Analgesic tolerance without demonstrable opioid-induced hyperalgesia: a double-blinded, randomized, placebo-controlled trial of sustained-release m… – PubMed – NCBI – Aug 2012
Although often successful in acute settings, long-term use of opioid pain medications may be accompanied by waning levels of analgesic response not readily attributable to advancing underlying disease, necessitating dose escalation to attain pain relief.
How can a doctor determine whether a patient’s increasing pain is attributable to “advancing underlying disease” or tolerance to opioids?
It’s impossible for anyone except the patient to determine this. Even for myself, it’s difficult to distinguish between increasing pain versus increasing tolerance to the medication. Continue reading
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
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
Looking beyond opioids: Stanford pain psychologist briefs Congress – Scope – by Jennifer Huber – September 25, 2018
Reducing opioid use has become a national priority, but where does that leave the millions of Americans who suffer from underdiagnosed or undertreated chronic pain?
Do alternative treatments strategies like cognitive behavioral, physical and pharmacologic therapies alleviate chronic pain? And how should these alternatives be implemented for different populations with different needs?
This is the first I’ve heard of chronic pain patients being described as “different populations with different needs”. What’s changed? Continue reading
Health Professionals Call on the CDC to Address Misapplication of its Guideline on Opioids for Chronic Pain through Public Clarification and Impact Evaluation – Date: September 24, 2018
Here’s an example of 5 medical professionals standing up for pain patients by demanding the CDC guideline be scrapped or amended or that the CDC at least forcefully clarify that these are guidelines, that should be individualized, and they are not appropriate to use as global limits.
Any professional who cares for patients, including physicians, pharmacists, nurses, psychologists and social workers, is invited to sign on to this letter, as are any professional organizations that wish to endorse formally.
I. In 2016, the Centers for Disease Control and Prevention, CDC, issued a Guideline for Prescribing Opioids for Chronic Pain for primary care physicians.
Here’s a little good news to make up for the darkness of the previous post:
A push for drug decriminalization surges in countries around the world — could the US be next? | TheHill | Aug 2018 | BY JAG DAVIES
Drug decriminalization has rapidly emerged as a mainstream political issue in Canada and several other countries, but few U.S. policymakers have embraced it so far. That could change soon.
Ending criminal penalties for drug possession, often referred to as decriminalization, means nobody gets arrested, goes to jail or prison, or faces other forms of criminal punishment simply for possessing a small amount of drugs for personal use. Continue reading
Despite epidemic, doctor says opioids help patients – Aug 2018 – by Janelle Griffith email@example.com
More doctors are starting to push back against the rampant anti-opioid fervor ignited and exacerbated by the media’s focus only on the risk of addiction, not pain relief, when using opioids.
Opioid addiction is an epidemic gripping the nation, leading to thousands of overdose deaths annually. But Dr. Kevin Zacharoff, an anesthesiologist with more than 25 years of experience in pain medicine, says opioids can also provide much-needed relief to many patients.
His 25 years of pain medicine have obviously shown him the truth and he has resisted the anti-opioid PROPaganda that has spread far and wide. Continue reading
Opioids for Legitimate Pain Patients, Their Needs Matter Too. – The Recover – By Shannon Werner – July 16, 2018
Finally, an article promoting opioid use where it is needed from a very unlikely source (therecover.com) and citing a review of 15 research studies that found opioids effective.
Addiction is rampant and crackdowns from the doctors limiting their prescription amounts, States are limiting the length of time patients can receive a prescription for and Medication manufacturers are even laying off their salesman with the increasing number of lawsuits they are facing every days.
So how are legitimate pain patients supposed to manage their extreme chronic discomfort within the confines of the opioid crisis limitations? Continue reading
Work-Enabling Opioid Management. – PubMed – NCBI – Aug 2017
OBJECTIVE: This study describes the relationship between opioid prescribing and ability to work.
METHODS: The opioid prescription patterns of 4994 claimants were studied.
This group is certainly large enough to draw conclusions from – and the scientifically proven conclusion is what we pain patients already know… Continue reading
Tapentadol Extended Release in the Treatment of Severe Chronic Low Back Pain and Osteoarthritis Pain – Pain Ther. Jun 2018 – free full-text /PMC5993688/
Tapentadol is a novel pain reliever with apparently synergistic dual mechanisms of action, capable of addressing both nociceptive and neuropathic components of chronic pain.
From Wikipedia: Tapentadol (brand names: Nucynta, Palexia and Tapal) is a centrally acting opioid analgesic of the benzenoid class with a dual mode of action as an agonist of the μ-opioid receptor and as a norepinephrine reuptake inhibitor (NRI). Analgesia occurs within 32 minutes of oral administration, and lasts for 4–6 hours
As an effective analgesic with good tolerability, tapentadol may be appropriate for patients suffering from severe chronic pain associated with low back pain (LBP) or osteoarthritis (OA). Continue reading