National Institute of Drug Abuse on the Opioid Crisis

First, commentary by @StefanKertesz:

This is probably the best summary of the crisis I’ve seen. It’s got lots of references supporting all of its claims, and lots of links to more detailed information.

Note that pharma and misprescribing played a role, but that diversion and misuse are also specifically mentioned as key factors.

And this is NIDA, a government agency that presumably not unduly influenced by Big Pharma on one side or PROP on the other.   Continue reading

Fentanyl: Potent and Deadly in Illicit Form

The Fentanyl Story – The Journal of Pain – Dec 2014 – free full-text article

Here’s everything you ever wanted to know about fentanyl, the ultra-strong opioid first synthesized in 1960 for IV medical use.

This article explains the history and the rationale for using this particular opioid medically in transdermal patches (continuous dose) and sublingual wafers (immediately effective).

Unfortunately, even in 2014, it seems the scientific community was unaware that fentanyl was and is being illicitly manufactured for sale on the black market. It is this illicit fentanyl that’s causing so many overdoses due to its extreme potency and poorly controlled careless handling.   Continue reading

Who Else Would Put Up with This?

Who Else Would Put Up with This? – by Fred N. Pelzman, MD August 24, 2018

Those checkbox forms would never fly in other professions.

Can you imagine lawyers, or bankers, or almost any other profession, allowing this to happen to them?

I’m writing about the standardization efforts that the makers of electronic health records are trying to institute for us as we try and build a record of what took place between us and our patients.

Make no mistake, standardization is driven by profit-seeking cost-cutting.   Continue reading

Does Your Doctor Trust You?

Does Your Doctor Trust You? – Sept 2018 – Source Newsroom: California State University (CSU)

Building a good relationship with your doctor—especially if you suffer from a painful chronic condition—is critical for getting the best treatment possible.

At the same time, clear, open communication with your medical team about how you’re feeling is essential, too.

This is all well and good, but absolutely impossible in the short visits dictated by the profit incentive of medical care these days.   Continue reading

Pain Minimized or Dismissed as Catastrophizing

Our Pain is being Minimized or Dismissed as Catastrophizing

When does normal concern about relentless pain become excessive and catastrophizing?

Who has the power to make this decision?

I’m exasperated and offended by the recent over-promotion and over-simplification of the latest popular theory about chronic pain, which uses the derogatory term “catastrophizing” to describe our well-founded concerns about our pain.   Continue reading

Chronic Pain Among Suicide Decedents

Chronic Pain Among Suicide Decedents, 2003 to 2014 | Annals of Internal Medicine | American College of Physicians – Sept 2018

The CDC finally looks at suicide and chronic pain:

“increases in opioid availability are not associated with greater suicide risk from opioid overdose among patients with chronic pain.”

During 2003 to 2014, the NVDRS identified 123,181 suicide decedents aged 10 years or older, 10,789 (8.8%) of whom had evidence of chronic pain. The percentage of decedents with chronic pain increased from 7.4% in 2003 to 10.2% in 2014, but the percentage who died by opioid overdose remained low overall (<2.0%).   Continue reading

Low Risk of Opioid Use Disorder in Primary Care

Low Risk of Producing an Opioid Use Disorder in Primary Care by Prescribing Opioids to Prescreened Patients with Chronic Noncancer Pain | Pain Medicine | Oxford Academic – March 2017

This study shows what pain patients have been saying all along: prescribing opioids for patients with chronic pain very rarely causes problems of drug abuse.

Objective: 

To examine the risk of developing aberrant behaviors that might lead to a substance use disorder (addiction) when prescribing opioids for the relief of chronic noncancer pain in primary care settings.   Continue reading

Does EBM adversely affect clinical judgment?

Does evidence-based medicine adversely affect clinical judgment? | The BMJ

For practical and theoretical reasons, says Michel Accad, evidence based medicine is flawed and leads to standardised rather than excellent individualised care, but

Darrel Francis argues that it protects patients from seemingly rational actions that cause more harm than good.

This is an interesting conflict arising when EBM, which is population-based, runs into individualized medicine, which is mostly based on a doctor’s judgment.   Continue reading

ADHD Linked to Fibromyalgia Syndrome

ADHD Linked to Fibromyalgia Syndrome in First-of-Its-Kind Study – Pain Medicine News – by Michael Vlessides

In one of the first-ever studies of its kind, a team of South African researchers found that nearly half of patients with fibromyalgia syndrome (FMS) suffer from concomitant adult attention-deficit/hyperactivity disorder (ADHD).

People suffering from both disorders also reported worse scores on the Revised Fibromyalgia Impact Questionnaire (FIQ-R) and greater cognitive impairment.

Well, this certainly explains a lot. The study also showed that over half of the fibromyalgia patients were depressed and 90% were anxious – no surprise there.  Continue reading