Benzodiazepines and risk of all-cause mortality in adults: cohort study | The BMJ – July 2017 – free full-text
Objectives: To evaluate the risk of all cause mortality associated with initiating compared with not initiating benzodiazepines in adults, and to address potential treatment barriers and confounding related to the use of a non-active comparator group.
Participants :1:1 high dimensional propensity score matched cohort of benzodiazepine initiators, and randomly selected benzodiazepine non-initiators with a medical visit within 14 days of the start of benzodiazepine treatment (n=1 252 988), between July 2004 and December 2013.
Main outcome measure: All cause mortality, determined by linkage with the Social Security Administration Death Master File. Continue reading
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
Difference between Lyrica and Gabapentin. What You Need To Know – Med Line Plus – Sept 2017
Pregabalin and Gabapentin are selective inhibitors of voltage- gated calcium channels, which act to inhibit these pumps at specific alpha2-delta site and inhibit calcium mediated release of neurotransmitters from synaptic vesicles.
The neurotransmitters that are inhibited are adrenaline and nor-adrenaline, which increases the sensitivity of neuropathic pain.
Neuropathic pain is caused due to damage, necrosis or compression that affects the nerves in our body. Continue reading
Intravenous Lidocaine Safe, Effective for Chronic Pain – by Jessica Martin – August 30, 2017
Lidocaine infusions were shown to provide long-lasting and adequate analgesia in 41% of patients with chronic pain, and to be associated with mild side effects in a study recently published in Pain Medicine.
Researchers retrospectively reviewed the charts of 233 adult patients (average age, 51; 54% women) with chronic pain (average pain duration, 7.7 years; 80% with neuropathic pain) who had received an initial lidocaine challenge of 1000 mg/h for ≤30 minutes (infusion rate, 16.67 mg/min), followed by up to 2 more lidocaine infusions (average lidocaine administered during first infusion, 381.4 mg). Continue reading
PROPer Nanny | Dr. Jeffrey Fudin – September 22, 2017
Dr. Fudin has written another clever piece about the absurdities of the lengths the anti-opioid lobby (PROP) is willing to go in their search for targets: the latest is their proposal that all “high-dose” opioids be banned.
They want to force us to take multiple lower-dose pills instead of one high-dose pill… in the name of reducing the skyrocketing numbers of overdoses from illicit injected opioids.
This is literally crazy: completely illogical, sustained only by mental fantasies. Continue reading
Pregabalin vs Gabapentin for Neuropathic Pain to Achieve Therapeutic Dose – Brandon May – September 2017
Patients with neuropathic pain are more likely to achieve effective therapeutic dose when treated with pregabalin compared with gabapentin, and gabapentin was found to often be prescribed to those patients at suboptimal doses, according to a retrospective study presented at PAINWeek 2017 in Las Vegas, Nevada
For patients with neuropathic pain, first-line treatment strategies often include the use of pregabalin and gabapentin, which share the same mechanism of action. Therapeutic ranges for these medications vary by practice.
At this time, there is no conclusive research to suggest optimal dosing, titration rates, or time to therapeutic dose. Continue reading
Gabapentin and Pregabalin for Pain — Is Increased Prescribing a Cause for Concern? — NEJM – August 3, 2017
Treatment of chronic noncancer pain during the opioid epidemic has become challenging for clinicians. Patients want their pain to be adequately managed, and clinicians are searching for safe, effective alternatives to opioids.
Recent guidelines from the Centers for Disease Control and Prevention (CDC) recommend that clinicians consider several other medication classes before turning to opioids for patients with chronic noncancer pain
For example, acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) are mentioned as first-line options for pain related to osteoarthritis and low back pain. Continue reading
Caffeine and Opioid Use Beneficial for Fibromyalgia-Like Chronic Pain By Brandon May – September 15, 2017
This headline is a bit misleading because opioids were only studied in tandem with caffeine and not separately recommended.
I drink a lot of coffee (even more now that I know it’s healthy) most of the day, so my opioids are usually combined with caffeine. I guess I stumbled onto a winning combination.
Caffeine is associated with lower pain catastrophizing, greater physical function, and lower pain interference in patients taking opioids to manage fibromyalgia pain, according to results from a survey-based study published in the Journal of Pain Research. Continue reading
‘Population-Based,’ Meet ‘Patient-Centered’ | Managed Care Magazine Online |MANAGED CARE | May 2012 – by Timothy Kelley
It’s hard to believe we’ve made so little progress on reconciling these two ideas since 2012.
With the coming increase in the elderly population who often have multiple interacting health problems, population medicine might end up being of little use.
Health care doesn’t lack for big ideas, even if their definitional boundaries do sometimes get fuzzy.
Take “population-based medicine” and “patient-centered health care,” for example. Both are phrases we hear and read every day, and maybe even believe in. But do they coincide or collide? Continue reading
What are Nav1.7 inhibitors and how are they used in the treatment of neuropathic pain? – August 2017 – By McKenzie C. Ferguson, PharmD, BCPS
Nav1.7 is a voltage-gated sodium channel isoform encoded by the SCN9A gene.
The Nav1.7 channel is normally expressed in the dorsal root ganglion neurons, trigeminal neurons, and their small-diameter peripheral axons
Mutations in these isoforms have been associated with several pain disorders, including erythromelalgia, paroxysmal extreme pain disorder (PEPD), congenital insensitivity to pain (CIP), and painful peripheral neuropathy. Continue reading