Opioid Bias Hurts Pain Patients

Opioid Bias Hurts Pain Patients - Editor’s Memo By Forest Tennant

As I travel around the country, two issues keep surfacing:

  1. the abrupt cutting off of legitimate patients from opioids, producing withdrawal and re-emergence of their pain; and
  2. the bias against the use of opioids by states, even for legitimate pain patients.

As all pain practitioners know, abruptly stopping opioids is never a good idea. Even if the patient is on a relatively low-dose, withdrawal symptoms can be very unpleasant. And as we all know, completely unnecessary if the patient is allowed to taper off medications.

Another growing concern is the inability of patients to fill their opioid prescriptions—that in extreme cases—leads to abrupt stoppage of medications.

Haves pharmaceutical suppliers become so uncaring and calloused that they no longer care for the welfare and comfort of our citizens who suffer daily with severe pain and infirmity?

It’s not realistic to expect human suffering to be factored into the profit-seeking corporate and political mindset.  Our medical system is fundamentally a financial system, where patients are merely “consumers” of more and more standardized (and automated) “services”.  Health and healing are secondary concerns to “increasing shareholder value”. Continue reading

Doc Says Blue Cross Opioid Policy Is Flawed

Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed | CommonHealth

Amidst concerns over a massive national increase in the use and abuse of prescription painkillers, health insurer Blue Cross Blue Shield of Massachusetts instituted a new policy to reduce pain medication addiction and misuse.

This week The Boston Globe reports that as a result of the new policy, Blue Cross has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months.

But Daniel P. Alford, MD, calls the policy “flawed and irresponsible.”

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All FDA Drug Approvals Not Created Equal

All FDA Drug Approvals Not Created Equal

a new study by researchers at Yale School of Medicine shows that the clinical trials used by the FDA to approve new drugs between 2005 and 2012 vary widely in their thoroughness.

“We found that during the study period, more than one-third of the drugs were approved on the basis of a single trial, without replication, and many other trials were small, short, and focused on lab values, or some other surrogate metric of effect, rather than clinical endpoints like death,”

Guest Opinion: Don’t buy all the Zohydro hysteria

Guest Opinion: Don’t buy all the Zohydro hysteria – Opinion – The Herald News, Fall River, MA   By Lawrence Robbins, M.D.

A much needed new pain drug, Zohydro, is a better version of the existing forms of hydrocodone (Vicodin, Norco). Zohydro has none of the acetaminophen that the other hydrocodone tablets contain, eliminating the risk to the liver and kidneys.

Zohydro is highly controlled, difficult to obtain, and requires additional paperwork and a special prescription. … Unfortunately, there has been an unwarranted firestorm of hysterical protest over Zohydro.

just prior to the drug’s launch, multiple print, TV, and radio outlets ran pieces slamming the drug. Every review of Zohydro was negative. The only physicians interviewed were addiction specialists, who do not treat chronic pain. Incredibly, the media chose to omit the opinions of pain specialists and patients.

Some of the falsehoods perpetuated by the media were:

  1. Zohydro will kill people as soon as it is released. (Nobody has died).
  2. Zohydro is 10 times stronger than Vicodin. (It is the same strength).
  3. It only takes 1 or 2 tablets to kill a patient. (Untrue).
  4. This is the worst decision by the FDA, a disaster and tragedy for this country. (It was the right decision).
  5. Zohydro is more powerful than anything on the market. (It is actually the least powerful opioid in its class, when compared to oxycodone or morphine)

These statements, each more ridiculous than the last, were parroted by the media without any balanced opinion by an expert in pain medications.

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When Politicians Play Doctor

When Politicians Play Doctor | Dr. Jeffrey Fudin

When politicians play doctor: patients lose, but politicians still win.

Vermont Governor Peter Schumin issued an executive order creating barriers for medical professionals to prescribe Zohydro ER in his state

Governor Deval Patrick of Massachusetts, who declared that Zohydro ER could not be sold in his state.

Despite the FDA approval of Zohydro ER, and the steadfast defense of the medication in light of a proven patient need, these Governors decided they know more than scientists and professionals at FDA. With the stroke of a pen, they threatened the promise of a unique, new pain medication developed specifically for a subset of people who suffer from chronic pain, but who cannot take other hydrocodone medications containing acetaminophen.

But while their motivation, in most cases, may be well-intentioned, their policy “solution” in this instance is totally misguided. More pointedly, these politicians ignore the needs of thousands of their own constituents – people suffering every day from serious, chronic, debilitating pain.  

One-fifth of Trauma Patients ‘Doctor Shop’ for Narcotics

One-fifth of Trauma Patients ‘Doctor Shop’ for Narcotic Prescriptions

As many as 20% of orthopedic trauma patients seek out multiple doctors, or “doctor shop,” for narcotic prescriptions, according to a study released at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting.

For the study, researchers from Vanderbilt University tracked 151 adult orthopedic trauma patients throughout 2011 using Tennessee’s Controlled Substance Monitoring Database (CSMD)

Why wasn’t this database used to stop them from getting those multiple prescriptions?  Why are legitimate patients suspected, penalized, and left to suffer, while abusers are allowed to continue gaming the system?

The investigators concluded patients who doctor shopped received 7 prescriptions on average and more medication for a duration of 110 days, while those with one provider averaged 2 prescriptions with a lower daily amount totaling 28 days.

Physicians’ Careers Suffer When They Don’t Prescribe Narcotics

When Physicians’ Careers Suffer Because They Refuse to Prescribe Narcotics – Richard Gunderman – The Atlantic

Perverse consequences of customer-satisfaction corrupt the judicious use of opiates for patients in pain.  Addicts game the system to access these medications, while legitimate patients are denied relief.

In some new systems where doctors are reviewed by patients, physicians unwilling to supply addicts with pain pills receive poor patient-satisfaction feedback. That is judged as poor performance by hospital administrators.

the “straw that broke the camel’s back,” he says, was the pressure he felt to increase patient satisfaction scores. What are these scores?

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The problem of pain and patient satisfaction surveys

Here are two articles pointing out the problem with the unintended consequences of patient satisfaction scores and how they can interfere with proper pain treatment.

The problem of pain: When best medical advice doesn’t equal patient satisfaction | A Penned Point

For physicians today in nearly every specialty, the problem of pain is how to treat it responsibly, stay on the good side of the Drug Enforcement Administration (DEA), and still score high marks in patient satisfaction surveys.

But what happens to doctors who try not to prescribe narcotics for every complaint of pain, or antibiotics for every viral upper respiratory infection? They’re likely to run afoul of patient satisfaction surveys.

This is only be true of hospitals, because pain patients who are struggling to get access to pain medication from their doctors aren’t given surveys to rate some of the disbelieving, intimidating, and seemingly callous doctors that deny them pain relief.

The results are often referred to as Press Ganey scores, named for the company that is the leading purveyor of patient satisfaction surveys. Today these scores wield alarming power over physician incentive pay, promotion, and contract renewal.   (See previous post Why Rating Your Doctor Is Bad For Your Health)

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Anesthesia recommendations for EDS patients

https://www.orpha.net/data/patho/Pro/en/Ehlers_Danlos_En.pdf

This article explains what and why extra precautions must be taken with EDS patients.  Some do not respond to anesthesia, especially local, and there are also issues with body positioning and procedures during full anesthesia and surgery.

Approx.  50% of all [EDS] patients have de-novo mutations with negative family history. Each subtype has typical symptoms; however individual symptoms and severity need to be investigated for each specific patient.

On an operational perspective, surgical and anaesthetic pitfalls relate to a mixture of common features shared by most subtypes and complications related to specific variants.

Local anaesthetics might have reduced or no effects in some patients.

Continue reading

Finger length pattern provides clue to chronic joint pain

medwireNews – Pain medicine – Finger length pattern provides clue to OA and chronic joint pain

Type 3 finger length pattern, where the fourth finger is longer than the second finger, may be a valid non-invasive biomarker for risk of chronic joint pain and osteoarthritis (OA) of the hand, research reveals.

This type of finger pattern is an indicator of prenatal exposure to high androgen levels, which are known to be involved in the development of the skeleton, the researchers note

The researchers also report that type 3 finger pattern was significantly associated with chronic joint pain, at an OR of 1.18.

“This suggests that not the OA […], but the chronic pain might explain the association found”