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When we consider the 50 billion brain cells and trillions of connections that are involved in the experience of pain, it’s preposterous to think that administering a pill or a series of pills or a patch is really going to change the environment substantially. There are so many ways to impact that...
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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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What I have found in the research as well as from my clinical experience has been that adolescents are often paired with pediatric and geriatric populations in the studies as well as treatment. But adolescents differ in many ways on biopsychosocial and spiritual levels. Biologically, the brain is...
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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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UDT is the preferred tool in patient centered care, and is increasingly important in risk management. Heit and Gourlay discuss how it can offer clinicians insight into patient identification, treatment, and monitoring, and provide objective data for risk evaluation.
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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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Worker’s Compensation patients differ from the average group health claim. Most people on Worker’s Compensation have had some kind of a physical injury that has led to a chronic pain condition. Whereas in group health claims for pain therapy it’s much more focused on management of diseases of either...
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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...