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Number 1, you’re doing a urine test for the patient, not to the patient. It’s to increase communication, not decrease communication. You have to know what question you’re trying to answer with a urine drug test.The test is an important tool but it’s just a tool and you have to know its strength and...
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Urine testing is very good at doing some things but I think we have to be careful that we don’t extend the science of urine drug testing beyond what it’s good for. Really what it’s good for is, as Howard says, opening a dialogue; facilitating a difficult, in some cases impossible, subject to broach...
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In the last two years, states regulators have essentially codified what amounts to standard treatment for chronic pain. Now we’ve always had the World Health Organization three-step ladder and a lot of guidelines, but states have drilled down and said that opioid dosage of between 60 and 120 mg of...
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Smartphone technology has been rapidly emerging and now there are about 44,000 health-related applications out on the market. A substantial proportion are directed at improving outcomes in people who suffer from pain. For older patients who live alone, they can be important clinical eyes and ears; a...
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The existence of opioid induced hyperalgesia has been debated, but I believe that it does. It’s when a patient uses an opioid and over time develops not just tolerance but super tolerance. Tolerance is normal. You take a medicine, your body adjusts to that dose. The side effects will usually go away...
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One of the things to keep in mind about good communication is really being in the room with your patient--really listening. I know that can be quite difficult for some specialties these days especially with mandated reporting on computers and such, but it is so important especially for teenagers to...
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There’s a new oral formulation for opioid induced constipation and it falls under the class of the PAMORAs which are the peripherally acting mu-opioid receptor antagonists.
So far on the market we have methylnaltrexone which is subcutaneous, we have alvimopan which is oral but it causes heart...
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When we think about the reward circuits in the brain, heavily dependent on dopamine and now more evidence to suggest the involvement of endogenous opioids, you can begin to recognize that from an evolutionary standpoint, we really do need those circuits. We need to be motivated to seek out things...
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Visceral pain relates to pain in the organs of the body, so it could be the chest, or more likely, the abdomen or the pelvis. It is somewhat unlike other pain syndromes in a sense that visceral pain activates the autonomic nervous system, specifically the parasympathetic nervous system or the...
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If we look at pain and we look at depression, pain is costing us about 600 billion dollars a year. Depression alone is costing us about 100 billion dollars a year. The comorbidity of these problems is extremely high--about 50 to 65 percent. With regard to treating people who are suffering with...