Opioids and the Treatment of Chronic Pain

Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions –  free full-text PMC article – Jul 2009

In most individuals, when opioids are taken to treat pain, there appears to be no overt effect from change in these systems. In some cases, however, powerful reinforcement occurs…

Opioids play a unique role in society. They are widely feared compounds, which are associated with abuse, addiction and the dire consequences of diversion; they are also essential medications, the most effective drugs for the relief of pain and suffering

This is a long post because the article contained so many gems of information (with references!).   Continue reading

Opioid Quality Metric Based on Dose Alone

An Opioid Quality Metric Based on Dose Alone? 80 Professionals Respond to NCQA by Dr. Stefan Kertesz

Efforts to reduce prescribing while optimizing care for patients with pain, and expanding access to addiction treatment, are of cardinal importance.

How we advance these objectives depends partly on changing our shared understandings of what it means to deliver good care. It also depends on policies, resources and formal methods to assess if we are doing a good job.

Dr. Kertesz points out that all these new restrictions aren’t based on any studies at all. Nor are any studies planned to investigate the effect of these new policies.   Continue reading

Is my doctor’s guideline for my treatment right for me?

Is my doctor’s guideline for my treatment right for me? – Melissa J. Armstrong, MD | March 11, 2017

Health care guidelines are produced in ever-increasing numbers. The National Guideline Clearinghouse, a U.S.-based public website compiling summaries of “clinical practice” (health care) guidelines, has over 1,000 entries and is updated weekly. The National Institute for Health and Care Excellence in the U.K. has over 180 clinical guidelines.

Health care guidelines impact policy decisions and care for individuals. Recent research, though, suggests that the public has only a vague understanding of what guidelines are and how they are developed.

Current high-quality clinical practice guidelines, though, are anchored in a thorough review of available medical evidence.

This was certainly not the case with the CDC Guidelines (see CDC Manipulated Data to Deceive, Contradictions in CDC Guidelines, and Updated: Evidence Against CDC Opioid Guidelines)   Continue reading

Pain and Ehlers-Danlos Syndrome (EDS): A Guide

Pain and Ehlers-Danlos Syndrome (EDS): A Guide – Joint Issues – from ehlersdanloscontemplations.wordpress.com

Why Write About Pain

Pain is debilitating. Pain can permeate many aspects of our lives. Pain can change the course our life takes and cause long-term psychological effects. We all deal with chronic pain in a way that we tailor to our individual circumstances.

My hope is that this article helps you to find your own path for dealing with your individual pain and to encourage you to make informed decisions and ask questions when something isn’t working for you.   Continue reading

Suicides in Rural America Increased More than 40%

Suicides in Rural America Increased More than 40% in 16 Years | American Council on Science and Health – By Alex Berezow — March 16, 2017

Rural America is facing an existential crisis. As cities continue to grow and prosper, small towns are shrinking.

The trend is clear: Rural America is literally fading away. It shouldn’t come as a surprise, therefore, that the opioid overdose epidemic has hit rural states, like Kentucky and West Virginia, especially hard. And the latest research from the CDC also shouldn’t come as a surprise: Suicides in rural America (labeled as non-core) have increased over 40% in 16 years.

From 1999 to 2015, suicide rates increased everywhere in America. On average, across the U.S., suicides increased from 12.2 per 100,000 to 15.7 per 100,000, an increase of just under 30%.

However, in rural America, the suicide rate surged over 40%, from just over 15 per 100,000 to roughly 22 per 100,000. Similarly, the suicide rate in micropolitan areas (defined as having a population between 10,000-49,999) went from 14 per 100,000 to 19 per 100,000, an increase of around 35%.

On the flip side, major cities saw much smaller increases in suicide rates, on the order of 10%.

The graph depicts a clear pattern: Suicide rates are highest in the most rural parts of the country, and they slowly decrease as urbanization increases.

What explains the difference?

The CDC suggests lack of proper mental healthcare, social isolation, the opioid crisis, and lingering effects of the Great Recession, all of which hit rural areas hardest. It appears fixing the suicide epidemic will require addressing very large societal trends and cultural problems.


Suicide rates are rising everywhere in this country and the opioid pain relief restrictions will undoubtedly lead to more.

Emergency Department Visits Related to Suicidal Ideation, 2006-2013 Jan 2017

Suicide is a major public health concern that causes immeasurable pain and suffering to individuals, families, and communities nationwide. Suicide is the tenth leading cause of death overall and the second leading cause among Americans aged 10-44 years. 

In 2014, the suicide rate reached a 30-year high, accounting for nearly 43,000 deaths.

Suicide is preventable, however. Suicidal thoughts or actions are signs of extreme distress and require intervention.  

If this is true, then many chronic pain patients are in “extreme distress” since the government decided to decrease access to effective pain relief in order to stop heroin overdoses.  (Clearly not a logically reasoned policy) Continue reading

2017 EDS articles – free full-text PDFs

American Journal of Medical Genetics Part C: Seminars in Medical Genetics

The PDFs below were taken from the American Journal of Medical Genetics Part C: Seminars in Medical Genetics Supplement to the American Journal of Genetics – Hypermobile EDS

Issue Information: Table of Contents, Volume 175C, Number 1, March 2017 (pages 1–2)

Introduction

The international consortium on the Ehlers–Danlos syndromes (pages 5–7)
Lara Bloom, Peter Byers, Clair Francomano, Brad Tinkle, Fransiska Malfait and on behalf of the Steering Committee of The International Consortium on the Ehlers-Danlos Syndromes   Continue reading

Opioids + Pain != Euphoria

Psychoactive Properties of Opioids and the Experience of Pain –  Journal of Pain and Symptom Management – February 2016

Here is a letter to the editor of a pain journal from Stephen R. Connor, PhD of the Worldwide Hospice Palliative Care Alliance.  

He points out what so many of us have noticed: if you take opioids when you’re in pain, you do not get “high” (see also Opioids, Endorphins, and Euphoria)

A frequently held view in palliative care is that when patients in pain use opioids, they do not experience the psychoactive or euphoric effects of opioids.

Furthermore, that those not in pain who use opioids do experience these euphoric effects that may lead to opioid-use disorder.   Continue reading

Chronic Pain IS a Catastrophe

We are told that we shouldn’t “catastrophize” our pain because that makes it much worse, and that we need cognitive therapy to disabuse us of our catastrophic notions.

However, the definition of “catastrophe” is an event resulting in great loss and misfortune, and this is the undeniable truth of chronic pain, and no amount of “magical thinking” can change that. 

I believe it’s much better to practice acceptance that this catastrophe of chronic pain happened. 

It would be a waste of energy to pretend chronic pain is not a catastrophe, to pretend everything is “OK”, that you’re not expending so much effort, expense, and pain to manage it, pretend it isn’t always a challenge get through the day without collapsing from pain and fatigue.  Continue reading

Theories About Cause of EDS Pain

Below are 2 PubMed articles insinuating that EDS pain is due to central sensitization or general extreme pain sensitivity.

I still insist that EDS pain is mechanical (due to lax tissues) and/or biochemical (because cell walls are also made from our defective connective tissue). However, we cannot know if the amount of pain we feel is in “normal” proportion to the nociceptive stimuli we experience.

The question is: do we have more pain than average or are we just more sensitive to average pain?

In the “good old days”, before I had to take pain medication around the clock, I seemed extremely pain sensitive. Even a wrinkle in the bedsheet would become painful if laid on it too long.   Continue reading

The common ground of mind-body therapies

Body Awareness: a phenomenological inquiry into the common ground of mind-body therapies | Philosophy, Ethics, and Humanities in Medicine | Full Text

Enhancing body awareness has been described as a key element or a mechanism of action for therapeutic approaches often categorized as mind-body approaches… with reported benefits for a variety of health conditions.

To better understand the conceptualization of body awareness in mind-body therapies, leading practitioners and teaching faculty of these approaches were invited as well as their patients to participate in focus groups.

The qualitative analysis of these focus groups with representative practitioners of body awareness practices, and the perspectives of their patients, elucidated the common ground of their understanding of body awareness.  Continue reading