Tag Archives: standards

Four Clusters of Chronic Pain Patients Identified

Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study) – free full-text article /PMC5805304/ – PLoS One, Feb. 2018

This the first study I’ve seen that begins to address the wide variety of “pain patients” that suffer from so many varieties of “chronic pain”. We are NOT a uniform group.

The major findings of the study were that the four groups/clusters were identified, which had the following characteristics:   Continue reading

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Has patient-centered care gone too far?

Has patient-centered care gone too far? – Ali Rafiq, MD | Physician | April 28, 2018

This article makes the good point that a metric-driven push to provide all kinds of patient-centered amenities in medical settings is far from optimal. The patient is not always right.

The first week of residency of any program is usually comprised of several orientation sessions in which the new interns are introduced to various important aspects of the residency program. One of the sessions regarding patient safety and quality though caught my eye. It was the introduction of the STEEEP model of health care.

It came across as a clever acronym that stood for safe, timely, effective, efficient, equitable and patient-centered (STEEEP) care — a motto that was supposed to be shared by all employees of the hospital.   Continue reading

Individualizing Pain Treatment: Start with Gender?

Individualizing Pain Treatment: Start with Gender? – ASPS 2018

When evaluating a new patient with pain, doctors may first think about the location of the pain, the potential mechanism, the severity or the age of the patient.

Inna Belfer, MD, PhD, has another idea: first, consider gender. “The approach to the patient should be individualized, first of all, based on sex, then age,” said Dr. Belfer, health scientist administrator at the National Institutes of Health (NIH) Office of the Director.

This seems so obvious to me that I’m surprised it’s worth an expert’s time to write about it.   Continue reading

CDC Admits It Screwed Up Counting Opioids

The CDC Quietly Admits It Screwed Up Counting Opioid Pills | American Council on Science and Health – By Josh Bloom — March 19, 2018

Here’s another take-down of the CDC’s corrupt counting:

Here’s the title of an opinion piece in the April issue of the American Journal of Public Health, which was published by four authors at the CDC: Quantifying the Epidemic of Prescription Opioid Overdose Death

(See previous post: CDC Over-Counting Rx Opioid Overdose DeathsContinue reading

Boston Pain Care Functional Pain Scale

I finally found a pain scale that relates to levels of functionality, not sensation.

I’ve always self-rated my pain by how much it interrupts me, if I can override the interrupts and still write or if I have to stop and lie down, or if I’m so consumed by some pain I can only lay unmoving with gritted teeth waiting for my pain medication to take effect (that can be over an hour sometimes).   Continue reading

Doctors Protesting Medicare Opioid Limits

Doctors Are Protesting Medicare Change That Would Let Insurers Deny Opioid Prescriptions – by Ed Cara – Mar 6, 2018

The most exceptional aspect of this article is where it appeared: in a publication devoted to high tech, Gizmodo. This means it will be seen by a completely different audience than most such pieces.

In response to the opioid epidemic that is killing tens of thousands of Americans a year, the U.S. government is poised to further restrict the amount of opioids Medicare patients can have access to at any one time, via a policy that would tell insurers to deny coverage for certain prescriptions on the spot.

But a group of doctors and researchers is pleading with officials to reconsider, saying the move would harm cancer patients and others who desperately need pain relief. Continue reading

Doctoring destroyed by legislators and admins

Our noble profession is being destroyed by legislators and administrators – KevinMD – CATHLEEN LONDON, MD | Aug 2017

A doctor describes the frustration of her hard-won knowledge and expertise being overruled by an insurance company minion with barely a high school degree.

I had a great day in the office today. Not that I came up with any brilliant diagnosis nor cured anyone.

I was able to just be a physician. No time wasted on the phone with insurance companies. No prior authorizations to do.

It was a reminder of how much I love my job.   Continue reading

DSM-5: Withdrawal = Substance Use Disorder

American Psychiatric Association Proposes 5 Changes to DSM-5 – Gary Rothbard, MD, MS – Feb 2018

I’m outraged that In the DSM-V, any drug withdrawal was coded with Substance Use Disorder (SUD), even when any reasonably intelligent person understands that withdrawal from any drug, whether opioids, caffeine, or antidepressants, is unrelated to a SUD. 

These ignorant people who insisted that withdrawal indicates a SUD were so sure of themselves they published it in *the* psychiatric manual used by every doctor and insurance company?

How many people read this nonsense and approved it? With so many psychiatric experts vetting this important manual, how did this complete distortion of fact get by?  Continue reading

Limitations of the DSM-5

Limitations of the Diagnostic and Statistical Manual of Mental Disorders — also known as the DSM – Medium Feb 2017 – by Jeffrey Guterman

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) may be among the most controversial and polarizing books in the world.

Informed by the medical model, the DSM-5 is the official diagnostic manual of mental disorders authorized by the American Psychiatric Association (APA, 2013).

It has engendered debate in the public arena as well as professional circles. At the same time, it has been a best-seller on The New York Times, Amazon, and other book lists.   Continue reading

Crash Course for Submitting Comments to CMS

#HPM Crash Course in Submitting Comments to CMS | Matthew Cortland on Patreon – Feb 2018 – by Matthew Cortland

Mr. Cortland gives excellent advice for the best way to write your comments on opioid policy. Though his words are aimed at Hospice & Palliative Medicine (HPM) clinicians, I believe many of us chronic pain patients have just as much knowledge and experience with this subject.

CMS has published their proposed changes to Medicare for 2019.

Here are the changes that, in my view, may be the most concerning to Hospice & Palliative Medicine (HPM) clinicians:  

  1. Starting to crack down on opioid ‘potentiator’ drugs – like gabapentin and pregabalin.
  2. Limiting opioids to 90 MME per day.
  3. Making it more difficult for patients to fill two or more long-acting opioids.    Continue reading