose Purpose is to Protect the Body

Pain is defined as an unpleasant subjective experience whose purpose is to motivate you to do something, usually to protect body parts that the brain thinks (rightly or wrongly) are damaged. If you feel pain, it means that your central nervous system (“CNS”) thinks the body is under threat, and that something has to be done about it.

  1.  Pain is an Output of the Brain, Not an Input from the Body

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Ketamine restores pleasure-seeking rapidly in depression

Rapid agent restores pleasure-seeking ahead of other antidepressant action

A drug being studied as a fast-acting mood-lifter restored pleasure-seeking behavior independent of — and ahead of — its other antidepressant effects

Within 40 minutes after a single infusion of ketamine, treatment-resistant depressed bipolar disorder patients experienced a reversal of a key symptom — loss of interest in pleasurable activities — which lasted up to 14 days. Brain scans traced the agent’s action to boosted activity in areas at the front and deep in the right hemisphere of the brain.

Our findings help to deconstruct what has traditionally been lumped together as depression,

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Researchers Closer To Discovering Causes of Serious Pain Syndrome

Researchers Closer To Discovering Causes of Serious Pain Syndrome : Physical Wellness : Counsel & Heal

Complex Regional Pain Syndrome (CRPS) is serious condition that affects a limb following an accident or operation. Researchers in the new study reported that they have successfully transferred antibodies from the serum of patients with CRPS to mice, causing many of the same symptoms to be replicated.

The findings of this study hint at a cause for it – harmful serum-autoantibodies – and raise the possibility of finding a treatment. In mice injected with the antibodies from CRPS sufferers, there was significantly more swelling of the affected limbs compared to mice injected with antibodies from healthy volunteers.

It’s quite possible that CRPS is caused by a fault in the immune system.  This study seems to pinpoint the cause as autoantibodies, and by examining this area further we can look to develop a cure,

 

 

The Effectiveness and Risks of Long-Term Opioid Tx of Chronic Pain

The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain

This is a government sponsored Research Review, from the Effective Health Care Program (Helping You Make Better Treatment Choices) under the Agency for Healthcare Research and Quality (AHRQ).  Below is the abstract from the 219-page report, which reaches the non-conclusion that has resulted from all other long-term studies: “More research is needed“.

Objectives.

Chronic pain is common and use of long-term opioid therapy for chronic pain has increased dramatically. This report reviews the current evidence on effectiveness and harms of opioid therapy for chronic pain, focusing on long-term (>1 year) outcomes.

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The phenomenological-existential comprehension of chronic pain

The phenomenological-existential comprehension of chronic pain: going beyond the standing healthcare models [Philos Ethics Humanit Med. 2014] – PubMed – NCBI

This is a very long full-text article of interest to those of us who enjoy philosophical musings about our pain.

A distinguishing characteristic of the biomedical model is its compartmentalized view of man

Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage

the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain

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When Chronic Illness Makes You World Weary

When Chronic Illness Makes You World Weary: A Guest Post | Psychology Today

A lot has happened—a lot continues to happen—in my world. The majority of what goes on is good. I have so much to be thankful for.

But then there is this illness. This chronic, relentless, imposing, hungry disease that makes Kubler-Ross’s Five Stages of Grief a condiment to my daily issue du jour. It’s never ending. And now, it’s become so difficult for me to actually write. Cognitive function is on the decline. Coming up with words, making sense, tying things together…all those things that for a lifetime have come so easily, now take so much work.  Not only does it take work, it takes time.

Then there is pain. Some of it constant, some of it coming and going on a whim. I never know when, where, why. Believe me, I have spent so much time trying to figure out what causes pain—joint pain, nerve pain, GI pain, head pain… I’m giving up. Which I think, at this stage of the game is good.

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