Tag Archives: standards

CVS Defends Rx Opioid Policy

CVS Defends Rx Opioid Policy — Pain News Network – Sept 28, 2017 – bu Pat Anson

I don’t like the idea that some corporation, in business purely to make profits, can make decisions about my medical care and, without a medical reason or even exam, limit the pain relief my doctor prescribes for me.

And if these limits don’t provide me the pain relief I had previously, if the actions of the drugstore corporation in reducing my prescription to some “standard” causes a deterioration in my quality of life, and if I then become despondent and suicidal… who will answer for my distress?

…Asked to comment on these and other concerns, CVS Health emailed a statement to PNN answering a series of questions we had about its new opioid policy.  Continue reading


The Conundrum: Individual Risk vs. Population Risk

The Risk-Prediction Conundrum: Individual Risk vs. Population Risk – CardioExchange CardioExchange May 21st, 2014 – by John W McEvoy, MB BCh BAO

How do you explain the difficulties of risk prediction with patients?

This is a difficult but necessary exercise. So much of what we do in medicine is based on risk.

Indeed, fully informing patients about the risks and benefits of their care depends on having at least a simple understanding of risk.   Continue reading

Pain Management in Patients With Hypermobility Disorders

Pain Management in Patients With Hypermobility Disorders: F… : Topics in Pain Management – Topics in Pain Management: July 2017Linda Stapleford Bluestein, MD – Continuing Education (CME) Activity

Learning Objectives/Outcomes: After participating in this CME/CNE activity, the provider should be better able to:

  1. Describe the various types of hypermobility.
  2. Identify signs and symptoms of hypermobility spectrum disorders.
  3. Develop treatment plans for patients with hypermobility disorders that address their specific and unique needs.

Chronic musculoskeletal symptoms account for a vast amount of health care utilization and are a leading cause of impairment and deterioration of quality of life.   Continue reading

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