Chronic Cancer versus Non-Cancer Pain: A Distinction without a Difference? | GeriPal – Geriatrics and Palliative Care Blog – March 2016 – by Eric Widera, MD (@ewidera)
In 1824, Jeremy Bentham published the “Book of Fallacies” in which he criticized fifty arguments used in political debate and explained the sinister interests that led politicians to use them.
One of these fallacies he describes as the “sham distinction”, now known better as a “distinction without a difference“.
This logical fallacy appeals to a distinction between two two things that ultimately cannot be explained or defended in a meaningful way. Continue reading
New CVS Opioid Policy Raises Concerns Over Prescription Limits, Nonmedical Switching – Sept 2017 – Donald M. Pizzi
CVS Caremark’s announcement that it is adopting an “enhanced opioid utilization management policy” in early 2018 (see Public-Health Experts Are Skeptical of the CDC’s New Anti-Opioid Campaign) has some in the pain community concerned that the pharmacy chain is dictating medical [care] to and potentially taking important medication options away from those who need them.
Chief among its features is a seven-day limit on the opioid medications it dispenses “for certain acute prescriptions for patients who are new to therapy.”
Remember, this 7-day limit is only for *new* prescriptions and does not apply to long-term prescriptions for chronic pain. Continue reading
The Opioid Epidemic in 6 Charts Designed To Deceive You – By Josh Bloom — October 12, 2017
In this article, Josh Bloom eviscerates Kolodny’s arguments showing the unrelenting anti-opioid bias and disregard for opposing evidence.
Dr. Kolodny, a psychiatrist, is the executive director of Physicians for Responsible Opioid Prescribing (PROP)—a group that played a significant role in creating the disastrous CDC Guideline for Prescribing Opioids for Chronic Pain (2016).
The CDC ended up incorporating much of PROP’s recommendations, which were supposedly designed to help the US mitigate the damage done by opioid drugs, despite the fact that the “evidence” contained in the recommendations had been carefully scrutinized and found unsupportable by FDA scientists.
Hormone abnormalities in patients with severe and chronic pain who fail standard treatments. – PubMed – NCBI – Dec 2014
Some patients with severe and chronic pain fail to obtain adequate pain relief with standard pharmacologic treatment agents, including low to moderate dosages of opioids.
Understandably, physicians might not believe patients who claim that a standard opioid dosage is an ineffective treatment. These patients may be severely impaired, nonfunctional, and bedridden or housebound.
To help characterize these individuals and develop treatment strategies for them, a serum hormone profile consisting of Continue reading
The conundrum of opioid tapering in long-term opioid therapy for chronic pain: A commentary – Ajay Manhapra , MD,Albert A. Arias , MD Jane C. Ballantyne , MD
In response to the opioid epidemic and new guidelines, many patients on high-dose long term opioid therapy (LTOT) for chronic pain are getting tapered off opioids.
As a result, a unique clinical challenge is emerging: while many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies and misuse, these issues may often worsen with opioid tapering.
Is she saying that all these detrimental effects of sudden opioid tapering should just be ignored because they are due to neuroplasticity? Continue reading
Study: Many Patients Don’t Use Prescribed Opioids After Surgery – Pain Medicine News – Oct 2017
A new study found that over two-thirds of patients did not use opioids prescribed to them postoperatively.
If opioids were as addictive as advertised, we wouldn’t be seeing opioids unused. The fact that patients may take only a few of their prescribed opioids contradicts the assertions that merely a taste of opioids causes almost everyone to become addicted.
How does the anti-opioid leader of PROP, Kolodny, explain that? Continue reading
Underlying Factors in Drug Overdose Deaths | Substance Use and Addictive Disorders | JAMA | The JAMA Network – October 11, 2017
JAMA Viewpoint: Deborah Dowell, MD, MPH; Rita K. Noonan, PhD; Debra Houry, MD, MPH
This is the “viewpoint” of the very influential Dr. Houry, the Director of the National Center for Injury Prevention and Control (NCIPC) at CDC, who has been instrumental in restricting prescription opioids.
Since 2010, overdose deaths involving predominantly illicit opioids (heroin, synthetic nonmethadone opioids, or both) have increased by more than 200% (Figure).
Increased use of heroin as an initiating opioid of abuse. – PubMed – NCBI – Addict Behav. 2017 Nov;
Note to CDC: data now clearly show that prescribed opioids are *not* the initiating drugs for addiction and fatal overdoses, so stop harassing pain patients!
Given the relatively recent growth in access to heroin and a more permissive atmosphere surrounding its use, we hypothesized that an increasing number of persons with limited experience and tolerance to opioids would experiment with heroin as their first opioid rather than more common prescription opioid analgesics.
Spoiler alert: their hypothesis was proven true. Continue reading
Bastyr University is trying to silence a blogger exposing naturopathy’s false claims — Quartz
Complementary medicine therapies drawn from traditional practices, ranging from massage and vitamin supplements to acupuncture and meditation, are today becoming broadly incorporated into mainstream medicine as more scientific studies validate their efficacy
But naturopathy, a belief system built on the concept that “nature knows best” when it comes to healing, takes it a step further.
Practitioners use a host of pseudoscientific techniques including energy healing and homeopathy that can be not only ineffective, but dangerous. Continue reading
Benzodiazepines and risk of all-cause mortality in adults: cohort study | The BMJ – July 2017 – free full-text
Objectives: To evaluate the risk of all cause mortality associated with initiating compared with not initiating benzodiazepines in adults, and to address potential treatment barriers and confounding related to the use of a non-active comparator group.
Participants :1:1 high dimensional propensity score matched cohort of benzodiazepine initiators, and randomly selected benzodiazepine non-initiators with a medical visit within 14 days of the start of benzodiazepine treatment (n=1 252 988), between July 2004 and December 2013.
Main outcome measure: All cause mortality, determined by linkage with the Social Security Administration Death Master File. Continue reading