Who’s Smoking Pot These Days?

Who’s Smoking Pot These Days? | High Times | Jon Gettman | Wed May 20, 2015

There are 20 to 33 million marijuana users in the United States.

Each year, the federal government conducts a survey of Americans, called the National Survey on Drug Use and Health (NSDUH). The most recent data is from the 2013 survey.

It is one of the best social science surveys in the world, though the nature of the survey (targeting household populations and asking about illegal behavior) renders its results as minimum estimates. Nonetheless, it is the best and most widely available data.

Over 115 million Americans have used marijuana at least once in their lives, about 44 percent of the total population  Continue reading

On the (f)utility of pain

On the (f)utility of pain – The Lancet

I took care of a 74-year-old man, Daniel, with bone metastases from prostate cancer. Daniel told me that he was in pain and admitted that he was not taking his full pain regimen. His son said, “my father is just being stoic”. Daniel’s response was: “son, there are worse things than pain”.

This remark struck me, mostly because many of the patients I had seen over the years had seemed to feel that there was nothing worse than pain. When I asked what he meant, Daniel clarified: “I want to be here for this”, he said with a sweep of his hand around the room, “even for the pain. Not really being here would make me suffer.”

This reinforces the erroneous belief that taking pain medication makes you “not really here”.  When taken for pain, opioids do not create euphoria or “altered states”. In fact, it is agonizing pain that takes us away from our lives, leaving us with only with desperation for some relief.  Continue reading

Clinical Anatomy of the Pelvis and Hip

Clinical Anatomy of the Pelvis and Hip 

This PDF (in English) from the  has many useful diagrams more information about the causes of hip and thigh pain:

After a brief description of the coxofemoral joint, the entities discussed include ilioinguinal neuropathy within the context of:

  • nerves that may be damaged during lower abdominal surgery,
  • meralgia paresthetica,
  • piriformis syndrome with the appropriate caveats,
  • trochanteric syndrome,
  • “ischial bursitis” and
  • trochanteric syndrome caused by ischemia.

These cases were chosen to stress our belief that rheumatologists are first and foremost internists. We further believe that being current in other pathologies such as peripheral neuropathies and certain vascular syndromes sooner or later benefits our patients.

If only the rheumatologists in the US adopted these patient-centered principles. Overall, patients with EDS have found them to be one of the least helpful specialties.

Impairment, Disability and Handicap

I was confused by these terms and I found several perspectives before I grasped the difference.  I don’t agree with the usage because it’s contrary to our usual grammar, but I learned it’s important to use the technically correct word.

First, a couple of definitions adopted by the World Health Organization and the United Nations. Then an explanation of the Stigma associated with the word “Handicapped” and the proper Etiquette.

The differences apparently have Medical Significance, yet are often incorrectly used because they are contrary to our usual Grammar. Finally, the Best Example I found to demonstrate the difference.  Continue reading

Nightly 8-Hour Sleep Isn’t a Rule. It’s a Myth

Nightly 8-Hour Sleep Isn’t a Rule. It’s a Myth. | Psychology Today

We’ve been told by health experts, and it’s conventional wisdom, that we should sleep between seven and eight continuous hours a day as an adult. Yet, the assumption that an eight-hour block of sleep is the ideal or norm may be a myth.

We’re familiar with the stories of polyphasic sleepers such as Leonardo da Vinci, Thomas Edison, Nikola Tesla, Buckminster Fuller and Margaret Thatcher, who got along fine with as little as four hours sleep each night, but little attention is paid to such sleep cycles today.

Consider these underexplored variations on daily sleep:  Continue reading

Repetitive Intranasal Blocks or Sumatriptan Powder for Migraine

Here are two more potential treatments for headaches:

Repetitive Intranasal Blocks May Be Effective Acute Treatment for Chronic Migraine | Pain Medicine News

Sphenopalatine ganglion (SPG) blocks delivered with the Tx360 nasal applicator may be an effective acute headache treatment option for people with chronic migraine (CM), a new study suggests.

Researchers conducted a double-blind, placebo-controlled study to test the long-term efficacy of repetitive SPG blocks with the Tx360, a single-use device that delivers topical transnasal analgesics to the nasal cavity.  Continue reading

National Pain Strategy: A Different View

National Pain Strategy: A Rough Beast? — Pain News Network by David Becker

(David Becker is a social worker, patient advocate and political activist who believes the needs and concerns of pain sufferers are not adequately addressed by the National Pain Strategy.)

A coalition of 17 chronic pain organizations called the Consumer Pain Advocacy Task Force was quick to endorse the National Pain Strategy, and is now lobbying the NIH to create an oversight body to implement the plan and provide funding for it

The Consumer Pain Advocacy Task Force started promoting the National Pain Strategy (NPS) less than a week after it was made public. Obviously they didn’t wait to hear from their members or people in pain — as they are intent on seeing that rough beast of a plan be born no matter what people in pain think or want. The NPS is not “urgently needed” as they claim.  Continue reading

DEA Mismanaging Quota Process

DEA needs better management of quota process for controlled substances | Drug Topics | May 08, 2015

The Drug Enforcement Agency (DEA), responsible for setting quotas of controlled substances, has not responded to manufacturers’ applications for these quotas in a timely fashion—and this has contributed to the shortage of controlled substances over the last decade, according to a recent GAO report.

Marcia Grouse, GAO’s director of Health Care, testified last week before the Senate Caucus on International Narcotics Control, explaining that both DEA and FDA are responsible for the prevention of controlled substances shortages and the response to any of these drug shortages.

We found significant weaknesses involving DEA’s management of the quota process for controlled substances. We found that DEA had not responded to manufacturers’ annual quota applications of bulk manufacturing and procurement quotas by its regulatory deadline of July 1 for any year from 2001 through 2014.  Continue reading

Reversing Fibromyalgia with Vagus Nerve Stimulation

“Reborn” – Reversing Fibromyalgia with Vagus Nerve Stimulation – Health Rising

The ‘vagus nerve’ is actually a bundle of different sized nerves. Aptly called the “wanderer”, the tenth and longest cranial nerve enters the brain at the medulla (Look up) and extends down into the chest cavity and into the abdomen.  Eighty percent of the nerve is devoted to relaying information from the body to the brain.

It affects everything from the swallowing to digestion to speaking to blood pressure

Reduced heart rate variability (HRV) findings suggest an underactive vagus nerve may not be keeping the sympathetic nervous system (fight/flight system) under control in chronic fatigue syndrome  (ME/CFS) and fibromyalgia (FM).    Continue reading

DEA Inflicts Harm on Chronic Pain Patients

DEA Inflicts Harm on Chronic Pain Patients – Lynn Webster, MD

(Hydrocodone combination products, like Vicodin and Norco, were rescheduled into a more restrictive category by the DEA in October 2014.)

In an effort to curb opioid drug abuse and addiction, the Drug Enforcement Administration (DEA) has issued new rules that limit the accessibility of hydrocodone, putting chronic pain sufferers who rely on the drug in an impossible situation.

The recent changes include the elimination of phone-in refills and a mandatory check-in with a doctor every 90 days for a refill.   Continue reading