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About 10 years ago I wrote a paper with Ken Kirsh and Howard Heit about how every stakeholder from the clinician to the patient, to the media, to law enforcement, regulators, could all work together to improve the state of affairs in pain management and the fate of people with pain. It was Ken Kirsh...
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You know, as healthcare providers, we all want to help our patients and we trust that the system is honest. The problem is that the system is not always honest, and we see both counterfeit medical delivery as well as counterfeit medications. The problem is much larger than just the few cases that...
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Methadone is an outstanding analgesic. It has a long half-life which can be very tricky of course, but it gives the patient the flexibility of only having to take their analgesic twice a day. It also has multiple mechanisms of action over and above the other opioids. It’s a mu receptor agonist but...
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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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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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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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Chronic pain patients who fail standard treatments represent a growing problem, and a dilemma for health care providers. A pain specialist and senior PAINWeek faculty member discusses what we know about treatment failure, and outlines some elements of a successful treatment approach.