Category Archives: Pain Management

Misconceptions about Opioid Abuse in Chronic Pain

Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies — NEJM – Nora D. Volkow, M.D. [Director of the National Institute on Drug Abuse (NIDA)], and A. Thomas McLellan, Ph.D. – Mar 2016 – free full-text article

I’m reposting this classic paper, which ironically came out the same month as the CDC Guidelines. Those guidelines showed zero understanding of the latest research and facts about opioid abuse and chronic pain that our own government is aware of.

Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage.

The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an overreliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction   Continue reading

Anti-Nerve Growth Factor for Pain: Jun 2016

Anti-nerve growth factor in pain management: current evidence – free full-text /PMC4908933/ – Jun 2016

Although significant advancements have identified myriad potential pain targets over the past several decades, the majority of new pain pharmacotherapies have failed to come to market.

The discovery of nerve growth factor (NGF) and its interaction with tropomyosin receptor kinase A (trkA) have been well characterized asimportant mediators of pain initiation and maintenance, and pharmacotherapies targeting this pathway have the potential to be considered promising methods in the treatment of a variety of nociceptive and neuropathic pain conditions.

It’s great that they found NGF to be an important mediator of pain initiation, but what else might it be an important mediator of?   Continue reading

VA Privatization = Longer Waits and Higher Costs

Increased Privatization of the VA Has Led to Longer Waits and Higher Costs for Taxpayers – By Isaac Arnsdorf & Jon Greenberg – Dec 2018

For years, conservatives have assailed the United States Department of Veterans Affairs as a dysfunctional bureaucracy. They said private enterprise would mean better, easier-to-access health care for veterans

Here’s what has actually happened in the four years since the government began sending more veterans to private care:

  • longer waits for appointments and,
  • a new analysis of VA claims data by ProPublica and PolitiFact shows, higher costs for taxpayers.   Continue reading

Nerve Growth Factor: Neuroscience and Therapy – May 2015

Nerve Growth Factor: A Focus on Neuroscience and Therapy – free full-text /PMC4812798/ – 2015 May

Here is more information on “nerve growth factor”, NGF, the reduction of which is being proposed as a pain reliever. This article details the many positive functions of NGF in our nervous system (and eyes), so it really doesn’t seem like a good idea to minimize it.

Nerve growth factor (NGF) is the firstly discovered and best characterized neurotrophic factor, known to play a critical protective role in the development and survival of sympathetic, sensory and forebrain cholinergic neurons.

NGF promotes neuritis outgrowth both in vivo and in vitro and nerve cell recovery after ischemic, surgical or chemical injuries. Continue reading

Phase 3 Chronic Pain Program For Tanezumab

Pfizer And Lilly Preparing To Resume Phase 3 Chronic Pain Program For Tanezumab – March 23, 2015

Pfizer Inc. (NYSE:PFE) and Eli Lilly and Company (NYSE:LLY) announced today that they are preparing to resume the Phase 3 clinical program for tanezumab.

In the prior clinical studies of more than 11,000 patients, tanezumab demonstrated clinically meaningful efficacy vs. placebo and other select commonly used pain medicines.

I wonder what other “select commonly used pain medicines” it was tested against, when “commonly used” includes everything from aspirin and Tylenol to oxycodone.   Continue reading

Complications of Uncontrolled, Persistent Pain

Complications of Uncontrolled, Persistent Pain – By Forest Tennant, MD, DrPH – Jan 2018

To the unfortunate patient who is afflicted and the practitioner who treats it, incurable, persistent pain is truly its own disease regardless of its underlying cause.

Persistent pain, which is also often characterized as chronic or intractable, has all the ramifications of a disease in that it may have pre-clinical and overt phases.

I like that he calls it “persistent pain” instead of “chronic pain”, a term which has become synonymous in the public’s eye as a whining, complaining, catastrophizing, gonna-be addict.    Continue reading

Reduce Inflammation and Pain through Diet – Really?

Reduce Inflammation and Pain through Diet – By Susan McQuillan, MS, RDN, CDN

I have my doubts about this, but it was published in a respected pain publication ( so I offer it here as just another thing to try. It makes sense that if your diet is really horrible your overall health will be negatively affected – and not just pain.

I’ve always been sort of a “health nut” and my diet is similar to what this article recommends, so I don’t know if a healthy diet can relieve any pain.  Even with my healthy diet, regular exercise, good sleep, and great friendships (good bio-psycho-social health) my pain can only be controlled by opioids.

This article was one of those annoying presentations where each point requires a click to a new webpage (and all its ads), so I’ve extracted the text for you in this single post. Continue reading

Meta-Analysis of Opioids for Chronic Noncancer Pain

This JAMA study showed what pain patients have always known, that the “use of opioids compared with placebo was associated with significantly less pain” and “significantly improved physical functioning”.

However, because the “magnitude of the association was small”, the anti-opioid zealots inspired a media circus trumpeting that pain relief from opioids was negligible. (Let’s see how they feel after they wake up from surgery without opioids.)

Below is the abstract of the study itself and then a clear and reasonable analysis of the results by Pat Anston, editor of Pain News Network.   Continue reading

HHS Report on Pain Mgmt Best Practices – part 3

Draft Report on Pain Management Best Practices | – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary.

I posted the second, most significant part yesterday, HHS Report on Pain Mgmt Best Practices – part 2, and the first part the day before: HHS Report on Pain Mgmt Best Practices – part 1.  

This is the third and final part of my series, and covers the middle of the document, starting where I left off in the second part detailing interventional procedures. Continue reading

HHS Report on Pain Mgmt Best Practices – part 2

Draft Report on Pain Management Best Practices | – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary. I posted the first part yesterday: HHS Report on Pain Mgmt Best Practices – part 1.

Below is the second part, covering more about opioid medication with all its “risk” and then the final, most significant section, covering the problems and errors of the CDC Opioid Prescribing Guidelines:

2.2.1 Risk Assessment  Continue reading