Tag Archives: standards

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

The fallacy of patient-centered care

The fallacy of patient-centered care– KevinMD.com – by – Mar 2019

According to NEJM CatalystPatient-and family-centered care encourages the active collaboration and shared decision-making between patients, families, and providers to design and manage a customized and comprehensive care plan

Under patient-centered care, care focuses more on the patient’s problem than on his or her diagnosis. Patients have a trusted, personal relationship with their doctors …”

Historically, patients have had better relationships with their physicians than they do today.    Continue reading

A patient’s opposition to the anti-opioid movement

A patient’s opposition to the anti-opioid movement – KevinMD.com – Mar 2019

I wrote this essay for the doctors’ blog, KevinMD.com. My original title was “California’s Death of Sanity Project” as I criticize what’s called the “California Death Certificate Project”.

It’s bad enough that they are prosecuting doctors for prescription they are writing now, but this project goes up to three years into the past, looking for any opioid prescription to a person who overdoses, even years after they received the prescription, even if the overdose was from fentanyl or a combination of multiple illicit drugs.

As I end my essay:

Trying to stem illicit opioid overdose deaths by mandating restrictions on opioids for patients in pain is only a cruel experiment fueled by ignorance and fear.

— Read on www.kevinmd.com/blog/2019/03/a-patients-opposition-to-the-anti-opioid-movement.html

Our health info bundled into simplistic “risk scores”

How your health information is bundled into a “risk score” – Twitter thread by Stefan Kertesz – @StefanKertesz – comment on previous Politico story.

1/How your health information is sold and turned into ‘risk scores’ – from @politico …Let me share a couple insights from using a risk tool paid for by US taxpayers https://www.politico.com/story/2019/02/03/health-risk-scores-opioid-abuse-1139978

2/First, risk scores of high quality use all health information, as VA studies show risk for OD/suicide reflects

(a) medical + mental + prior substance use, &
(b) # of co-prescribed sedating mess that are crucial.

Actual #opioid dose, formulation are relevant, but less so

https://twitter.com/StefanKertesz/status/1092266758436802560/photo/1 Continue reading