Overview of Depression Mgmt during Pain

Depression Management during the Presence of Pain: An Overview – January 20, 2015 – free full text article

Depression and anxiety are frequently associated with increased risk of medical problems. The severity of these problems varies from persistent pain to severe cardiovascular illness.

The pathophysiology of chronic pain and depression overlap in the noradrenergic and serotonergic pathways.

Antidepressants, especially dual acting which affect both pathways, are a frequent and effective choice of treatment for chronic pain.

The effectiveness of antidepressants for pain has not been proven and many pain patients get zero relief from them, including me.n Continue reading

Alternative Facts on Opioid Risk

Alternative Facts on Opioid Risk | Dr. Jeffrey Fudin

While media muckrakers and anti-opioid zealots continue to fuel a fire of opiophobia and political strategists march like zombies in a parade of vote-seeking rhetoric, a simple fact remains ignored.  

Morphine Equivalent Daily Dose (MEDD) equal to or above 100mg per day scores third on the risk scale for opioid-induced respiratory depression (OIRD).

Government agencies and third party payers continue to employ MEDD limits while ignoring other equally or more important factors that influence risk of opioid-related deaths, including that opioid abuse does not equal chronic opioid use in legitimate patients.   Continue reading

The suicide rate is increasing. Why is that?

The suicide rate is increasing. Why is that? – KevinMD – Christopher Johnson, MD | Conditions | April 11, 2017

After years of declining, the suicide rate in our country has been increasing, now at about 125 percent of the rate of several decades ago.

This increase accelerated after 2006.  Although all age groups showed an increase, the rate among women, particularly adolescent girls, took a notable jump.

In 2012 suicide was the second leading cause of death in adolescents aged 12 to 19 years, accounting for more deaths in this age group than cancer, heart disease, influenza, pneumonia, diabetes mellitus, human immunodeficiency virus, and stroke combined.   Continue reading

Opioid Cessation Prior to Surgery?

Does Opioid Cessation Prior to Surgery Help or Hurt? – April 4, 2017 By Thomas G. Ciccone

Patients receiving opioids prior to elective abdominal surgery had slightly longer hospital stays and were at higher risk of being discharged to a rehabilitation facility than opioid-naïve patients, according to the results of a new study.

“Chronic opioid use complicates management following surgery, and increases postoperative healthcare utilization and costs independent of other risk factors.”

None of these studies consider that opioids are prescribed for severe pain. Severe pain before surgery or unsuccessful surgery is what affects continuing opioid use.   Continue reading

Benefits and harms of drugs for “neuropathic” pain

Benefits and harms of drugs for “neuropathic” pain | Therapeutics Initiative – January 19, 2016

Chronic pain (at times presumed to be “neuropathic” in origin) is a common problem in clinical practice. It is now well recognized that the results of drug treatment are more often disappointing than no

Despite this, from 2005-2014 the number of British Columbians prescribed

  • gabapentin increased 1.8 fold,
  • pregabalin 17 fold, and
  • duloxetine 3.6 fold (from 2008).
  • Use of venlafaxine (mostly for depression/anxiety) has remained relatively stable.

Continue reading

New opioid active only where inflammation present

A New Opioid Targets Active Sites of Inflammation to Relieve Pain – by Nathan T. Fried on 23 Mar 2017

Summary: NFEPP binds and activates mu-opioid receptors only at low pH, soothing pain in rats without typical side effects

Adverse effects of opioids can occur because the drugs act at both injured and healthy tissue, but if researchers could find a way to direct opioids only to the former and not the latter, perhaps the drugs would lack off-target activity.

Now, a new report reveals the design of a novel opioid that only works where inflammation exists, leaving healthy tissue untouched and avoiding the unwanted consequences seen with traditional drugs.   Continue reading

Chronic pain leads to epigenetic changes

Chronic pain changes our immune systems | Channels – McGill University – By Cynthia Lee – Jan 2016

Many anti-opioid folks believe it’s always better not to prescribe/take opioids because they are so extremely dangerous, while pain is “just a feeling” that a person can “deal with”.

However, they are wrong. Pain is not just a “feeling”.

Leaving pain poorly controlled can lead to changes in how our genes are expressed, especially in the immune system.

Pain is the body’s alarm system, intended to get you moving to either fight or flee. It’s an extreme stressor which initiates a chain of biochemical consequences, including those that turn some of our genes on and off.  Continue reading

New Opioid Drugs Promise Pain Relief, Not Side Effects

Next Gen Opioid Drugs Promise Pain Relief Without Side Effects – Health Rising – March 2016

Opioid based pain drugs have dominated the pain relief marketplace for years but their dominance has more reflected a lack of other options than anything else.

They’re quite effective at reducing acute pain but not so good at with chronic pain or with neuropathic pain.

They can produce a paradoxical hypersensitivity to pain and more mundane but still troublesome problems with constipation and itch.

Plus there’s the euphoria that abuse causes which can lead to addiction and a host of other problems.

Plus, patients responses to the drugs vary so widely that pain medicine has been called more of an art than a science.  Continue reading

The Link Between Opioids and Unemployment

The Link Between Opioids and Unemployment –  OLGA KHAZAN – Apr 18, 2017

Since 1990, drug overdose deaths have increased by 500 percent.

A new study suggests unemployment might be one of the factors behind that dramatic rise. The paper, published by NBER last week, finds that:

As the unemployment rate increases by one percentage point in a given county,

  • the opioid-death-rate rises by 3.6 percent, and 
  • emergency room visits rise by 7 percent.  

Continue reading

3 Things You Need to Know About Opioid Pain Meds

3 Things You Need to Know About Opioid Pain Meds — Pain News Network 3/6/17 – By Janice Reynolds, RN, Guest Columnist

All medications have the potential to be dangerous, yet opioids are the only class of medication being treated as if they are the gateway to Armageddon.  Due to “fake news” and “alternative facts,” many see opioids as bad for acute pain, as well as persistent pain.

This hysteria has even affected the use of opioids to treat non-pain medical conditions — one being as a first line therapy for potential heart attack or heart failure. Opioids cause blood vessels to dilate and lower blood pressure; getting more oxygen to the heart, decreasing anxiety, and reducing the risk of a heart attack.   Continue reading