Category Archives: Uncategorized

Impact of High-Dose Opioids on Overdoses

Zyp Czyk really outdid herself with this one…hard to imagine, but it’s true. Incredibly concise, clear statement of FACTS (remember those?).

EDS and Chronic Pain News & Info

Cohort Study of the Impact of High-Dose Opioid Analgesics on Overdose Mortality | Pain Medicine | Oxford AcademicJanuary 2016

Objective.

Previous studies examining opioid dose and overdose risk provide limited granularity by milligram strength and instead rely on thresholds.

We quantify dose-dependent overdose.

Spoiler: there is no linear or incremental increase in overdose risk by dosage.  The 90MME limit proposed by the CDC Guideline isn’t based on science, but more like a consensus “best guess” by addiction doctors. 

View original post 1,250 more words

Advertisements

Leave a comment

Filed under Uncategorized

Switching Opioids for Better Pain Relief

Another excellent piece with insightful comments by my very good friend & amazing resource, Zyp Czyk

EDS and Chronic Pain News & Info

Could Switching Opioids in Cancer Patients Provide Relief? – Lori Smith, BSN, MSN, CRNP – Nov 12, 2018

I’m disappointed to see this limited only to cancer patients. Since we know that there’s NO DIFFERENCE between cancer and non-cancer pain, these findings would also apply to other kinds of chronic pain.

Side effects and inadequate pain relief with the use of opioids in cancer patients is a challenge for healthcare providers to manage and can cause considerable problems for these patients.

While the topic is still debated within the medical community, opioid switching in cancer patients may provide relief of pain and alleviation of opioid-related side effects, according to the results of a recent Italian study.  

View original post 409 more words

Leave a comment

Filed under Uncategorized

Study: Limiting opioid Rx won’t reduce overdose deaths

Another highly informative post by my good friend, Zyp Czyk

EDS and Chronic Pain News & Info

Limiting opioid prescriptions will do little to reduce overdose deaths, study says – by Felice J. Freyer Globe Staff  February 01, 2019

This article is about a very important, and for us very encouraging, new JAMA study that just came out showing that prescription limits barely reduce overdoses. We pain patients have known this all along, but when it’s officially researched and published it will be taken more seriously.

The anti-opioid zealots will try to explain away its findings, but it will be a piece of hard evidence that saner minds can use to push back against these ridiculously ineffective prescription opioid limits.

When the death toll from opioid overdoses began to soar a few years ago… Policy makers naturally sought to put a lid on opioid prescribing.

But a study published Friday in JAMA Network Open finds that reducing opioid prescriptions will have little effect on the death rate…

View original post 1,113 more words

2 Comments

Filed under Uncategorized

Complications of Uncontrolled, Persistent Pain

EDS and Chronic Pain News & Info

Complications of Uncontrolled, Persistent Pain – By Forest Tennant, MD, DrPH – Jan 2018

To the unfortunate patient who is afflicted and the practitioner who treats it, incurable, persistent pain is truly its own disease regardless of its underlying cause.

Persistent pain, which is also often characterized as chronic or intractable, has all the ramifications of a disease in that it may have pre-clinical and overt phases.

I like that he calls it “persistent pain” instead of “chronic pain”, a term which has become synonymous in the public’s eye as a whining, complaining, catastrophizing, gonna-be addict.   

View original post 1,321 more words

Leave a comment

Filed under Uncategorized

HHS Report on Pain Mgmt Best Practices – part 3

EDS and Chronic Pain News & Info

Draft Report on Pain Management Best Practices | HHS.gov – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary.

I posted the second, most significant part yesterday, HHS Report on Pain Mgmt Best Practices – part 2, and the first part the day before: HHS Report on Pain Mgmt Best Practices – part 1.  

This is the third and final part of my series, and covers the middle of the document, starting where I left off in the second part detailing interventional procedures.

View original post 2,466 more words

Leave a comment

Filed under Uncategorized

HHS Report on Pain Mgmt Best Practices – part 1

EDS and Chronic Pain News & Info

This seems like the first good news in a while: a government agency admitting that most opioid overdoses are from illicit fentanyl. The report also documents the downsides of non-opioid medications and highlights the predicament of pain patients.

Draft Report on Pain Management Best Practices | HHS.gov

This document is so long and detailed that I spent hours picking it over to find the critical pieces and add my own commentary. It’s far from perfect, but still a welcome change from the usual PROPaganda – and I choose to celebrate.

Here’s the first part:  

View original post 3,915 more words

Leave a comment

Filed under Uncategorized

HHS Report on Pain Mgmt Best Practices – part 2

EDS and Chronic Pain News & Info

Draft Report on Pain Management Best Practices | HHS.gov – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary. I posted the first part yesterday: HHS Report on Pain Mgmt Best Practices – part 1.

Below is the second part, covering more about opioid medication with all its “risk” and then the final, most significant section, covering the problems and errors of the CDC Opioid Prescribing Guidelines:

2.2.1 Risk Assessment 

View original post 4,004 more words

Leave a comment

Filed under Uncategorized

The civil war over prescription opioids

Another outstanding post with excellent analysis by Zyp! Should be required reading for everyone involved in prescribing policies, & especially for all the media morons who’ve spread the lies so effectively.

EDS and Chronic Pain News & Info

The civil war over prescription opioids – by Lynn Webster, MD – Dec 2018

The war is between science and fact versus PROPaganda and media hype.

Over the past 10 to 15 years, attitudes towards opioid use for pain have shifted dramatically. In the 1990s and early 2000s, pain relief was front and center on the newsstands and in medical literature.

During that time, compassion for people in pain increased and permeated our culture and opioids became standard therapy for chronic pain, because few affordable and effective treatment alternatives existed. 

View original post 893 more words

Leave a comment

Filed under Uncategorized

doctoral contempt

I had a visit recently with the most amazing diagnostician I’ve ever met. This pain doctor, who himself said that he doesn’t know much about migraines or their treatment, nevertheless knew all about & diagnosed mine on our first meeting, in less than 30 minutes! Amazing, eh? I went to a neurologist back in NC for almost as many years as I had minutes with the new guy, a neurologist who is a headache specialist & keeps up to the minute in the field of pain & migraines. That neuro saw & examined me hundreds of times, did all kinds of tests, tried literally dozens of medications, procedures, and treatments, had me keep HA & food & pain & all sorts of hour-by-hour diaries, consulted with fellow headache specialists, and in the end all he was able to do was to declare the migraines intractable and try to treat the symptoms as effectively as possible –we’ve tried every medicine anyone ever heard of that supposedly was prophylactic for migraines or reduced their frequency or severity, including some that were purely WAGs, some of them multiple times over the years.

So on one side I had this brilliant, thoughtful (in both meanings of the word), physician who specializes in migraines and spent decades trying to deal with mine. On the other there’s the pain ‘specialist’ who may not even really believe migraines even exist, but by golly he was able to pinpoint in moments the truth about mine: they’re not intractable, they’re not being treated appropriately, and they’re not really even that bad.

As galling as it is to have this cretin make this snap judgement –and it was very judgmental– about these nightmares that I’ve had to deal with my entire adult life, what really burns my buns is the fact that the jerk put down, as the official diagnosis, “migraines, not intractable.”

Now, NC Neuro first suggested I consider applying for disability in about 1989. I was missing six to twelve days of work per month. I spent those days huddled in bed in a dark room with ice bags on my head; as an added bonus, some of the time I would spend hours on end vomiting with such violence that I’d end up with black eyes because the  pressure caused all the blood vessels around my eyes to burst. It took days to recover, only partly because I always end up severely dehydrated because I can’t even suck on ice cubes when the nausea is bad (yes, I’ve switched tenses; it’s still going on, nearly thirty years later, except there’s some months when I lose more like twenty days a month to indescribable agony).

Anyway, the disability. I was utterly appalled and infuriated when NC Neuro brought it up; I was not a moocher or a sponger, I’m an independent & responsible adult who does not need to be taken care of. The very idea offended me on such a core level that I was rather surprised; I’m not generally judgmental about people who need assistance, it’s just that I wasn’t and would never be one of those people.

Well, the last time I worked, I spent nearly seven out of the last eight weeks of the job in bed, under ice, praying for death. It made for a kick-ass diet, and I probably should’ve been taken to the hospital at least for the dehydration, but I survived. Then I applied for disability. The day I sent in the application I spent most of the time throwing up from the incredible, grinding sense of shame I felt. Friends & my docs told me it wasn’t my fault, that I’d worked for many years around the blinding pain (& sometimes with it; I worked at my lab bench while wearing two pairs of sunglasses because the light was so painful). It was not a confession of weakness to admit that I wasn’t able to work because of the horrible headaches which I’d tried everything to stop –or even reduce.

It sure felt like an admission of weakness & worthlessness.

But along comes this little twerp of a physician who clearly had made up his mind about me before ever laying eyes on me. He saw that I was taking opioids, which are generally not considered the best option for migraines, and passed judgement on me and on my long-term doctor (who agreed to try opioids; he wsn’t a fan of them either, but he knew me, knew my conditions. They helped tremendously and gave me a few more years working). The fact that The Twerp obviously considered me a whiner or faker or whatever pisses me off enough, but it’s far from the first time that’s happened. But the fact that he basically declared that my NC Neurologist is incompetent seriously pisses me off. That poor man worked like a dog (a brilliant dog) for decades to try and help me, and I know I’m a frustrating patient. Not because I disobey directions or am not trying to get better, but because nothing he or I did worked to get me better. I’m firmly convinced that if anyone in the world could’ve come up with a way to do away with the headaches, NC Neuro and I would’ve found it. He’s a brilliant, kind, empathetic physician who treated me like a real human being, moreover like a human with a functional brain (& let me tell you, that’s an incredibly rare way for a physician to treat a patient). And here’s this schmuck dispensing condemnation of me and of NC Neuro; pah!!

Also, I can’t help but worry that The Twerp’s diagnosis –that insidious little “not” that he just had to put in front of “intractable”– will cause trouble with the disability payments. Because the migraines have not gotten much (if any) better since I’ve not been working. It is a relief not to be letting my employer down or feeling guilty &/or overwhelmed about missing work, but that relief hasn’t translated to a decrease in headaches.

We are in such a position of powerlessness to physicians. And many of them revel in being in the power position so much that they lose all compassion and humanity –assuming they had any to begin with. I spent most of my working years as a medical research technician, the person who does the laboratory work. After my first position I advanced to a point of being substantially responsible for designing the research plan; my PI (Principal Investigator) would tell me the kind of information they wanted to figure out, I’d go determine which procedures would best to get it. I worked for years at a lab attached to a teaching hospital, so I had the dubious honor of training newly minted MDs in laboratory techniques. Out of the dozens I trained in the lab, I recall only two who were willing to admit that a mere female, one with only many, many post-graduate courses (but not a Master’s –I was ABT– or Doctorate), could possibly have anything to teach them. These were people who didn’t know a beaker from a bean, but by God, they knew it all anyway.

MD arrogance is a stereotype for a reason; many MDs are arrogant. They firmly believe they are infallible, know everything there is to know, and can evaluate a patient’s mental, physical, and substance abuse status in one micro-second glance. After that, the patient is pigeonholed forever. I have contracted weird and rare health conditions throughout my life; rare indeed is the physician who will spend an instant listening to me say explain them. They are taught in Med School that “when you hear hoofbeats, think horses, not zebras.” In other words, a common condition that seems to fit presented symptoms is the more likely diagnosis. But here’s the thing: zebras do actually exist. Finding a physician who believes in zebras has gotten orders of magnitude more difficult over the last 2-3 decades.

Then there are physicians like The Twerp above, who refuse to even believe that horses exist. That patients are liars. Whiners. Fakers. Subhuman. Deserving not only not being listened to, but not even being treated politely. No, not all physicians are this appallingly narrow minded and bigoted, but given the current insane hysteria gripping the country, more and more are falling into snap judgement –even before attempting a diagnosis, if they even bother with that.

The Twerp could still come back to bite me metaphorically on the ass; I never went back to him, but that “not intractable” determination, based upon absolutely nothing other than his own arrogant prejudice, still lurks in my records somewhere. There is nothing I can do if it rears up, sea monster-like, to destroy my life. This is not hyperbole. We are even more prisoners of medicine than ever, even if we don’t get kidnapped and locked in a hospital like some have been. These doctors hold not only our physical lives in their arrogant, bigoted hands, but our very existence. Lab rats have greater protection against abuse.

 

5 Comments

Filed under health/pain stuff, medical, medical philosphy, Uncategorized

pooch’s SLO update

Brief update on Kenta the Wonder Dog, aka “Mr Fluffypants.” We had a checkup with our incredibly wonderful allergy/immunology vet in Springfield Oregon, Dr Ashley, a little while back. She said that his little tootsies looked so good that if she hadn’t seen him during his flare-up, she wouldn’t have believed he’d ever had one.

He’d started to refuse to eat his super-expensive Super Special Bunny & Sweet potato prescription food a few months ago, so she said to put him back on regular food (no use having healthy feet if you’re anorexic, I suppose). So for the last 2-3 months, he’s been on nothing but the fish oil (300 mg/day) & ToW non-chicken foods. Still looking good & being wonderful enough to provide me with sufficient oomph to keep slogging on.

Words can’t explain –tho I tried– how terrified I was at the prospect of him having chronic pain…just like Mom. At least Mom knows what the heck is going on. It’s so wonderful to see the little guy feeling good & being healthy again! SLO is a fairly rare condition, especially in small breeds, but anyone who has to face it in their beloved dog may take heart in the story of one dog who’s doing well. So far. And Dog, I hope it stays that way. I read a lot on the Net when he was diagnosed, & didn’t run across of terribly optimistic tales…it seemed divided about 33/33/33: a third have the initial flare-up then never again, a third have repeated flare-ups that aren’t too bad, a third a crippled & in agony. I didn’t like the odds at all. There’s no guarantee that he’ll never have another flare-up, but I’ll keep hoping & giving him the fish oil. The hair loss from the doxycycline was just bizarre…another trait he shares with Mom; weird side effects. Grrrrreat.

So, all two or three of you who’ll ever read this, thanks & pass it along to someone who could use a hopeful boost.

Book recommendation for the month: “Are We Smart Enough to Know How Smart Animals Are?” by Frans de Waal. Lots of ape stories, but he also talks about crows & other corvids, & there’s some dog stories. Really well-written, very accessible to anyone who’s interested in animals & how their minds work, many terrific stories and descriptions of his studies of animals over the years, sprinkled with wit & humor. I’ve read science/nature/natural history books* for decades, & about halfway thru the first chapter I flipped to the author info & exclaimed “How have I missed this guy?!”(Kenta jumped about a foot & looked at me the way he does when I talk to books instead of him). The book is outstanding. Kenta sez check it out; he’s all for animal cognition, even if he’s not a canine Einstein.  But he’s still perfect.

* Stephen Jay Gould, David Quammen, Harold Klawans, Natalie Angier, Cynthia Moss, Konrad Lorenz, etc. Lorenz’s “King Solomon’s Ring” is a must for anyone who loves animals, btw. I’ve  given away probably 3 dozen copies over the decades, & nobody’s not loved it.

Leave a comment

Filed under Uncategorized