Category Archives: Chronic Pain

Paltering: When the truth is used to deceive

Paltering: When the truth is used to deceive – by Shannon Casey, PA-C July 2019

One evening in the clinic’s bullpen provider office, a colleague of mine wondered aloud how to respond to a difficult question a patient asked via patient portal message.

A physician within earshot responded, “Just because someone asks you a question doesn’t mean you have to answer that question.” I tried to empathize with where the physician was coming from.

Some actions don’t require empathy as much as correction.  Continue reading

Being in pain is a pain

7 reasons why being in pain is a pain –  by Franklin Warsh, MD, MPH | Physician | December 27, 2017

I’m now walking the second mile in another man’s moccasins, and it’s no more enjoyable than my first mile.

Many doctors cringe when they see a chronic pain patient on their day’s schedule or at least certain chronic pain patients.

Some of that dread isn’t directly caused by the patient but rather the deluge of third-party administrative demands: workman’s compensation updates, disability applications, insurance forms, lawyers’ letters, etc.

Can we learn anything when that patient is a doctor?   Continue reading

Education of a physician in the school of pain

The re-education of a physician into the school of pain – Heather Finlay-Morreale, MD | Physician | July 27, 2019

Since childhood, I have suffered from severe stabbing headaches.

Thus, my first lesson in pain management. Getting accurate, effective, pain treatment is a lengthy and difficult process.

Actually, it’s usually impossible to find truly effective pain relief, especially when the most effective medication (opioids) is being withheld. Pain treatment is still handled with the same old standbys: NSAIDs, Tylenol, and opioids.

Throughout medical school, I learned about pain receptors and pathways, but little about how to treat pain. Continue reading

Suicidal Thoughts Linked to Musculoskeletal Pain

Suicidal Thoughts Linked to Pain in Those with Rheumatic or Musculoskeletal DiseaseBy Janice Wood July 2019

A new survey highlights the significant impact of rheumatic and musculoskeletal diseases (RMDs) on mental health.

The survey of more than 900 RMD patients revealed that pain had caused one in 10 to have suicidal thoughts in the previous four weeks. Pain also caused 58 percent to feel that everything was unmanageable for them.

This is a feeling I know only too well: the sinking sensation every time I think about how I’m going to get through this life, feeling completely overwhelmed by even trivial tasks, running around in mental circles looking for a way out of an unbearable situation…  Continue reading

Cancer Pain and Non-Cancer Pain are Equivalent

The fabricated distinction between cancer pain and non-cancer pain is often used to argue that opioids are only effective for the first, but not effective for all other chronic pain.

This never made sense to me, so I researched it trying to find the basis for the much-hyped difference between the two and discovered this distinction is a complete myth. 

Below are 4 previous posts covering scientific articles (including NIH/PMC and Cochrane reviews) questioning the legitimacy of regulating and restricting the treatment of non-cancer pain differently than cancer pain.

Cancer vs Noncancer Pain: Shed the Distinction    Continue reading

Even Insects Feel Chronic Pain after Injury

Insects feel chronic pain after injury – University of Sydney – July 2019

Even Insects feel chronic pain after a traumatic injury, proving it to be a very real process, without the “psychological” and “social” factors that are now blamed for our pain. 

These poor insects prove that chronic pain cannot be attributed to “catastrophizing”, which has become the culturally chic way of dismissing our pain.

Associate Professor Greg Neely and his team of pain researchers in the Charles Perkins Centre have found compelling evidence that insects feel persistent pain after injury.     Continue reading

First Generic Versions of Lyrica Approved by FDA

First Generic Versions of Lyrica Approved by FDA – Pain Medicine News – based on a press release from the FDA – July 2019

The FDA approved the first generic versions of the pain medication pregabalin, the agency announced. It accepted multiple applications, granting approvals to nine manufacturers, including Teva Pharmaceuticals.

I have to wonder why *nine* manufacturers are lined up to sell this medication. Competition “should” lower the price, but that’s not how things work in pharmaceutical pricing.  Continue reading

The Global Burden of Musculoskeletal Pain

The Global Burden of Musculoskeletal Pain—Where to From Here? – free full-text /PMC6301413/ – Am J Public Health. 2019 January

This article makes it clear that our chronic musculoskeletal pain is a serious burden, not just for us, but for all of society too. It itemizes reasons why chronic pain is so often regarded as a mere nuisance and isn’t taken as seriously as other health concerns.

In the 2010 Global Burden of Disease Study (GBD), which broadened the scope of musculoskeletal conditions that were included over previous rounds, low back pain imposed the highest disability burden of all specific conditions assessed, and subsequent GBD reports further reinforce the size of this burden.

Over the past decade, the GBD has produced compelling evidence of the leading contribution of musculoskeletal pain conditions to the global burden of disability, but this has not translated into global health policy initiatives.   Continue reading

Patient Perspectives on Opioids

Patient Perspectives on Opioids: Views of Inpatient Veterans with Chronic Pain | Pain Medicine | Oxford Academic – July 2018

Objective: To elucidate perspectives on opioids and opioid use from hospitalized veterans with comorbid chronic pain using qualitative methods.

Design:

This was an analysis of individual qualitative interviews.

The semistructured interview guide was developed by a hospitalist with clinical expertise in pain treatment with guidance from a medical anthropologist.   

I’m surprised and baffled to see that a “medical anthropologist” was involved. With just this abstract available, I have no idea why or what for.  Continue reading

The Landscape of Chronic Pain

The Landscape of Chronic Pain: Broader Perspectives – free full-text /PMC6572619/ – by Mark I. Johnson – May 2019

Here is a recent lengthy review of what’s known about chronic pain: the various aspects of various types of pain under various circumstances.

This article shows the folly of making any numerical one-dimensional measurement of chronic pain, which can arise from a variety of causes, vary greatly over time and location, and make such intrusive incursions into our inner lives.

This special issue on matters related to chronic pain aims to draw on research and scholarly discourse from an eclectic mix of areas and perspectives.   Continue reading