My cabin home burned down

I moved into a funky 600-sqft cabin in the wilderness of the Santa Cruz mountains 30 years and 5 months ago, just a small rudimentary cabin bolted to huge wooden poles set into the steep slopes of a deeply forested hill.

It was surrounded by groves of huge redwoods, many oak and madrone trees, and all kinds of wild critters from mountain lions and deer to coyotes, raccoons, and adorable little deermice. With large windows, few neighbors, and no need for curtains, it was like camping out in a tree house.

It was a difficult place to live: 30 steps of stairs up to the cars, 10 miles of tiny crinkly roads to the nearest town and 20 steep curving miles “over the hill” to jobs (and medical,care) in Silicon Valley. The only heat was from a woodstove and we cooked on a miniature stove fueled by a propane tank in the kitchen.

“Do No Harm” Means Providing Proper Pain Treatment

“First Do No Harm” Means Providing Proper Pain Treatment – By Lynn Webster, M.D – July 2020

Many physicians say their ethical duty is to “First, do no harm.” This principle is often mentioned in the context of prescribing opioids.

Some people believe that prescribing opioids to treat people in pain violates the Hippocratic Oath, because, they say, a doctor’s first obligation is not to do anything that could make things worse for a patient.

However, that is a flawed oversimplification of the “First, do no harm” directive.   

Doctors and pain patients: Conflict and collaboration

It seems more folks are starting to see that our current medical system and its methods have made doctors and patients into adversaries. Both initially assume the other isn’t truthful, is either maximizing (patient) or minimizing (doctors) pain.

It’s become a contest: patients want the pain relief opioids provide and doctors want to avoid prescribing them. Both parties have valid reasons for their views and both have valid reasons to distrust the other, a sorry situation for all fo us.

Doctors and patients in pain: Conflict and collaboration in opioid prescription in primary care – PubMed – free full-text /25261714/ – Dec 2014 

Forced Tapering of Opioids Ethically Impermissible

Is Nonconsensual Tapering of High-Dose Opioid Therapy Justifiable? | Journal of Ethics | American Medical Association – by Travis N. Rieder, PhD – Aug 2020

This case considers a so-called legacy patient, one whose behaviors and symptoms express a legacy of past, aggressive opioid prescribing by a clinician.

Some prescribers might feel pressured to taper doses of opioids for such patients, but this article argues that nonconsensual dose reductions for stable opioid therapy patients is impermissible because it both puts a patient at risk and wrongs an individual in a misdirected attempt to ameliorate a systemic wrong.

Although perhaps surprising, this argument is supported by current evidence and recommendations for patient-centered pain care. 

The social threats of COVID for pain pateints

The social threats of COVID-19 for people with chronic pain – free full-text /PMC7382418/ – July 2020

The negative impact of social changes prompted by the COVID-19 crisis may disproportionately affect individuals living with long-term painful conditions.

Living with chronic pain can threaten an individuals’

• fundamental social needs for autonomy (agency or independence),
• belonging (social connection), and
• justice (fairness).

In turn, for some, experiencing heightened social threat can maintain and exacerbate chronic pain.  

Melatonin Affects Muscle and Exercise

Impact of Melatonin on Skeletal Muscle and Exercise – free full-text /PMC7072499/ – Cells. Feb 2020

Skeletal muscle disorders are dramatically increasing with human aging with enormous sanitary costs and impact on the quality of life.

Melatonin, the indole produced at nighttime in pineal and extra-pineal sites in mammalians, has recognized anti-aging, anti-inflammatory, and anti-oxidant properties.

Mitochondria are the favorite target of melatonin, which maintains them efficiently, scavenging free radicals and reducing oxidative damage. Here, we discuss the most recent evidence of dietary melatonin efficacy in age-related skeletal muscle disorders in cellular, preclinical, and clinical studies.

Pharmacies Sued for Discrimination Against Pain Patients

Pharmacies Sued for Discrimination Against Pain Patients — Pain News Network – by Pat Anson – Aug 2020

This is wonderful news, to finally push back against the anti-opioid forces aligned against us.

Class action complaints against Walgreens, Costco and CVS Pharmacy were filed in California and Rhode Island on behalf of two women seeking legal relief that will allow them to get their opioid prescriptions filled without delays or restrictions, and without the fear that their prescriptions will be denied. 

Pain patients in the U.S. have complained for years about pharmacists refusing to fill their opioid prescriptions or reducing them to lower doses. It’s also not uncommon for patients to encounter delays and excuses, such as a pharmacy claiming it was out of stock of a particular medication.  

Exercise Hyped as Universal Solution to Chronic Pain

Is exercise the new snake oil? or just a dirty word? | HealthSkills Blog – by Bronnie Thompson – Aug 2020

This is a great article explaining that while exercise is generally “good for you”, it does very little to relieve pain and disability. The studies that supposedly prove this are problematic and cited more than they deserve to be.

Exercise can do all these wonderful things – help you lose weight, reduce heart disease, moderate insulin and blood glucose levels, improve your mental health, and yes! reduce pain and disability when you’re sore. (check this list out)

The claims sound suspiciously similar to the claims made by old snake oil merchants.

Qualitative researchers have often investigated how people with pain view exercise:

DOJ Tricks Used in Prescribing Prosecution

DOJ Tricks Used in Healthcare Fraud and Prescribing Prosecution – by Ron Chapman II on twitter: @HealthcareDef – June 2020

This is a sickening view into the murky drug-war tactics that our doctors have to face any time they prescribe opioids for chronic, ongoing pain.

I have had the opportunity to represent hundreds of healthcare professionals facing scrutiny from the federal government for healthcare fraud and drug trafficking. From this perspective I have been able to see the evolving playbook utilized by the DOJ to prosecute physicians.

Here are ten tricks used by the DOJ to convict physicians and other healthcare professionals for charges of healthcare fraud and unlawful prescribing.  

Potentially More Chronic Pain after COVID

Considering the potential for an increase in chronic pain after the COVID-19 pandemic: PAIN – August 2020

I’m immediately skeptical after noticing that the first 2 of the 4 authors specialize in various forms of mental illness: Psychiatry, Psychosomatic Medicine, and Psychotherapy.

• Clauw, Daniel J. – Departments of Anesthesiology, Medicine (Rheumatology), and U Chronic Pain and Fatigue Research Center, the University of Michigan Medical School, Ann Arbor, MI, United States
• Häuser, Winfriedb, – Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany and Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany. 

The toll of this pandemic extends beyond physical illness, with important psychosocial stressors that include prolonged periods of limited interpersonal contact, isolation, fear of illness, future uncertainty, and financial strain.