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The use of cannabis is big business in the United States and internationally, so we’re dealing a lot with cannabis in terms of both medicinal and recreational applications. What does that mean? I really think that clinicians now need to be encouraged to educate themselves about what is known and...
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What I generally hear people say when we go in and introduce ourselves and say we’re part of the palliative care team is “But I’m not dying.” That’s the big confusion. Palliative gets mistaken for hospice. We try to define what it truly is: symptom management and conversation and support for anybody...
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There are a lot of different causes of pelvic pain, and there’s never just one cause of pelvic pain. Many times there is more than one or two, three, or four causes in someone who presents with pelvic pain. And it expands all organ systems. It goes from vascular, urological, gynecological...
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As we look at the difference between interdisciplinary and integrative, it really helps to back up the train, so to speak, to see what the words actually mean. Over the years, we’ve seen progress from multidisciplinary to interdisciplinary care, and the medical home model that emphasizes how the...
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“Spinal bracing” is using braces to help give people stability and pain relief in their spine, particularly in the neck and then the low back. Braces help people move. We want to change people from a focus on pain to a focus on function, and spinal bracing helps us to do that. In the old days...
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It has been suggested that stroke associated loss of inhibitory neurons in the spinothalamic tract causes disinhibition of thalamic neurons, which generate ectopic nociceptive action potentials responsible for the pain experience. However, recent data suggests that pain is dependent on the...
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What scares me is our pendulum of pain management was all the way in one direction, pushing for aggressive pain management, taking that pain score without any kind of other understanding about tolerability or functionality and now we’re a little hysterical. And this pendulum has swung the other way...
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I think suicide is a silent epidemic. I think we’ve been so obsessed with the “opioid crisis” that we really miss this cry for help from patients with chronic musculoskeletal or nonmalignant pain and malignant pain. Almost 50% of patients with chronic pain have suicidal thoughts, and they may not...
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Primary care should know that the number of regulatory agencies that are getting involved in the management of chronic pain seems to be growing by the week. Since 2011, the Food and Drug Administration has become really involved with the post-marketing prescribing of opioids, with REMS being...
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Looking at medication options for substance use disorder, there is buprenorphine which is a full mu opioid agonist and also has an affinity to the kappa receptor which is what makes it lower liability in terms of abuse. Buprenorphine has been around for a long time. In the 1980s it was an injectable...