In excruciating pain, sickle cell patients shunted aside

‘Every time it’s a battle’: In excruciating pain, sickle cell patients are shunted aside – By Sharon Begley @sxbegle – Sept 2017

The U.S. health care system is killing adults with sickle cell disease. Racism is a factor — most of the 100,000 U.S. patients with the genetic disorder are African-American — and so is inadequate training of doctors and nurses.

And the care is getting worse, sickle cell patients and their doctors said, because the opioid addiction crisis has made ER doctors extremely reluctant to prescribe pain pills.

STAT interviewed 12 sickle cell patients who described the care they received and didn’t receive. They were old and young, men and women, scattered from coast to coast, some with jobs or attending school and some too sick to do either.   Continue reading

Whole family with local anesthetic resistance

Whole-exome sequencing of a family with local anesthetic resistance. – PubMed – 2016 Oct

Local anesthetics (LA) work by blocking sodium conductance through voltage-gated sodium channels.

Complete local anesthetic resistance is infrequent, and the cause is unknown. Genetic variation in sodium channels is a potential mechanism for local anesthetic resistance.

A patient with a history of inadequate loss of sensation following LA administration underwent an ultrasound-guided brachial plexus nerve block with a complete failure of the block. We hypothesized that LA resistance is due to a variant form of voltage-gated sodium channel.   Continue reading

Pediatric Fibromyalgia

Pediatric Fibromyalgia – By David D. Sherry, – Cara Hoffart – 2013

This article claims to be an overview of pediatric fibromyalgia but to me, it sounds like doctors are being told to ignore the pain because it’s just psychogenic pain, generated by a psychiatric disorder.

This is how they used to treat adults with FMS too, but adults pushed back and insisted on more research and evidence. Now it’s known that fibromyalgia is a “real” physical issue which includes brain inflammation.

That only makes this article seem crueler when it insists that children with diffuse pain are suffering from a mental, not physical, problem. This whole article conflates fibromyalgia with diffuse amplified pain, which is considered a mental disorder, not a medical issue, a classic example of gaslighting: psychologically manipulating someone so that they question their memories, perception, or sanity Continue reading

Emotional Impact of Pain

Emotional Impact of Pain | Pain Management & Understanding | Arthritis.org

Although it may feel like it’s coming from your joints, pain – particularly the chronic pain common to arthritis – is also an expression of your state of mind.

If you’re depressed or anxious, you’ll very likely hurt more than when your mood is lighter or more balanced.

The crucial distinction is that depression or anxiety will only worsen *pre-existing* pain, not create new pain.

The fact that pain itself is depressing and worrying only makes the problem worse.  Continue reading

Writing Prescriptions Without Medical Basis

Opioid Prescriptions Without Medical Basis– by Gigen Mammoser – Sept 2018

A new study has found that, in a startling number of visits to a physician between 2006 and 2015 when an opioid was prescribed — nearly 30 percent — there was no recorded indication for pain.

The study, published this month in the Annals of Internal Medicine, highlights a potential administrative problem among physicians who prescribe opioids, and a need for better documentation practices

What did the study find?

In the study, opioids were found to be prescribed in 31,943 visits, of which only 5 percent documented a cancer-related pain diagnosis.  Continue reading

Oregon’s Ignorant Forced Opioid Taper Idea

What I Would Have Told Oregon Officials About Its Forced Opioid Taper Idea – by Kelly Howard – Nov 2018

As a trained biology researcher, Ms. Howard sees exactly how such forced tapers are not supported by evidence of any kind. She cuts to the quick of the matter by showing how scientific data actually supports the opposite of what the Pain Task Force claims.

“My name is Kelly Howard. I have been a chronic pain patient since the late 70s. My doctor first suggested I apply for disability in 1989; I worked 22 more years because of responsibly used, prescribed pain medication.

Many of those years I worked as a medical research specialist, so I’m here to discuss the bibliography of this task force.  Continue reading

Addressing the dual crises of pain and opioids

Addressing the dual crises of pain and opioids — a case for patient-centeredness – by Beth Darnall – Oct 2018

Caring for pain has become deeply intertwined with the opioid crisis. Though largely fueled by illicit opioid use, the opioid crisis has understandably spurred national and local organizations, as well as the public, to seek methods of pain treatment that carry the lowest risks. That in turn has led to policies that often emphasize limits on opioid prescribing.

We must remember, however, that opioid limits alone do not constitute a pain care plan, nor do blanket opioid limits appreciate the individual differences across patients who live with pain.

I couldn’t agree more. Those entities passing down these opioid limits are not medical professionals, but rather bureaucrats and politicians who have no idea about the medical realities of those of us living with constant pain. Their ignorance has terrible consequences: it’s warping medical treatments and spreading the lie that “opioids lead to addiction”. Continue reading

Fibromyalgia patients have brain inflammation

PET scans show fibromyalgia patients have inflammation in the brain – Oct. 5, 2018 – By Serena Gordon, HealthDay News

“Finding an objective neurochemical change in the brains of people who are used to being told that their problems are imaginary is pretty important,” explained senior study author Marco Loggia.

I think this is wonderful news. The public usuallly believes that fibromyalgia isn’t a “real” condition, so our suffering from the chronic pain it causes is dismissed as “psychological”. We still can’t detect or measure the pain, but now there’s a way to objectively detect one syndrome/disease that’s causing it.

The new research used an advanced imaging test called positron emission tomography, or PET, and looked at 31 people with fibromyalgia and 27 healthy “controls” from Boston and Stockholm, Sweden.  Continue reading

Opioid Policies Based On Morphine Milligrams

Opioid Policies Based On Morphine Milligram Equivalents Are Automatically Flawed – By Josh Bloom — October 23, 2018

  • Calhoun, who died in 1989 at age 55, was 6’4″ and weighed 601 pounds
  • Dinklage, who is 4’5″ tall, weighs 110 pounds.

Now imagine that both Dinklage and Calhoun have headaches and need aspirin. The recommended adult dose for Bayer Aspirin is two 325 mg tablets every four hours.

Will this dose be suitable for both men?   Continue reading

Automating clinical decisions with predictive analytics

Automating clinical decisions with predictive analytics – Twitter discussion from Terri A Lewis, PhD @tal7291

This is Dr. Lewis’ take on how Appriss is using the electronic health record (EHR) of pain patients to automatically calculate an “opioid risk score” and guide the doctor to prescribe less and/or add a naloxone prescription. (see EHR tool to assess patient risks for opioid abuse)

This kind of automated standardization flies in the face of the supposed intention to individualize treatments. Unfortunately, such personalized care is expensive, while standardization is cheap.

Allow me to point out the obvious. Med records are far too inconsistent, messy, wrong, incomplete for this to be a valid, reliable tool upon which to make clinical decisions that involve predictive analytics. JUST SAY NO.   Continue reading