Tag Archives: standards

EBM only works for the mythical “average patient”

Evidence-Based Medicine (EBM) figures prominently in these efforts and is vigorously pursued and implemented by corporate healthcare (whose prime directive is to create profit for shareholders).

The best treatment(s) for chronic primary musculoskeletal pain

The best treatment option(s) for adult and elderly patients with chronic primary musculoskeletal pain: a protocol for a systematic review and network meta-analysis –  free full-text /PMC6842192/ – Nov 2019

When researchers try to design studies about pain without differentiating between different kinds of pain, which I think invalidates those studies right away.

For myself, I’ve noticed several types of pain and each requires a different treatment:

  • For the pain from subluxations in joints, opioids work.
  • For my cervicogenic headaches, neck exercises work (and opioids initially).
  • For muscle spasms along the spine, muscle-relaxants are effective.
  • For the burn in muscles being used, nothing has worked.

Different pain requires different treatment, and I haven’t seen any studies about “pain” that rigorously control what kind of pain subjects have.  Continue reading

Profit Motive as Cause of Previous Over-Prescribing

I keep reading about studies that show opioids to be no more effective for pain than non-opioid medications or other therapies. I still cannot believe that.

At first, I was convinced the studies had been corrupted, then I thought that the statistics were improperly manipulated, then I thought the patients had been poorly selected, but now I’m running out of excuses to insist those studies are wrong.

Still, it makes no sense to me that the only medication or treatment or therapy that has reliably reduced my pain for decades can be “proven” to be no better than drugstore pills (NSAIDs).  Continue reading

Stanford finds personalized approach to opioids better

Opioids: Stanford researchers find personalized approach a better way to prescribe painkillersBy Denise Dador Dec 2019

This article demonstrates the importance of personalization for quality healthcare and shows that standards are inappropriate for medication choice and dosing.

Why do some people get addicted to opioid painkillers and others don’t?

Stanford School of Medicine researchers have developed an innovative program called the Humanwide Project. Through wearable technology, genetics, and other tools, it aims to personalize care and take the mystery out of how we work.

Debbie Spaizman was nearly sidelined by a health concern. Surgery was needed, but she hesitated due to how she reacted to pain medication.   Continue reading

Pain Needs Patient-Centered and Individualized Care

The HHS Pain Management Best Practice Inter-Agency Task Force Report Calls for Patient-Centered and Individualized Care – Jianguo Cheng, MD, PhD, FIPP, Molly Rutherford, MD, MPH, FASAM, Vanila M Singh, MD, MACM – January 2020

At least these folks see the reality: for pain, both acute and chronic, standard treatment with standard doses of standard medications is simply not medically appropriate. Pain treatment is not suitable for standardization.

Some healthcare services must be personalized to be effective, even when they become much more complicated and difficult (meaning, expensive).

The same people insisting on standard dose limits for opioids wouldn’t think of suggesting standard dose limits for blood thinners or insulin or cancer treatments.

The Pain Management Best Practices Inter-Agency Task Force (Task Force) was convened by the US Department of Health and Human Services (HHS), in conjunction with the Department of Defense, the Department of Veterans Affairs, and the Office of National Drug Control Policy. Continue reading

Guidelines should allow for individual decisions

National Academies outlines new guidelines for opioid prescribing – By Andrew Joseph @DrewQJosephDec 2019

 A new report issued Thursday by the National Academies of Sciences, Engineering, and Medicine outlines a framework for prescribers and others to develop their own plans for acute pain, without offering any direct recommendations itself. 

Here is finally a sensible “guideline” that essentially says to ignore specific “rules” and work with individual patients to find what works best for them.

But I expect the simplistic anti-opioid rules fabricated by non-medical “experts” will continue to override any thoughtful guidance from respected scientific groups like the National Academies of Sciences, Engineering, and Medicine.

After all, what could scientists possibly know that PROPagandists don’t?   Continue reading

CDC Guideline Harms Pain Patients

CDC Guideline Harms Pain Patients, Panel Saysby Judy George, Contributing Writer, MedPage Today – March 11, 2019

The CDC’s 2016 opioid guideline is being implemented in ways that harm chronic pain patients, a panel of physicians said here.

I agree that the problem isn’t with the guidelines themselves.  They were just

1) suggestions,
2) for primary care providers and
3) first-time opioid prescriptions.

The problem is that they have been weaponized by anti-opioid crusaders to make laws and rules that force opioid tapers even when not medically indicated.  Continue reading

Reducing the global burden of chronic pain

Reducing the global burden of chronic pain – Beth D. Darnall, Clinical Professor, Stanford University School of Medicine

The profound global burden of chronic pain is increasing as the world population ages, and particularly so for low and middle income countries.

Reducing the global burden of pain requires

  • national policy and investment to develop coordinated local, national and international efforts to improve professional and public pain education;
  • promotion of the biopsychosocial model of evidence-based pain care;

However, the biopsychosocial model is based on poor or biased evidence. Many pain patients ultimately respond only to the effectiveness of opioid therapy.  Continue reading

Medical guidelines may be biased, overly aggressive

Medical guidelines may be biased, overly aggressive in USCornell University – Apr 2019

Dr. Sunita Sah practiced general medicine for several years in the United Kingdom’s National Health Service. When she came to the United States, she noticed something strange.

The U.K. guidelines for tests such as mammograms and colon cancer screenings drastically differed from those in the U.S…

…even though they were based on the same medical evidence.   Continue reading

Inconsistent Definitions of Opioid Use Disorder

Agreement between definitions of pharmaceutical opioid use disorders and dependence in people taking opioids for chronic non-cancer pain (POINT): a cohort study – The Lancet Psychiatry – free full-text – Mar 2015

Background

Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used.

I find it outrageous that OUD can be diagnosed on a whim just by using the fitting definition in one of the several classification systems.

The DSM-5 is the worst, thanks to its “spectrum” of Opioid Use Disorder (OUD), which always places us pain patients, with our regularly prescribed opioids, into the low end of this spectrum.  Continue reading