Category Archives: Chronic Pain

How Did We Come to Abandon America’s Pain Patients?

How Did We Come to Abandon America’s Pain Patients? – Filter Magazine – Alison Knopf – July 2019

Overdoses—not those involving prescription opioids, but of heroin and illicit fentanyl, often combined with benzodiazepinescontinue to go up. But

And many physicians, caught in the middle, have stopped prescribing because they don’t want to get in trouble and possibly lose their livelihood.   Continue reading

Women More Adept Than Men At Discerning Pain

Women May Be More Adept Than Men At Discerning Pain : Shots – Health News : NPR – August 26, 2019 – Patti Neighmond  – Twitter

I like this article because it has links to reputable sources, like PubMed abstracts from the NIH. Unfortunately, it starts out with the usual trope:

The pathway to opioid abuse for women often starts with a prescription from the doctor’s office. [wrong, wrong, wrong…]

This is an outdated and completely incorrect myth of anti-opioid propaganda. The CDC data clearly shows that pain patients taking prescribed (for them) opioids account for only a minuscule number of the opioid overdoses, as I have posted previously:  Continue reading

Different Pain, Different Neural Circuits

Responses to External Threats and Sustained Pain Travel Via Different Neural Circuits – Practical Pain Management – By Kerri Wachter with Qiufu Ma, PhD – Jan 2019

New study outcomes in mice suggest that common pain measurement tools may be inadequate.

Different neural pathways appear to underlie

  • reflexive responses to external threats and
  • coping responses to sustained pain

I’m surprised this hasn’t been obvious to researchers because it’s certainly clear to pain patients. The experience of acute pain, like stubbing your toe, is wildly different than that of long-term pain, like failed back surgery, so it seems obvious to me that different aspects of our nervous system are involved.  Continue reading

Pain Awareness IS Suicide Prevention

Coincidentally, the month of September is “Pain Awareness Month” and its 2nd week is also “Suicide Prevention Week”.  I believe pain awareness *is* suicide prevention, so here is my yearly post about the unintended serendipity of these two awareness campaigns going on at the same time.

By now we have direct evidence that a lack of pain awareness, as demonstrated by all the politicians and healthcare “experts” enshrining the CDC “guideline” prescription opioid restrictions as law, is leading to suicides of patients with uncontrolled pain.

Can the connection become any more obvious?  Continue reading

Even Moderate Pain Associated With Suicide Risk

Moderate, Severe Chronic Pain May Be Associated With Suicide Risk in Veterans – Clinical Pain AdvisorBrandon May – Mar 2019

Pain intensity may represent a reliable indicator of suicide risk in veterans, according to a study published in the Journal of Pain.

The data of veterans who used Veterans Health Administration pain specialty services (index visit) between 2012 and 2014 were analyzed (n=221,817);

Medical records and suicide surveillance sources were used to identify suicide attempts in the year following the initiation of pain services.    Continue reading

When the standard of care is bad medicine

When the standard of care is bad medicine – KevinMD.com – Myles Gart, MD | Physician | July 2019

This article explains that when you are in the hospital with acute pain, there’s a simple formula for prescribing pain medication (opioids) according to your stated pain level. No wonder so many patients inflate their numbers!

However, even though this article was published in July 2019, it assumes pain will be treated according to a patient’s report of their pain. That’s not what I’m hearing from pain patients who are sent home with aspirin or Tylenol even after major surgeries.

For the last three decades, the numeric pain score has been the go-to assessment for acute pain in the hospital setting. Since this methodology was developed for research purposes to see if drug “A” had an effect on patient “A,” its clinical utility is not just worthless but dangerous.

Continue reading

Management of chronic pain in EDS – part 2

Management of chronic pain in EDS – Nov  2018 – part 2

This post continues from the first part, with more detailed descriptions of various types of pain that arise from our tissue fragility and from consequences of related genetic changes.

3. Discussion

3.1 Chronic pain and EDS overview  (covered in previous post)

3.1.1 Musculoskeletal pain

Nociceptive, joint pain is usually the first manifestation of pain in EDS.  Continue reading

Management of chronic pain in EDS – part 1

Management of chronic pain in Ehlers–Danlos syndrome: Two case reports and a review of the literaturejournals.lww.com –  November 2018 – Part 1

I have a lot to say about this long article, so I’m going to break it into 3 separate posts:

Ehlers–Danlos syndromes (EDSs) are a heterogeneous group of heritable connective tissue disorders involving defective collagen synthesis.

Patients with EDS are prone for chronic myofascial pain, apart from other comorbidities.

Although the initial pathology is commonly nociceptive, progression of EDS leads to neuropathies and central sensitization of pain signals.   Continue reading

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