Category Archives: Uncategorized

Local Anesthetic Responsiveness Survey

Vanderbilt University is conducting a Local Anesthetic Responsiveness Survey for people with connective tissue disorders. If you have the time, I urge you to take the survey to show the researchers how many of us have this problem. 

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Challenge to ACA’s Preexisting Conditions Protection

Administration Challenges ACA’s Preexisting Conditions Protection In Court | Kaiser Health News – June 8, 2018 – By Julie Rovner and Julie Appleby 

This is frightening news and could create huge difficulty and expense for anyone with pre-existing conditions, like EDS, fibromyalgia, CRPS, asthma, allergies, kidney disease, heart conditions, and, of course, chronic pain.

The Trump administration is refusing to defend key parts of the Affordable Care Act, essentially arguing that federal courts should find the health law’s protection for people with preexisting conditions unconstitutional.

The federal lawsuit hinges on the ACA’s individual mandate, or the requirement to get health coverage or pay a penalty. The mandate has long been a sticking point for conservatives, who argue that the government should not be telling individuals what coverage they must have.

Insurers were not allowed to raise costs for people with preexisting conditions.  Continue reading

PDMPs: Ideology Meets Reality

Deploying Prescription Drug Monitoring to Address the Overdose Crisis: Ideology Meets Reality – Indiana Health Law Review –  May 8, 2018 – Leo Beletsky

This article focuses on the principal element of this expansion—prescription drug monitoring programs (PDMPs).

By collecting information on who is prescribing, dispensing, and receiving scheduled drugs, PDMPs are intended to detect—and deter—problem patients, rogue prescribers, and pharmacists who may be diverting potentially addictive and otherwise risky drugs

PDMPs are far from new, but the recent scale-up in the number, scope, funding, and legal mandates of these systems has occurred without sufficient scrutiny.   Continue reading

What Every Patient Should Know About NarxCare

What Every Patient Should Know About NarxCare — Pain News Network – May 2018 – by Rochelle Odell

Recent studies question the value of PDMP’s, but 49 states have implemented them so that physicians, pharmacists and insurers can see a patient’s medication history.

What is NarxCare? Appriss Health developed NarxCare as a “robust analytics tool” to help “care teams” (doctors, pharmacists, etc.) identify patients with substance use disorders.

Each patient is evaluated and given a “risk score” based on their prescription drug history. According to Appriss, a patient is much more willing to discuss their substance abuse issues once they are red flagged as a possible abuser.   Continue reading

A perspectival tale of 4 guidelines

Of lamp posts, keys, and fabled drunkards: A perspectival tale of 4 guidelines – Trisha Greenhalgh – April 2018

I owe my life to evidence‐based medicine (EBM), but that is not the story I want to tell in this article. Here, I want to tell a more critical story—of how the assiduous application of “good” evidence‐based guidelines can sometimes result in a “bad” patient experience

Evidence‐based medicine saves lives, but it is not perfect.

Valkenburg et al distinguish between limits to EBM that might someday be overcome by more research and more philosophical limits that are inherent to EBM’s recommended approach.   Continue reading

As Opioid Prescriptions Fall, Opioid Deaths Rise

As Opioid Prescriptions Fall, Opioid Deaths Rise – |

This is another great article by Jacob Sullum pointing out the obvious that has obviously not been noticed by policymakers.

The decline in opioid prescriptions that began in 2011 accelerated last year, according to the latest data. Meanwhile, opioid-related deaths continue to rise. The opposing trends show the folly of tackling the “opioid crisis” by restricting access to pain medication.

A report published yesterday by the health consulting firm IQVIA shows that the total volume of opioids prescribed in the United States, indicated by the green area below, fell by 29 percent between 2011 and 2017.   Continue reading

Research: Lab Mice not like Wild Mice not like Humans

The comparative immunology of wild and laboratory mice, Mus musculus domesticus : Nature Communications – May 2017

Though this article focuses on the immune system, it exposes differences that could definitely have implications for pain research as well.

Of course, using any animal to study our pain makes no sense, since our pain is supposedly a bio-psycho-social disorder, with the focus mostly on “catastrophizing”. I’m not sure mice can do that or how it could be measured.

Wild mice are immunologically different from laboratory mice. Continue reading

War on Drugs proven to be a failure again

Rising drug overdose deaths a testament to the failure of the War on Drugs – Orange County Register

For half a century, the United States has waged a failed War on Drugs. More than $1 trillion have been spent, millions of people have been arrested and imprisoned, and yet, we are not only not a drug-free society, but for the past decade or so America has found itself in the grips of a so-called opioid crisis.

A growing body of evidence makes clear that government efforts to stop the opioid crisis by cracking down on prescription opioids have not only failed to stop the continued rise in overdose deaths, but have actually made the problem worse.   Continue reading

Government Data Versus Government Policy

Government Data Versus Government Policy – National Pain Report – March 21, 2018 – By Angelika Byczkowski.

It’s truly astonishing how our schizophrenic government can straddle two utterly incompatible versions of reality.

  1. On the one hand, the government collects drug overdose data and creates beautiful graphics and charts that show it’s now illicit fentanyl, not prescription opioids, driving the overdose crisis.
  2. On the other hand, the same government is still creating new policies to limit the use of these prescription medications, supposedly with the goal of stemming the overdose crisis, which is no longer driven by prescription opioids.

Original article continues: Government Data Versus Government Policy – National Pain Report

Surrogate endpoints in global health research

Surrogate endpoints in global health research: still searching for killer apps and silver bullets?March 2018

In clinical research, there is widespread acceptance that surrogate endpoints may not translate to long-term benefits.

Clinical epidemiologists highlight the hazards of surrogate measures (eg, biomarkers, laboratory test results and short-term improvements in health) that substitute for outcomes which are important for patients (eg, avoiding premature death or severe disability).

For example, in cardiovascular research, improvements in parameters such as blood pressure or cholesterol may not improve outcomes such as deaths.   Continue reading