239 Experts Claim Coronavirus Is Airborne

239 Experts With 1 Big Claim: The Coronavirus Is Airborne – The New York Times – By Apoorva Mandavilli  July 4, 2020

These experts are only saying what I and certainly many others have been thinking since the start of this plague. Many other types of infectious agents are spread through the air.

The coronavirus is finding new victims worldwide, in bars and restaurants, offices, markets and casinos, giving rise to frightening clusters of infection that increasingly confirm what many scientists have been saying for months: The virus lingers in the air indoors, infecting those nearby.

If airborne transmission is a significant factor in the pandemic, especially in crowded spaces with poor ventilation, the consequences for containment will be significant. Continue reading

Pain Patients Angry and Fearful about Govt. Interference

Charges against pain doctor reveal undercurrent of anger, angst among patients at federal government – cleveland.comBy John Caniglia, The Plain Dealer – Jul 2020

For more than 25 years, patients suffering in pain sought out Dr. William Bauer. They had crippling injuries from car crashes and work accidents, chronic headaches and debilitating spine issues. At 83, Bauer had a practice in Sandusky that cared for many of the same patients for 10 to 20 years.

Federal prosecutors have accused the neurologist of illegally prescribing thousands of opioid pills between 2015 and 2018. 

But realistically, “prescribing thousands of opioid pills” for pain patients is medically appropriate. These drug-warriors should do the math before they toss around meaningless phrases like this just to create drama. Continue reading

A virus walks into a bar…

Packed Bars Serve Up New Rounds Of COVID Contagion | Kaiser Health News – By Jordan Rau and Elizabeth Lawrence June 25, 2020

As states ease their lockdowns, bars are emerging as fertile breeding grounds for the coronavirus.

Public health authorities have identified bars as the locus of outbreaks in Louisiana, Florida, Wyoming and Idaho.

Bars are tailor-made for the spread of the virus, with loud music and a cacophony of conversations that require raised voices. The alcohol can impede judgment about diligently following rules meant to prevent contagion.  Continue reading

Effects of Social Distancing on Body and Brain

The Effects of Social Distancing on Body and Brain — BrainPost | Easy-to-read summaries of the latest neuroscience publications – Post by Anastasia Sares – June 2020

This virus is a true biopsychosocial disaster – very similar to the impact of chronic pain when we can no longer participate in active social lives or our favorite pursuits – but I don’t see anyone suggesting we are catastrophizing about it.

Humans evolved to be social with one another, and we function best when we have strong relationships and regular social contact.

However, in many cities, half or more of the inhabitants live alone, and in the current COVID-19 pandemic, people are additionally deprived of in-person interactions at work and social gatherings.

It is a good time to remind ourselves of the far-reaching impacts of loneliness and find ways to mitigate it.  Continue reading

hEDS Deficit in Pain Control Mechanisms

hEDS-related Pain May Be Linked to Deficit in Pain Control Mechanisms – by Marta Figueiredo – June 2020

Pain in people with hypermobile Ehlers-Danlos syndrome (hEDS) likely is the result of an impaired pain suppression system that may lead to widespread pain, a study shows.

Well, that would certainly explain a lot!

contradict a previous theory that EDS-related pain was caused by damage in nerve fibers. Continue reading

Neuropathic Pain & Wind-Up Phenomenon

Managing Difficult Pain Cases: Neuropathic Pain & Wind-Up Phenomenon – WSAVA2013 – VIN – 2013

I was looking for information on the “pain wind-up” phenomenon and found this veterinary paper that explains it well – and without any special fuss about opioids, treating them the same as any other pain-relieving medication. What a refreshing change!

And with animals, there are no “biopsychosocial” factors to blame for increasing pain, so vets take it seriously and don’t just discount it as an attitude problem.

The options for analgesia are ever increasing as our understanding of pain physiology improves.

Yet for humans, there is still little understanding of chronic pain and few new treatments significantly different from the old.  Continue reading

Higher Expectations from Patients than Doctors

Study Reveals Presurgical Expectations of Foot and Ankle Patients Exceed Those of Their Surgeons – by Hospital for Special Surgery – June 2020

In the first-ever study to compare surgeon and patient expectations in foot and ankle surgery, research performed at Hospital for Special Surgery (HSS) in New York City has determined that two-thirds of patients have higher presurgical expectations than their surgeons.

That’s probably because they’re desperate for relief – especially nowadays when effective pain relievers are so hard to get. Plus, these surgeries and so profitable there may be some bias on the surgeon’s side.

Somehow, I can’t imagine a surgeon asking a patient what they expect the result to be; they’re too busy *telling* patients what the results will be.  And they do the “telling” in vague language that doesn’t convey the full impact of this brutal assault on their body.

Patients aren’t informed how little or short-lived the improvements might be, or that surgery can often leave not just visible scars, but invisible internal scars that become the source of chronic pain later.

I can’t imagine a doctor telling a patient, in a way that really gets through to them, the critical message: “it will never be as good as the original“.

The paper, titled “Comparison of Patients’ and Surgeons’ Expectations in Foot and Ankle Surgery,” is available online as part of the AAOS 2020 Virtual Education Experience.

Patient expectations of orthopaedic procedures have been demonstrated to be strongly associated with clinical outcomes and postoperative satisfaction.

If patients have high expectations shouldn’t this create the placebo effect? Just like negative expectations (sometimes called catastrophizing) are alleged to worsen chronic pain and lessen functionality, shouldn’t positive expectations lead to less pain and more functionality?

If “patient expectations” determine the outcome of treatment, this would apply to all treatments; the placebo effect either is or isn’t a factor. A placebo can’t have different effects for different treatments like surgery where a placebo doesn’t work and chronic pain where a placebo supposedly does work.

If higher expectations don’t lead to better results, the placebo effect is not.

In reviewing the operative schedules of seven foot and ankle surgeons at HSS, Dr. Ellis and his colleagues hypothesized

  • that patients would have greater expectations for their outcomes than their surgeons,
  • that there would be greater differences in preoperative expectations between patients and surgeons in major versus minor foot or ankle surgery, and
  • that greater differences between patient and surgeon expectations would be associated with worse preoperative physical and mental health.

“Although most surgeons do their best to engage in open conversations with their patients about what they can expect from surgery, many find it difficult to tell patients that they are not going be as good as new postoperatively,

…patients completed Patient-Rated Outcomes Measurement Information System (PROMIS) computer adaptive tests in Physical Function, Pain Interference, Pain Intensity, Depression and Global Health prior to their procedures.

“We determined that

  • 66.3% of patients had higher expectations than their surgeons,
  • 21.3% had concordant expectations, and
  • 12.4% had lower expectations,” said Dr. Ellis.

“In addition, the study showed that the majority of patients who had worse preoperative PROMIS scores had higher postoperative expectations.

That makes sense because people who are worse off are more desperate for surgery and also more likely to see at least some improvement from it.

We also found that depressed and anxious individuals had greater expectations than their surgeons, as did patients with a higher body mass index.”

Again, these are the desperate ones, not the ones who can still tolerate their pain. Because their condition is so bad, there’s a lot of room for improvement so their high expectations seem logical.

Going forward, said Dr. Ellis, future research should delve into other potential factors such as medical literacy and patients’ knowledge of their condition, as well as the bond between surgeon and patient.

What “bonds” can there be within standardized Evidece-Based Medicine? Can a guideline be written to standardize the doctor-patient bond?

Would such a guideline be ike the scripts they give to flight attendants, the ones they are required to recite at the start of every flight?

I went with my mother to an appointment with her PCP at Kaiser which was unnecessary but required because she takes 2 Vicodin a day.

The doctor had to speed read to us over a dozen questions from her screen and quickly type in or select the answers (a click and a delay meant she was scrolling through a drop-down menu).

She wasn’t talking to us, she was reading. Everything my mother said was met with an utterly ineffective and obvious suggestion.

  • Pain? take more Tylenol.
  • Fatigue? You’re just old.
  • Hips so painful can’t walk? Do more walking exercise (!)
  • Piriformis pain? Here’s some Voltaren Gel. (I looked it up and there’s no way it can penetrate deep into a buttock where that muscle is but, hey, at least it’s not an opioid!)

I feel sorry for the doctors that are forced to “practice” like this because it’s clear they can be replaced by data entry clerks (and eventually robots). No medical knowledge or treatment is required, literally only the ability to read questions and transcribe answers.

In the meantime, we suggest that a preoperative educational class for foot and ankle patients would go a long way towards a rapprochement between patients and surgeons when it comes to expectations.

Self-administration of Hydrocortisone for Pain

General theory of inflammation: patient self-administration of hydrocortisone safely achieves superior control of hydrocortisone-responding disorders by matching dosage with symptom intensity – free full-text /PMC6581742/ – J Inflamm Res. 2019;

Objective: To determine if patient self-administration of hydrocortisone will safely achieve superior symptom control for all hydrocortisone-responding disorders as it does for Addison’s disease and rheumatoid arthritis.

Methods: 2,480 participants with hydrocortisone-responding disorders were brought to a minimum symptom state using daily administered hydrocortisone tablets in a 24-week, open study.

Thereafter, participants used 5-day, low-dose hydrocortisone regimens to quench subsequent disorder exacerbations (flares) to maintain the minimum symptom state. Stressors such as emotional traumas, infections, allergies, and injuries were minimized to reduce disorder intensity, hydrocortisone consumption, and participant discomfort.   Continue reading

Illicit opioid use after loss of access to opioids for pain

Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain. PLOS ONE. May 4, 2020.

Here’s a finally a study showing the potentially hazardous actions taken by pain patients when their pain relief is cut off. I’m surprised they found the same thing with increasing the dose – if anyone can think of an explanation, please let me know.

In a retrospective study of more than 600 patients in San Francisco receiving opioid pain relievers (OPR) for chronic, non-cancer pain, the researchers found that

  • [l]oss of access to prescribed OPRs was associated with more frequent use of non-prescribed opioids and heroin, and
  • increased OPR dose was associated with more frequent heroin use.

In addition to being cautious with increasing OPR dose, care providers should consider the potential unintended consequences of stopping OPR therapy when developing opioid prescribing guidelines and managing practice.

Indoor transmission of COVID NOT likely

Indoor transmission of SARS-CoV-2 from medRxiv preprint server – Apr 2020

Finally, they’ve studied and validated what has always seemed obvious and logical to me: of course, a disease will spread more easily in a confined indoor area than out in the open!

Yet, our officials cooped us up in crowded indoor spaces even though that’s where you’re most likely to get infected from the prolonged close contact. This practically guaranteed that everyone would get sick if any single household member got sick.

Still, I was in favor of the lockdown as a desperate measure to buy us time to start research, craft policies to mitigate harm, and prepare our healthcare infrastructure for the predicted surge of patients needing intensive care.

But that didn’t happen…  Continue reading