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Many prescribers are faced with ethical and legal dilemmas stemming from patients who they suspect might be diverting their prescription drugs. And it’s going to be difficult for prescribers to detect this deception because even police officers have difficulty doing so. And if a physician or...
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When faced with a problem patient, it’s important to remember the physician-patient relationship, and to keep that front and center. Prescribers should avoid labeling and not avoid the issue. State-licensing boards are going to encourage the provider to talk to the patient about a potential problem...
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The Chronic Migraine Education Program (CMEP) gives frontline practitioners a bird’s eye view of chronic migraine. It introduces concepts about diagnosis, on risk factors, of what to watch out for patients who may have frequent episodic migraine and the risk factors for conversion to chronic...
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Peripheral nerve entrapment is predisposed many times by metabolic disorders. We know that when a nerve has a metabolic disorder such as diabetic peripheral neuropathy, it causes that nerve to function differently. It causes it to swell. It has a higher water content. It becomes heavier. It has a...
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Over the last decade, it’s become very clear that many people who experience widespread pain or maybe first experience pain in their distal extremities, burning pain, difficulties with sweating, difficulties with bowel function, difficulties with urination, may be experiencing small fiber neuropathy...
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Why is complex regional pain syndrome so challenging? I think part of the debate is what really constitutes CRPS, because it’s really a difficult diagnosis. You can see flagrant cases of it where you’ll get some atrophy and you’ll get color changes, temperature changes. Typically diagnostic tests...
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Roughly 40 percent of anyone’s chronic pain comes from their food. If your pain is worse or you’re having a bad day there’s a reason for it and the most overlooked reason is our food. The food that we eat causes tremendous amounts of inflammation and if we’re eating inflammatory foods, that turns...
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Morton’s neuralgia, as it turns out, is not a true growth of the nerve, but is a compression-type injury of the peripheral nerve as it is in the plantar aspect of the foot, heading out towards the toes. It produces some remarkable symptoms that have folks limping in through the door. The diagnostic...
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Most state licensing boards specify that if you’re in a chronic opioid prescribing situation, you have to do a history and physical evaluation, write up a treatment plan, be sure there is informed consent, and a treatment agreement. If it’s a new patient that you don’t know well, think about a slow...
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I don’t think it’s out of the scope of good practice to even have a conversation pre-prescription of opioids to say, I’m considering prescribing these things to you, but just keep in mind that these can cause problems with people and you really don’t know whether it will or won’t unless you do it or...