In the face of an ever-worsening opioid crisis, physicians concerned about fueling the epidemic are increasingly heeding warnings and feeling pressured to constrain prescribing in the name of public health.
As they do so, abruptly ending treatment regimens on which many chronic pain patients have come to rely, they end up leaving some patients in agonizing pain or worse.
Last month, one of us was contacted by a 66-year old orthopedic surgeon in Northern California, desperate to find a doctor for herself. Since her early 30s, Dr. R suffered from an excruciating condition called Interstitial Cystitis (IC). Continue reading
Justification of Morphine Equivalent Opioid Dosage Above 90 mg – Practical Pain Management – August 16, 2017
It is recognized that some patients with severe chronic pain require opioid dosages over 90 morphine milligram equivalents (MME) a day.
The Centers for Disease Control and Prevention (CDC) has stated in its opioid prescribing guidelines that physicians should evaluate and carefully justify the rationale for prescribing above this level.
In California, where we practice, also has written guidelines that require justification for a daily opioid dosage above 80 MME. Continue reading
Opioids: In defense of the pain pills – Washington Times – By Cheryl K. Chumley – The Washington Times – August 11, 2017
If you’ve never experienced chronic pain, or been around someone with a pain that just won’t end, it’s easy to dismiss opioids as evil and to make grand calls for their prescription restriction, or even outright bans.
But walk through any hospital’s critical care ward — spend some time with someone whose body has suffered a shock and awe that can’t be imagined — and it’s not to easy to simply say, hey, take an aspirin.
Hey, mind over matter. Continue reading
Below is the “official” checklist from the CDC for opioid therapy.
Nowhere does it say that doctors cannot prescribe opioid doses above 90MME, and if your doctor is telling you this, they are misinformed.
High opioid doses only require more caution and more documentation, which should already be the case due to the complexity of our care. Continue reading
Gabapentin, a drug for nerve pain, becomes a new target of abuse – By CARMEN HEREDIA RODRIGUEZ — KAISER HEALTH NEWS – JULY 6, 2017
Gabapentin is approved by the Food and Drug Administration to treat epilepsy and pain related to nerve damage, called neuropathy.
Also known by its brand name, Neurontin, the drug acts as a sedative.
It is widely considered non-addictive and touted by the federal Centers for Disease Control and Prevention as an alternative intervention to opiates for chronic pain. Continue reading
Views toward suicide have changed in recent decades. Once largely perceived as a selfish act and a “permanent solution to a temporary problem,” society has become more compassionate toward those who suffer in silence. This is an enormously positive development, and it is likely an outgrowth of our greater understanding of mental illness.
The causes of suicide are complex, but they seem to involve some combination of nature (genetics) and nurture (culture and environment).
According to the CDC, the suicide rate in the U.S. in 2015 grew to 15.7 per 100,000, sparking fears of a “suicide epidemic.” Continue reading
Online Therapy Shows Promise But Raises Plenty Of Ethical Questions – May 2017 – by Jessica Goodheart
For pain patients who have trouble transporting themselves to the weekly appointments required for therapy, this could be a solution. However, I have doubts about how effective it could be for the supposed “catastrophizing” for which we are urged to seek therapy.
These were some of the “success stories” posted this month on the website of Sunnyvale-based BetterHelp, one of a handful of online therapy companies that substitutes the often hard-to-access office visit to a therapist’s office with a suite of online offerings.
Many who need mental health care can’t afford it, while many regions suffer a severe shortage of mental health professionals, and even in counties rich with therapists, many lack the time to make the visit. Continue reading
Mast Cell Activation Disorder – Yes, It’s Real – Science-Based Medicine – by Steven Novella on May 31, 2017
I have been asked several times about Mast Cell Activation Disorder (MCAD) by people who think there are red flags that maybe this is a made-up disorder.
As I will review below, it is a legitimate and interesting disorder. What is more interesting, from an SBM perspective, is why people would question the diagnosis.
The educated and skeptical public cannot trust apparent experts when they say that a diagnosis is real because there are so many fake diagnoses (and fake experts) out there. Continue reading
Chronic pain’s emotional toll can lead to suicide – By Lori Kurtzman & Mike Wagner, The Columbus Dispatch – Sep 4, 2016
There were brain surgeries and constant headaches, sleep binges that lasted for days. His right side partially frozen, Steven Lichtenberg could barely walk.
Then came Crohn’s disease, which caused regular bouts of diarrhea and nausea, leaving him keeled over. Eventually the chemo treatments, pain meds and surgeries stripped Lichtenberg of his ability to show emotion.
When life was darkest, he couldn’t even cry.
In May 2015, without warning to his loved ones, the 32-year-old Dublin man shot himself at his parents’ home. Continue reading
Patients with chronic pain who participated in an interdisciplinary chronic pain rehabilitation program achieved a significant reduction in central sensitization, according to a preliminary assessment.
When managing the most refractory of chronic pain patients in clinical practice, “we have noticed high overlap in various conditions like fibromyalgia, irritable bowel syndrome, pelvic pain, migraine, temporomandibular joint disorder and back pain,said principal investigator Xavier Jimenez, MD, medical director of the Cleveland Clinic Chronic Pain Rehabilitation Program
“patients seem to improve with interdisciplinary chronic pain rehabilitation program (iCPRP) treatment,” Dr. Jimenez said. Continue reading