Tag Archives: standards

Glut of Anesthesia Guidelines a Disservice

Glut of Anesthesia Guidelines a Disservice, Except for Lawyers – Pain Medicine News – Mar 2017 – By Robert E. Johnstone, MD

Anesthesia practice guidelines are out of control—too many to adopt, too anecdotal to accept and too political to take seriously!

Every society seems to issue them now, in order to announce their existence, promote their brand or troll for members. I would ignore most of them, but unfortunately lawyers use society guidelines as standards of practice for malpractice suits, to evidence actionable breaches.

I might try to follow them, except their scientific bases are weak and they sometimes conflict with each other.  Continue reading

Medicare Sets NO Maximum Opioid Dose

CMS finalizes 2018 payment and policy updates for Medicare Health and Drug Plans, and releases a Request for Information – 2017-04-03

The final policies are similar to those proposed and discussed in the Advance Notice and draft Call Letter in February but incorporate several changes in response to feedback received during the public comment period.

CMS apparently read our comments and reacted to them, unlike the CDC, which completely ignored input on their opioid prescribing guidelines.

This is the first national policy to give authority back to physicians to manage opioid medications for chronic pain patients. It could be a sign that the medical industry is finally reconsidering its rash generic restrictions on what should be a treatment plan developed by doctors with their patients.  Continue reading

Is my doctor’s guideline for my treatment right for me?

Is my doctor’s guideline for my treatment right for me? – Melissa J. Armstrong, MD | March 11, 2017

Health care guidelines are produced in ever-increasing numbers. The National Guideline Clearinghouse, a U.S.-based public website compiling summaries of “clinical practice” (health care) guidelines, has over 1,000 entries and is updated weekly. The National Institute for Health and Care Excellence in the U.K. has over 180 clinical guidelines.

Health care guidelines impact policy decisions and care for individuals. Recent research, though, suggests that the public has only a vague understanding of what guidelines are and how they are developed.

Current high-quality clinical practice guidelines, though, are anchored in a thorough review of available medical evidence.

This was certainly not the case with the CDC Guidelines (see CDC Manipulated Data to Deceive, Contradictions in CDC Guidelines, and Updated: Evidence Against CDC Opioid Guidelines)   Continue reading

Ehlers-Danlos receives new classification update

‘Most neglected disorder in modern medicine’ receives major classification update | The Ehlers Danlos Society

This long-awaited review updates the diagnostic criteria for the first time in 20 years, and provides management and care guidelines.

Full paper will be published
at http://ehlers-danlos.com/
on March 15th.

Latest Info 3/16
2017 EDS International Classification

Continue reading

Need for High Opioid Dose Linked to CYP450

Need for High Opioid Dose Linked to CYP450 | Medscape | September 25, 2012 by Nancy A. Melville

The problem of extreme variability in opioid metabolism has been known for years, yet is completely disregarded in creating more and more guidelines for standardized dosages.

Patients with chronic pain who require high doses of opioids to achieve pain relief show exceptionally high rates of defects of the cytochrome P450 (CYP450) enzyme system compared with the general population.

The CYP450 enzyme system is known to play an important role in the metabolism of opioids, and recent advances in genetic testing allow for the easy detection of defects to the enzymes.  Continue reading

Opioid regulation ignores the larger issues

Treating chronic pain: Regulation ignores the larger issues |Shirie Leng, MD | Meds | December 23, 2014

In 2009, the FDA asked for recommendations on restricting prescribing which were met with opposition from drug companies and physicians’ lobbying groups.

They are talking about pain patient advocacy organizations here, insinuating that they have nefarious motives, and that suffering patients are just lobbyists for pharmaceuticals or doctors (whichever is the punching bag in the particular article).

It’s a conundrum for pain patients because we happen to need what the pharmaceutical industry wants to sell, even while our goals and motives are not just different, but oppositional:   Continue reading

Some People Need more Salt (or Opioids) than Others

Shaking up the Conventional Wisdom on Salt | Competitive Enterprise Institute | Michelle Minton • January 24, 2017 – What Science Really Says about Sodium and Hypertension

This situation parallels the current restrictions on opioids, only with less drastic results.

Somehow, the someone got the idea that all Americans should restrict their sodium intake to some arbitrary level to reduce the rate of hypertension in the population.

This turns out to be nonsense.   Continue reading

Defective Opioid Metabolism in Pain Patients

Here are two more articles about the great variety in individuals’ ability to metabolize opioids (and a list of 6 previous posts about this), which leads to great variety in the pain relief they achieve from opioids.

This is the scientific arguments against the CDC opioid guidelines and other such “standards” limiting opioid doses to some arbitrary standard.

Genetic Mutations in Cytrochrome P 450 2D6 – P1 – Practical Pain Management – March 2014

The majority of opioid medications are metabolized by one or more of the CYP450 isozymes.   Continue reading

Why CMS Should Not Remove Pain Questions

Why CMS Should Not Remove Pain Questions From Payment Calculations – Pain Medicine News – Oct 13, 2016

The Centers for Medicare & Medicaid Services recently recommended removing pain questions from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which would remove pain questions from payment calculations. This is an alarming development for many reasons.

The Affordable Care Act promotes a new paradigm of patient-centric health care and seeks to empower patients. Removing pain questions from the survey essentially removes pain control from their power:

Patients will suffer pain to the extent that their health care providers permit it, and they can do very little about it.

This is the very antithesis of the patient-centered model. We need to give a voice to our patients, not silence them.   Continue reading

Chronic Pain Management in Adult Cancer Patients

New Guideline Issued on Chronic Pain Management in Adult Cancer PatientsJohn Schieszer  –  July 27, 2016

 On July 25, 2016, The American Society of Clinical Oncology (ASCO) issued a new clinical practice guideline that deals comprehensively with the pain patients experience after cancer treatment.

In this article, authors propose recommendations based on clinical evidence for safe and effective treatment of persistent pain.

This new guideline is the first to address the growing population of cancer survivors with chronic pain.

More than 15 million people are living with cancer in the United States and studies suggest the prevalence of pain in cancer survivors is close to 40%.   Continue reading