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Practitioners have been outspoken in describing how they feel a lack of confidence in their own abilities to use opioids, in who to use them, and how to use them. If you couple that with their lack of knowledge about the alternatives to opioids, you really have a situation that is bound to fail...
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I definitely would agree that methadone needs to be respected. I think the other thing, though, is there is such a negative stigma about it that a lot of practitioners have kind of thrown their hands up saying, ‘I don’t understand this, we’re not going to do it.’ What we learn about are always the...
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I would start off by saying that methadone definitely doesn’t have a sense of humor. I think as a practitioner, you have to not only understand the literature for methadone but also the limitations of what we know of methadone. It can be very unforgiving, and so really having a respect for those...
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When we talk about complex pain and patients with advanced illness, there are some basics that people need to know, which is how to treat the patients with opioids and other coanalgesic medications, but the key point is that it’s a team affair, and I would ask primary care physicians not to do it...
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We know that chronic pain does have a biological interface. There are structural and functional changes in the brain, such as gray matter loss and a functional reorganization. We also know that chronic pain is associated with systemic effects, such as increased inflammation throughout the body such...
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When we look at things like frequency, intensity, duration, and extent of pain, we’re better able to evaluate the effect on the system and it’s not only affecting the brain, it’s affecting all the stress response systems. There is work that’s showing that we can actually capture this and show that...
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I think we’ve been so focused on this opioid crisis that we have forgotten that these are very brittle people who have significant psychiatric co-morbidities, including depression, anxiety, sleep disorders, substance use disorders. I think that suicide is really a silent epidemic that has not been...
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For the last decade or longer, we’ve been talking about the challenges with opioids, and they are a challenging class of drug. On the one hand, they’re great at treating severe levels of pain; they may be the only class of medicine that works for severe pain. But there’s a lot of baggage...
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With respect to treating Complex Regional Pain Syndrome, we have had to deal with almost strict empiricism; people just used what they thought worked and what they were comfortable with. Of course, being a researcher, I was always ‘we need better evidence and more data.’ One of the hurdles against...
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Sexual pain affects almost 20% of women across the world and in the United States somewhere between 8% and 20% depending on who you read. It’s been associated with a lot of physical disability, sexual dysfunction, psychiatric disability and excessive healthcare costs. The problem is because it’s...