New Tx Target for Fibro: Brain Inflammation

Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain – National Pain Report – April 11, 2017 – By Ginevra Liptan, MD

Scientists have long suspected that inflammation in the brain (neuroinflammation) could be the cause of the amplification of pain signals in the brain seen in fibromyalgia.

They can show this to be the case in lab animals, but this theory has been hard to prove in humans—mostly because researchers can’t very easily biopsy brain tissue of living people!

However, some very creative Swedish scientists figured out a different way assess levels of inflammation in the brain, by sampling the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord. Continue reading

CDC Observations on Opioid Guideline

Observations presented to the National Center for Injury Prevention and Control’s Board of Scientific Counselors on behalf of the Opioid Guideline Workgroup – May 2016

This presentation covers many of the problems pain patients and pain doctors have been trying to point out.

Update @11am 4/22/2017: I had thought that our concerns may be reaching the awareness of the CDC, but Richard Lawhern pointed out that this document is from May 2016, just 2 months after the final version of the CDC opioid guideline was released.

It seems to list our concerns merely as issues to be overcome by the “implementation” of the guidelines, which shows they knew all along that the guidelines would be “implemented” as rules for pain patients.

Below, I have extracted the text from the slides of the presentation:  Continue reading

The Impact of Proprioception on Pain

The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception: Disability and Rehabilitation: 24 Jun 2016 – Free full-text article

The patients diagnosed with Ehlers–Danlos Syndrome Hypermobility Type (EDS-HT) are characterized by pain, proprioceptive inacuity, and muscle weakness, potentially leading to activity limitations.

Twenty-four EDS-HT patients were compared with 24 controls.

Results:

  • Muscle strength is associated with activity limitations in EDS-HT patients.
  • Joint proprioception is of influence on this association and should be considered in the development of new treatment strategies for patients with EDS-HT.

Continue reading

Is It Negligent For a Doctor to Abandon a Patient?

Is It Negligent For a Doctor to Abandon a Patient? – AllLaw.com – by Andrew Suszek

When a patient is harmed by a doctor’s cessation of treatment – commonly called “patient abandonment’, or “medical abandonment” – a malpractice case may result.

A patient will often visit a doctor at a fairly distressing time, often at the height of the patient’s vulnerability.

As a result, a doctor may harm a patient merely by declining to provide treatment or by ceasing the provision of care before it is medically reasonable to do so.   Continue reading

Pain and Suicide: The Other Side of the Opioid Story

Pain and Suicide: The Other Side of the Opioid Story | Pain Medicine | Oxford Academic – March 2014 – Lynn R. Webster, MD

Here is a very sad story about a pain patient’s suicide that will resonate with many of us. It illustrates how arbitrary opioid restrictions put doctors in an impossible situation and leave patients without hope. 

A former patient whom I’ll call Jack came to me for help after three back operations. He was on disability because of his pain. I treated him for about four years, struggling all the while to get his insurance to cover his therapies. I tried to get him to see a psychologist, but his insurance would not pay for the service. He was on what most physicians today would term a high dose of opioids and other medications.

He was mostly inactive and reported little improvement in pain or function while on his medication.   Continue reading

Quantifying quality doesn’t help patients

Quantifying quality doesn’t help patients | KevinMD.com | Kjell Benson, MD | April 4, 2017

Metrics did not always exist in medicine.

The moment we got serious about quality is often cited as Caper’s 1988 article “Defining Quality in Medical Care.”

Even as medicine invented “quality” in the 1980s, Caper pointed to some misgivings about the terminology. His Health Affairs article suggests abandoning the word “quality” and instead using three terms that correlate to desirable medical outcomes: efficacy, appropriateness and the caring function.   Continue reading

Let’s not kill pain patients to “save” patients with addiction

Let’s not kill pain patients to “save” patients with addiction.
– @StefanKertesz on Twitter

As a physician, I urge caution as we cut back opioids | TheHill | By Dr. Stefan G Kertesz – Mar 28, 2017

“If all we talk about is a pill, for or against,
we are having the wrong conversation
.
We don’t take care of prescription pads.
We take care of people.” 
Continue reading

Spinal Manipulation Therapy – A Sham Procedure?

Spinal Manipulation Therapy – A Sham Procedure? | Medpage Today | Apr 2017

Proponents have proclaimed a slew of benefits of spinal manipulation therapy, but most data is anecdotal. Spinal manipulation therapy is one of those treatments that just thrives on anecdote.

If you’re like me, you’re skeptical about some of the claims certain providers make about spinal manipulation. Mostly because a lot of these claims lack biologic plausibility

So I was intrigued to see this meta-analysis appearing in the Journal of the American Medical Association: Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis.   Continue reading

Where is the patient in the discussion of the opioid epidemic?

Where is the patient in the discussion of the opioid epidemic? – KevinMD | Blake Kelly, MD | April 13, 2017

This pain management doctor knows us; he understands exactly why pain patients need opioids. He points out that opioids are used as the last (and only) resort for pain patients that have tried absolutely everything else.

The opioid epidemic has been declared loud and clear in the media over the past several years.  

Doctors have been demonized, and patients have been stereotyped.  The statistics are alarming.  

However, I have yet to see anything published that focuses on the patient who lives with chronic pain.  There is very little understanding for these individuals.
Continue reading

Statins Increase Diabetes Risk by up to 50% in Older Women

Statins Increase Diabetes Risk by up to 50% in Older Women – By Pam Harrison – March 2017

Statin therapy increases the risk of new-onset diabetes in elderly women by 33%, and the higher the dose, the greater the risk, a new analysis of the observational Australian Longitudinal Study on Women’s Health shows.

The new analysis included 8372 Australian women aged between 76 and 82 years at baseline who were followed for 10 years; it is published in the March issue of Drugs and Aging.

Dr Jones and colleagues note that the majority of participants in statin trials have been males and that females, especially elderly ones, have been underrepresented.   Continue reading