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Ask the Expert: Dependence versus Addiction

Ask the Expert: Dependence versus Addiction

Why is dependence so often confused with addiction?  Here’s the problem:

The DSM-IV, to avoid the word “addiction”, used “dependence” instead, even though they are not interchangeable.

The DSM-IV erroneously equated all medication dependence with drug addiction. According to this criteria, all patients are “addicted” to their anti-depressants.   Continue reading

The physiological effects of unrelieved pain

Understanding the physiological effects of unrelieved pain | NursingTimes.net | Sept 2003

This is a lengthy, well-organized, and detailed list of each of the physiological reactions to chronic pain.

A noxious stimulus or pain is a stressor that can threaten homeostasis (a steady physiological state). The adaptive response to such a stress involves physiological changes that, in the initial stages, are useful and are also potentially life-saving.

However, if the stress response is allowed to continue, a variety of harmful effects may ensue that involve multiple systems of the body and are potentially life-threatening.   Continue reading

The long-term impact of torture on pain processing

The long-term impact of tissue injury on pain processing and modulation: a study on ex-prisoners of war who underwent torture. – PubMed – NCBI | 2014 Apr

BACKGROUND: Tissue injury may, in some instances, induce chronic pain lasting for decades.

Torture survivors suffer from high rates of chronic pain and hypersensitivity in the previously injured regions. Whether torture survivors display generalized alterations in pain perception and modulation, and whether such alterations underlie their chronic pain is unknown.

Having severe chronic pain and being denied pain medication could be seen as a kind of torture.  In either case, when severe pain endures long enough, it becomes permanent. Continue reading

Crusade against pill mills turning into a witch hunt

Is the crusade against pill mills turning into a witch hunt?

I care for a 65-year-old woman suffering from sarcoidosis affecting her lungs, her skin, her bones, her nerves, her blood chemistries, her kidneys, her colon and her mind. She describes her foot pain as feet burning on fire.

An experimental course of an IV immunosuppressant provided short-term relief and hope for relief of pain, but those drugs effectiveness waned quickly

Normal barium enemas and colonoscopies initially resulted in her being considered a neurotic quack.  Continue reading

Impact of Disbelief in Chronic Pain

A Narrative Review of the Impact of Disbelief in Chronic Pain
http://www.medscape.com/viewarticle/810602

This narrative review sought to explore the wider social context in which individuals with chronic pain may experience disbelief toward their pain.

The experience of stigma can occur in a number of ways. It may be through actual or perceived encounters with others; it can be through the use of psychological explanations of pain; it can come through a perceived challenge to one’s integrity and subsequently affect an individual’s identity; and such stigma may be influenced by negative female stereotypes.  Continue reading

Intractable pain may find relief in tiny gold rods

Intractable pain may find relief in tiny gold rods – Medical News Today

A team of scientists at Kyoto University’s Institute for Integrated Cell-Material Sciences (iCeMS) has developed a novel technique using tiny gold rods to target pain receptors

Gold nanorods are tiny rods that are 1-100 nanometers wide and long. In comparison, a human hair is 100,000 nanometers wide.

The team coated gold nanorods with a special type of protein that transports fat within the body known as a lipoprotein. This allowed the nanorods to bind efficiently to nerve cell membranes bearing a pain receptor called TRPV1 (transient receptor potential vanilloid type 1).  Continue reading

War on Drugs and the Pain Crisis

The War on Drugs, the War on Doctors, and the Pain Crisis in America

This is a long treatise by Alexander DeLuca, M.D. (who has had to leave his practice due to his own health problems) explaining how our society reached this point, starting with the Harrison Act in 1914 and continuing with a perpetual War on Drugs and repeated drug “epidemics”  which have created the Pain Crisis.

There is a Pain Crisis in America

Its primary manifestation is the routine and widespread under-treatment of pain, especially chronic, non-cancer pain.   Continue reading

Tension between medical values and commercialism

The tension between traditional medical values and expanding commercialism is real

The history of American medicine is the story of the rise and fall of a professional guild.  In the 19th and early 20th centuries, physicians distinguished themselves from other healers by banding together to form professional associations dedicated to science-based practice.  

Even more important, medical ethics put the patient first, above considerations of personal gain or even collective social goods.  The medical guild may have been insular, self-protectively territorial and paternalistic, but it was also self-sacrificing and altruistic.  Doctors earned the public’s trust one patient, or family, at a time.   Continue reading

Patients are not customers

Patients are not customers.  Here are 6 reasons why.

One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.”  

Here’s a quote from the online journal produced by Accenture, the management consulting company:

With these kinds of cross-sector comparisons now the norm, hospitals will have to venture beyond the traditional realm of merely providing world-class medical care.   Continue reading