Pain Cream Invented, But Untested

Pain Cream Invented, But Untested: Shots – Health News : NPR – By Joe Palca – September 28, 2017

Let’s say you’re a scientist, and you’ve invented what you think is a useful treatment for pain. But you have a problem.

You don’t have the money to go through the regulatory approval process.

Should you try to sell it to consumers anyway, and run the risk of being accused of selling snake-oil?  Continue reading

Advertisements

On humility and pain in medicine

Toward the stars: On humility and pain in medicine | Michael Kaplan, MD | Physician | June 25, 2017

Whereas the eyes of our medical forefathers were turned toward the heavens in search of answers to seemingly unknowable questions — how does blood move around the body? — my eyes, and those of my colleagues, are focused intensely on computer screens.

We’re preoccupied not by concepts or theory, but data analysis and randomized controlled trials.

In an age of cardiac catheterizations and endoscopic ultrasound, we’ve become so firmly rooted in the objective, the concrete, that we’ve lost our sense of wonder for the subjectivities in our world and their biological underpinnings.    Continue reading

Mast Cell-Mediated Mechanisms of Nociception

Mast Cell-Mediated Mechanisms of Nociception – IJMS | Free Full-Text – November 2015

Mast cells are tissue-resident immune cells that release immuno-modulators, chemo-attractants, vasoactive compounds, neuropeptides and growth factors in response to allergens and pathogens constituting a first line of host defense.

The neuroimmune interface of immune cells modulating synaptic responses has been of increasing interest, and mast cells have been proposed as key players in orchestrating inflammation-associated pain pathobiology due to their proximity to both vasculature and nerve fibers.

Molecular underpinnings of mast cell-mediated pain can be disease-specific.   Continue reading

Optimal Opioid Prescribing Based on Type of Surgery

Seeking an Optimal Opioid Prescribing Pattern Based on Type of Surgery – October 2, 2017

Guidelines for prescribing opioid pain medication with regard to acute pain recommend the lowest dose possible for the shortest duration needed to relieve pain, but specific guidelines for outpatient pain relief following surgery are still lacking.

Now, an analysis of more than 200,000 patients who had one of eight common surgical procedures may offer more clear guidance for this much needed pain management population. The study was published in JAMA Surgery.  

“Optimal” prescription lengths varied widely, according to senior study author Louis L. Nguyen, MD, MBA, MPH, associate professor of surgery at Harvard Medical School and a vascular surgeon at Brigham & Women’s Hospital in Boston.   Continue reading

Opioid Tracking Is Killing Americans

The Heroin Gap in Opioid Tracking Is Killing Americans | Cato Institute By Jeffrey A. Singer – This article appeared on The Hill on August 24, 2017.

Prescription drug monitoring programs (PDMPs) are state-based data banks that track opioid and other controlled substances prescribed by healthcare providers and filled by patients at pharmacies.

They are supposed to cut down on the abuse and overuse of such substances by reducing the rate at which physicians prescribe opioids.

While many policy makers think they’re a great idea, they may be actually contributing to the rise in opioid overdose deaths.   Continue reading

Public-Health Experts Are Skeptical of the CDC’s New Anti-Opioid Campaign

Public-Health Experts Are Skeptical of the CDC’s New Anti-Opioid Campaign – Pacific Standard – Oct 2017

Last month, the Centers for Disease Control and Prevention (CDC) launched an advertising campaign aimed at reducing addictions and deaths that are linked to prescription opioids

The campaign suggests the government wants Americans to eschew opioid prescriptions altogether. Its tagline is, “It only takes a little to lose a lot.” 

In his featured ad, Duggan says, “One prescription can be all it takes to lose everything.

This is the biggest lie of all because addiction is in the person,  not the drug.

The videos are incredibly moving—and yet, according to nearly every public-health researcher Pacific Standard consulted, they probably won’t do much. Why not? 

Everyone pointed to the same fatal flaw: The ads tell viewers that prescription opioids are a big problem, but don’t tell them what steps to take.

What were they asking people to do?” clinical psychologist Craig LeFebvre asks me, rhetorically, when I interview him.

As LeFebvre and others point out, telling Americans to avoid prescription opioids altogether just isn’t feasible. 

The drugs may, in many cases, be a good choice to treat pain.

I’m heartened to see the truth stated so clearly. Now, if only the rest of the media would catch on.

In fact, advising people not to use opioids at all contradicts the CDC’s own “Guideline for Prescribing Opioids for Chronic Pain,” which was published last year.

The guideline recommends caution, not abstinence.

This has been the problem all along: doctors are being told (ordered, if they are employees) to stop prescribing opioids without any alternatives for their patients. 

All other methods of pain control are either much less effective or too expensive for insurances to cover. 

Alternative medicine usually involves on-going treatments, often weekly, for the rest of the patient’s life.

The video ads do show a URL at the end, cdc.gov/RxAwareness, but it disappears quickly and there’s no indication of what the site offers.

In addition, campaigns that tell people to just not do something, without offering alternatives, don’t typically work, argues Bill DeJong, a professor of community health sciences at Boston University. 

DeJong offers the example of efforts in the United States to reduce drunk driving, which got off to a slow start until a suite of changes in the late 1980s, including the invention of the idea of a designated driver. “It wasn’t until there were changes in policy and enforcement, changes in the law, coupled with offering steps you could take to avoid it, like the designated driver, that we got some real change,” DeJong says.
Psychological theory explains why “Just say no” doesn’t work. 

It’s thought that, before they’ll change their behavior, most people need to feel empowered to do so. The technical name for the feeling is self-efficacy. 

Without that self-confidence, the CDC’s opioid campaign just makes viewers sad and afraid, emotions they may deal with unproductively.

Some of the experts Pacific Standard talked with took the stance that the CDC ads would be at least somewhat effective,

DeJong, however, has a harsher opinion. “The campaign isn’t going to make a damn bit of difference,” he says.

I’m relieved to hear this and, for all our sakes, hope he’s right.

The CDC is one of America’s major science agencies. It employs scientists of many stripes, including epidemiologists who do crucial work in tracking drug use in America, which helps doctors and officials stay on top of a fast-changing epidemic. 

Why, then, would it sponsor an ad campaign that health psychologists don’t think will work? 

The agency’s press office didn’t fulfill requests for a phone interview about the campaign, nor did it answer questions sent over email. 

This is because the CDC’s missteps on the opioid epidemic are indefensible.

DeJong speculates the problem might be the federal government approaching public service announcements as advertising problems, rather than health-behavior ones. 

This is because PROP and the recovery industry *are* using overdose deaths as advertising for their ineffective “recovery” programs, trying to scare us all by telling us that opioids can turn anyone into an addict instantly.

In the past, the government has hired (or received pro bono services from) ad firms to try to discourage Americans from drunk driving and drug use.
America’s ad men can indeed be effective at persuading people to change their behaviors—for example, to use body wash instead of soap, or to spritz the toilet before sitting on it.

 But getting people to be healthier is different. 

As DeJong puts it: “We don’t tell people that you’re going to die if you don’t use Crest toothpaste.”

The Myth of an Opioid Prescription Crisis

The Myth of an Opioid Prescription Crisis – Oct 2017 – by Jeffrey A. Singer

…many have called for stricter regulations on prescription opioids. But are doctor-prescribed drugs truly the cause of the increase in overdoses?

At a Capitol Hill Briefing in June, Arizona surgeon and Cato senior fellow Jeffrey A. Singer argued that regulators, in their rush to interfere in the patient-doctor relationship, are actually causing more problems than they’re solving.

This is something pain patients know only too well, as our pain relieving drugs are taken away even while overdose rates are skyrocketing.  Continue reading

From Cancer or Not, the Pain is the Same

Terminology of chronic pain: the need to “level the playing field” – Free full-text /PMC4734783/ –  Jan 2016 – John F Peppin and Michael E Schatman

This article, published in the Journal of Pain Research, makes it clear that there is NO biological/medical/physical difference between “chronic cancer pain” and “chronic noncancer pain”.

Pain medicine as a separate subspecialty is in its infancy, only fairly recently being recognized as such by the American Board of Medical Specialities. As it continues to find its way in the ever-changing world of medicine, terminology becomes an important consideration.

Terms carry tremendous impact:  Continue reading

The corruption of modern academic medicine

The corruption of modern academic medicine — How your doctor was bought – by Jason Fung, MD – July 2017

Many doctors are genuinely puzzled why much of the general public does not trust what they say.

Many doctors blame ignorance and the media for these phenomena, but this is simply a patronizing attitude. The truth is this. Many people simply do not believe doctors anymore.

But why? The answer is $$$$. Simply, the public does not trust doctors because they know that many doctors, especially those in academic medicine and the universities are on the take.   Continue reading

Patient Advocates Call on Brandeis to Fire Kolodny

Patient Advocates Call on Brandeis to Fire Kolodny — Pain News Network – October 03, 2017 – By Pat Anson, Editor

A coalition of physicians, patient advocates and pain sufferers has written an open letter to Brandeis University asking for the dismissal of Andrew Kolodny, MD, a longtime critic of opioid prescribing who is co-director of opioid policy research at the university’s Heller School for Social Policy and Management.

Kolodny is the founder and Executive Director of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group that has lobbied politicians and regulators for years to enact stronger measures to limit prescribing of opioid pain medication.   Continue reading