Study: Long-term opioid therapy for chronic pain

Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario | 2015 Jul | Free full-text PMC article

Characteristics of patients receiving long-term opioid therapy (≥ 6 months) for chronic noncancer pain are poorly understood. We conducted a cross-sectional survey of this patient population to explore

  • demographic variables,
  • pain relief,
  • functional improvement,
  • adverse effects and
  • impressions of an educational pamphlet on long-term opioid therapy.

Methods   Continue reading

Chronic Pain After Mastectomy

Chronic Pain After Mastectomy: A Common and Challenging Pain Syndrome | May 09, 2016 | by Chris Iliades, MD

For many women, the pain of breast cancer does not end after surgery, and chronic pain after mastectomy—termed postmastectomy pain syndrome (PMPS)—can be mentally and physically debilitating.

Studies have shown that between 20% and 30% of women develop symptoms of PMPS after surgery. This number varies in the literature,” says Susan K. Boolbol, MD, chief of breast surgery at Mount Sinai Beth Israel,

Etiology of PMPS

PMPS was first described in the late 1970s.

As with other neuropathic pain syndromes, the condition starts with tissue damage, inflammation, and nerve damage.  Continue reading

Factors Associated with Pain After Breast Cancer

Identification of a Factors Associated with Persistent Pain Following Breast Cancer Surgery | July 2016

Though patients who undergo breast cancer surgery have a 10-year survival rate of 83%, up to 60% of them suffer from persistent pain following surgery that may affect quality of life and level of functioning.1

According to their findings, moderate-quality evidence suggests an increased risk of persistent pain in patients with preoperative pain (odds ratio [OR] 1.29, 95% CI, 1.01-1.64), and high-quality evidence indicates that increased risk is associated with the following factors:

  • Younger age (OR for every 10-yr decrement 1.36, 95% CI, 1.24-1.48)
  • Radiotherapy (OR 1.35, 95% CI, 1.16-1.57)
  • Axillary lymph node dissection (OR 2.41, 95% CI, 1.73-3.35)
  • Greater acute postoperative pain (OR for every 1 cm on a 10-cm visual analogue scale 1.16, 95% CI, 1.03-1.30)

Chronic Pain: Psychogenic Roots

Chronic Pain: Psychogenic Roots and Psychological Treatment – No Life Limited By Pain – Dec 21, 2015 – Edwin K. Yager, PhD

I’m disappointed that this was published by a group that is supposedly supporting pain patients: the venerable American Academy of Pain Management.

This article minimizes pain and belittles pain patients with its musings on pain’s supposedly psychogenic roots. (Psychogenic: Originating in the mind or in mental or emotional processes; havingpsychological rather than a physiological origin.)

Chronic pain may serve a purpose without the sufferer having conscious awareness of that purpose.

Approaching a pain patient with this attitude will only reinforce a doctor’s prejudices and lead them to interpret everything a patient says as a mental problem. Once Mr. Yager starts talking about what he believes goes on in a pain patient’s mind, this article is pure speculation wrapped in scientific obfuscation.   Continue reading

CDC: Opioid Guidelines Not a Rule, Regulation or Law

CDC: Opioid Guidelines ‘Not a Rule, Regulation or Law’ – | July 19, 2016 | By Pat Anson, Editor

It’s no secret in the pain community that many patients are being taken off opioid pain medication or weaned to lower doses because of an overzealous reaction by doctors to the CDC’s opioid prescribing guidelines.

Those guidelines – which discourage opioid prescribing for chronic pain — are meant to be voluntary and are intended only for primary care physicians. Yet they are having a chilling effect on many doctors and their patients.

… letter was from Debra Houry, MD, Director of the CDC’s National Center for Injury Prevention, which oversaw the guidelines’ development.   Continue reading

Quicker Test for Acetaminophen Toxicity

A Quicker Test for Acetaminophen Toxicity – Anesthesiology News

Twenty minutes may be all it takes to identify a case of acetaminophen (APAP) poisoning, according to the developers of a new test for the condition […in] patients with liver failure related to the drug.

In a recent study, the 20-minute test (AcetaSTAT, Acetaminophen Toxicity Diagnostics) was performed as well as the current gold standard, high-performance liquid chromatography with electrochemical detection (HPLC-EC), to detect APAP toxicity.

Both techniques look for a biomarker produced after exposure to excessive and toxic amounts of the [non-opioid] painkiller.

AcetaSTAT rapid test results were consistent with the HPLC-EC assay and discriminated between APAP and non-APAP [acute liver failure],” the researchers reported. The test had a sensitivity of 97%, a specificity of 83%, a positive predictive value of 88% and a negative predictive value of 96%.  

Appropriate Use of Opioids in Managing Chronic Pain

CE: Appropriate Use of Opioids in Managing Chronic Pain : AJN The American Journal of Nursing | AJN, American Journal of Nursing: July 2016 | Denenberg, Risa MSN, RN, ARNP; Curtiss, Carol P. MSN, RN-BC

This is a very long and complete article on all aspects of opioid prescribing, so even my annotations run to almost 3,000 words.

Perhaps because it is written by nurses, who seem to be more realistic about pain, this is a much more balanced article than the usual alarmist anti-opioid propaganda.

Abstract:  The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal.  Continue reading

A placebo can work even when you know it’s a placebo

A placebo can work even when you know it’s a placebo – Harvard Health Blog – Harvard Health Publications – July, 2016 – Mallika Marshall, MD, Contributing Editor @mallikamarshall

If your doctor told you that she was giving you a placebo and that it would help you, would you believe her? As it turns out, based on new research, maybe you should.

Placebos are often considered “fake” treatments. You may have heard them described as “sugar pills.” They usually take the form of pills, injections, or even entire procedures that are used in clinical trials to test “real” treatments.

For example, one group of study participants is given an active drug and another group is given a placebo, which looks exactly like the active medication but is completely inactive.   Continue reading

Pain Care Shouldn’t Be Political Theater

Pain Care Shouldn’t Be Political Theater — Pain News Network – June 20, 2016 –  By Richard Oberg, MD

The old saying, “It takes one to know one”, is demonstrated by this courageous physician willing to defend opioids for pain patients.

The current hysteria over opioid pain medication is, without a doubt, the most unbelievable and difficult situation for patients I’ve ever seen in my 30 years of practice. With an increasing number of deaths due to overdose, the message has become that opioid medication is the problem.

Healthy people, including healthy physicians, don’t seem to believe chronic pain really exists to the degree that it does.   Continue reading

For Coffee Drinkers, the Buzz May Be in Your Genes

For Coffee Drinkers, the Buzz May Be in Your Genes – The New York Times

The health community can’t quite agree on whether coffee is more potion or poison.

  • The American Heart Association says the research on whether coffee causes heart disease is conflicting.
  • The World Health Organization, which for years classified coffee as “possibly” carcinogenic, recently reversed itself, saying the evidence for a coffee-cancer link is “inadequate.”
  • National dietary guidelines say that moderate coffee consumption may actually be good for you – even reducing chronic disease.

Why is there so much conflicting evidence about coffee? The answer may be in our genes.   Continue reading