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
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
Why Most Published Research Findings Are False – PLoS Med. 2005 Aug – free full-text PMC article
There is increasing concern that most current published research findings are false.
Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true.
Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.
In this essay, I discuss the implications of these problems for the conduct and interpretation of research. Continue reading
Dependence on Prescription Opioids – Apr 2006 – Free full-text PMC article
This PubMed article describes “opioid dependence” as it is currently (and wrongly) defined in the ICD-10. This version of the standard diagnoses and billing manual has created a linear model of opioid “use disorder” (as though any use at all were a disorder).
This model relates the severity of the “disorder” to the frequency and amount of use, vilifies normal medication side-effects, and confuses symptoms of chronic pain with symptoms of opioid addiction.
It completely ignores the critical distinction between dependence and addiction, which results in a strange paradox: Continue reading
Cancer Survivors With Chronic Pain Face Uncertainty – Pain Medicine News – Mar 2017
Reading this article made so furious I had to stop, breathe deeply, and wait for my anger to subside several times.
Towards the end, a couple of doctors do say a few sensible things, but most of the article exhibits the usual misunderstandings/propaganda about opioids and pain. Unfortunately, these people are the ones making rules for us.
New opioid regulations rankle many in cancer community
Last fall, the CDC released a draft of its guidelines for prescribing opioids for chronic pain. nTo counteract the problem, it urged physicians to prescribe the drugs only when other pain management strategies prove ineffective Continue reading
An Epiphany – March 2017 – by Lynn Webster, MD
Myra Christopher is the PAINS Director and someone I’m proud to call a friend. She has given me permission to re-post her blog, An Epiphany, here. It was first published at PainsProject.org.
This morning I was a guest on Central Standard, a program which airs on the local Kansas City NPR station. The program’s focus was chronic pain. Over the weekend the host’s producer called to do a “pre-interview.” One of the questions he asked me was about the relationship between efforts to improve chronic pain care and the opioid epidemic.
Although I am agnostic about opioids, on more than one occasion, I have been the victim of what a colleague calls “hit and run journalism” and alleged to be an “agent of big pharma” because of the position I take. I think we have overused opioids. Continue reading
Too Much Emotional Intelligence Is a Bad Thing – Scientific American – By Agata Blaszczak-Boxe on March 1, 2017
Profound empathy may come at a price
Recognizing when a friend or colleague feels sad, angry or surprised is key to getting along with others. But a new study suggests that a knack for eavesdropping on feelings may sometimes come with an extra dose of stress.
This and other research challenge the prevailing view that emotional intelligence is uniformly beneficial to its bearer.
In a study published in the September 2016 issue of Emotion, psychologists Myriam Bechtoldt and Vanessa Schneider of the Frankfurt School of Finance and Management in Germany asked 166 male university students a series of questions to measure their emotional smarts. Continue reading
Psychoactive Properties of Opioids and the Experience of Pain – Journal of Pain and Symptom Management – February 2016
Here is a letter to the editor of a pain journal from Stephen R. Connor, PhD of the Worldwide Hospice Palliative Care Alliance.
He points out what so many of us have noticed: if you take opioids when you’re in pain, you do not get “high” (see also Opioids, Endorphins, and Euphoria)
A frequently held view in palliative care is that when patients in pain use opioids, they do not experience the psychoactive or euphoric effects of opioids.
Furthermore, that those not in pain who use opioids do experience these euphoric effects that may lead to opioid-use disorder. Continue reading
NEJM editor: “No longer possible to believe much of clinical research published” | The Ethical Nag |Blog post from 2009/11/09
Harvard Medical School’s Dr. Marcia Angell is the former Editor-in-Chief at the New England Journal of Medicine, arguably one of the most respected medical journals on earth
But after reading her article in the New York Review of Books called Drug Companies & Doctors: A Story of Corruption, one wonders if any medical journal on earth is worth anybody’s respect anymore.
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” Continue reading
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain | Annals of Internal Medicine | American College of Physicians
Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatmentwith
- superficial heat (moderate-quality evidence),
- acupuncture, or
- spinal manipulation (low-quality evidence). Continue reading