Docs Feel Pressure to Give Addicts Opioids

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By Kristina Fiore, Staff Writer, MedPage Today,Published: October 24, 2012

A push to treat chronic pain and financial disincentives for treating addiction may pressure clinicians into prescribing opioids for patients who are already addicted, a researcher suggested.

Over the past decade, there’s been a perfect storm of changing clinician attitudes toward pain treatment and patient attitudes towards suffering, combined with a lack of compensation for time-consuming clinic visits such as addiction counseling, Anna Lembke, MD, of Stanford University, wrote in a perspective in the New England Journal of Medicine.

That may be leading doctors to write scripts for pain pills even if they know those patients are abusing their medications, Lembke wrote.

“Treatment of pain is held up as the holy grail of compassionate medical care,” she wrote, and clinicians have, over the last decade, felt more compelled to deliver treatment.

They also have the additional pressure of consumer ratings sites, because patients who are dissatisfied may turn around and leave a less-than-favorable review online. Lembke cites the example of one colleague who will occasionally bite the bullet: “Sometimes I just have to do the right thing and refuse to prescribe them, even if I know they’re going to go on Yelp and give me a bad rating,” the colleague told her…

Related Resources

• Cochrane reviews for pain management (anesthesia and pain control)
  More info about Cochrane reviews (systematic summaries of medical studies) at 
  http://www.cochrane.org/cochrane-reviews
  
• MedlinePlus-Pain has links to resources on treatments, alternative therapy, research news, and more

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Studies explore new approaches to treating pain

Hippocrates stares down at the UCSF doctors, continually reminding them to stick to his oath.

From the 14 Novemer 2011 Eureka news alert

Research includes drug and non-drug interventions

Washington — Scientists are discovering promising approaches to treating pain, one of the most common and debilitating neurological complaints, according to research released today at Neuroscience 2011, the annual meeting of the Society for Neuroscience and the world’s largest source of emerging news about brain science and health. Studies show that “mirror box therapy” can help reduce arthritis-related pain, and that a new opioid-like drug may be able to relieve acute pain without the euphoric effects that can lead to dependency. Additional research also identifies the possible neurobiological source of common side effects of morphine.

Specifically, today’s new findings show that:

• Two of morphine’s most common side effects, itch and headache, may be due to the drug’s activation of immune cells in the membrane surrounding the brain and spinal cord (Julie Wieseler, PhD, abstract 178.12, see summary attached).
• A visual feedback technique called mirror box therapy can help alleviate hand pain in patients with arthritis (Laura Case, abstract 72.03, see summary attached).
• In an animal study, a novel drug relieves acute pain without the dangerous side effects associated with opioid painkillers such as morphine (Stephen Harrison, PhD, abstract 178.10, see summary attached).

Other recent findings discussed show:

• A gene therapy treatment reduced pain in 10 people in a Phase I clinical trial that tested for treatment safety (David Fink, MD, see attached speaker’s summary).
• A naturally occurring protein that supports the survival and growth of neurons in the brain and spinal cord may be a potential therapeutic intervention to prevent chronic pain following spinal cord injuries, according to animal research (Ching-Yi Lin, PhD, see attached speaker’s summary).

“Pain is one of the most intransigent and difficult symptoms to treat,” said Allan I. Basbaum, PhD, FRS, of the University of California, San Francisco, press conference moderator and expert on the neurobiology of pain. “These studies and others are helping us better understand the complex neural pathways involved in pain and the long-term consequences of injury. With this, researchers will be better poised to develop approaches to alleviate pain and aid in recovery from injuries.”

 

###

 

This research was supported by national funding agencies, such as the National Institutes of Health, as well as private and philanthropic organizations. Dr. Basbaum has consulted with Nektar Therapeutics, Inc., but was not involved in research presented today.

View full release at www.sfn.org/newsroom.

 

 

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Upcoming Launch of Online Module on Safe Use of CAM (Complementary and Alternative Medicine)

The American Pain Foundation will soon be launching a PainSafe (Safety & Access For Everyone) module on CAM and pain. This module, created with materials and assistance from NCCAM, aims to educate and empower both consumers and health care professionals.
www.painsafe.org

Better chronic pain management

From the 15 August Eureka news item

Pain care management needs to be improved, with health care professionals committing to improve care as well as a retooling of the health care system to help people who are suffering, states an editorial in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) 
http://www.cmaj.ca/site/embargo/cmaj111065.pdf
.

According to a recent analysis, chronic pain affects people of all ages, with an estimated 500,000 Canadians aged 12 to 44 years, 38% of seniors in long-term care institutions and 27% of seniors living at home experiencing regular pain.

“Experts agree that much can be done now with newer analgesics, nonpharmacologic techniques such as nerve blocks and physical therapies, as well as spiritual and supportive care,” write Drs. Noni MacDonald, Ken Flegel, Paul Hébert and Matthew Stanbrook. “Availability of quality care for pain is the major problem. Health professionals have not mounted a response commensurate with the magnitude of the problem.”

The authors argue for a broad strategy to help increase pain management expertise, including education, technology, and supported self-care and lay coaching.

 

 

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To Help Doctors and Patients, Researchers Are Developing a ‘Vocabulary of Pain’

From the 26 July 2011 Science Daily article

All over the world, patients with chronic pain struggle to express how they feel to the doctors and health-care providers who are trying to understand and treat them.

Now, a University at Buffalo psychiatrist is attempting to help patients suffering from chronic pain and their doctors by drawing on ontology, the branch of philosophy concerned with the nature of being or existence.

The research will be discussed during a tutorial he will give at the International Conference on Biomedical Ontology, sponsored by UB, that will be held in Buffalo July 26-30.

“Pain research is very difficult because nothing allows the physician to see the patient’s pain directly,” says Werner Ceusters, MD, professor of psychiatry in UB’s School of Medicine and Biomedical Sciences, and principal investigator on a new National Institutes of Health grant, An Ontology for Pain and Related Disability, Mental Health and Quality of Life.

“The patient has to describe what he or she is feeling.”

Read the article

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Counterbalance Interactive Library provides views on complex issues

The Counterbalance Interactive Library*** offers  new views on complex issues from science, ethics, philosophy, and religion. Here you’ll find extensive resources on the evolution/creation controversy, biomedical ethical challenges, and much more.

A sampling of health and medical related topic sets

• AAAS Report on Stem-Cells
• E. Coli at the No Free Lunchroom
• Genetic Engineering and Food
• Genetics and Ethics
• Stem-Cell Debate: Ethical Questions

From the About page

About Counterbalance Foundation Counterbalance is a non-profit educational organization working to promote counterbalanced perspectives on complex issues.  It is our hope that individuals, the academic community, and society as a whole will benefit from a struggle toward integrated and counterbalanced views. Counterbalance provides design, consulting, and technical services. It is our intention to use our considerable experience in these areas to serve as a catalyst by. Helping make existing multidisciplinary research work accessible to a wider audience, principally though the use of interactive technologies. Helping collaboration within, and among research groups by providing on-line technology services, such as the shared Meta-Library andAutoReference tools. Our services are used by PBS Online, The Center for Theology and the Natural Sciences, the AAAS, Science and Religion Forum (UK), and others. Counterbalance is funded by donations and the Adrian M. Wyard Charitable Trust.

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Crossing The Line: What Constitutes Torture?

From the 12 April 2011 Medical News Today article

Torture. The United Nations defines it as the “infliction of severe physical or mental pain or suffering.” But how severe is severe? That judgment determines whether or not the law classifies an interrogation practice as torture.

Now, a study published in an upcoming issue ofPsychological Science, a journal of the Association for Psychological Science, condemns this method of classification as essentially flawed.

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The reason: The people estimating the severity of pain aren’t experiencing that pain-so they underestimate it.

As a result, many acts of torture are not classified-or prohibited-as torture, say authors, Loran F. Nordgren of Northwestern University’s Kellogg School of Management, Mary-Hunter Morris of Harvard Law School, and George Loewenstein of Carnegie Mellon University.

The researchers were moved to undertake the study by their alarm at the Bush Administration’s defense of “enhanced interrogation techniques,” such as stresspostures and waterboarding. In court and the media, officials minimized the psychological and physical distress caused by these techniques-and insisted they were not torture.

In this denial, the authors saw a perfect demonstration of a psychological phenomenon called the “empathy gap,” says Loewenstein: “People in one affective state”-hunger, anger, pain-”cannot appreciate or predict another one.” If you’re warm, you can’t imagine the misery of being cold; if you’re rested, sleep deprivation doesn’t seem so bad…

…The study’s conclusion: “The legal standard for evaluating torture is psychologically untenable.”

So what can be done? First, overcompensate. “Knowing that we tend to be biased toward not counting torture as torture, we should define torture very liberally, very inclusively,” says Loewenstein. And don’t trust empathy. “This is an area where we can’t rely on our emotional system to guide us. We have to use our intellect.”

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MRI Shows Mind Over Matter May Really Diminish Pain

MRI Shows Mind Over Matter May Really Diminish Pain

From the April 8 Medical News Today item

Focus, zen, meditate and your pain may go away or diminish. A new MRI brain image study shows that just after a short period of meditation, pain intensity is weakened when subjected to unpleasent stimuli such as extreme heat.

The study participants were taught a meditation technique known as focused attention, which involves paying close attention to breathing patterns while acknowledging and letting go of thoughts that distract you.

Fadel Zeidan, PhD, who is a postdoctoral fellow at Wake Forest University School of Medicine, says:

“This is the first study to show that only a little over an hour of meditation training can dramatically reduce both the experience of pain and pain-related brain activation.”…

….Source: Wake Forest Baptist Medical Center News Release

 

Relationships With Friends May Hinge On How Well You Know Them

Relationships With Friends May Hinge On How Well You Know Them

From a March 26, 2011 Medical News Today item

How does your best friend feel when people act needy? Or, about people being dishonest? What do they think when others seem uncomfortable in social situations? According to an upcoming study in Psychological Science, a journal of the Association for Psychological Science, if you don’t know – your relationship may pay a price. There are lots of ways to know someone’s personality. You can say “she’s an extrovert” or “she’s usually happy.” You may also know how he or she reacts to different situations and other people’s behavior…

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Or contact me through this blog

Related article

Social Rejection And Physical Pain

[Medical News Today] March 29, 2011 4:00:00 AM EDT Share

Physical pain and intense feelings of social rejection “hurt” in the same way, a new study shows. The study demonstrates that the same regions of the brain that become active in response to painful sensory experiences are activated during intense experiences of social rejection. “These results give new meaning to the idea that social rejection ‘hurts’,” said University of Michigan social psychologist Ethan Kross, lead author of the article published in the Proceedings of the National Academy of Sciences…

• Psychological Problems In Childhood Have Long-Term Economic And Social Impact, Study Finds

From a Medical News Today March 29, 2011 item

Psychological problems experienced during childhood can have a long-lasting impact on an individual’s life course, reducing people’s earnings and decreasing the chances of establishing long-lasting relationships, according to a new study. Analyzing information about large group of British residents followed for five decades from the week of their birth, researchers found that family income was about one-fourth lower on average by age 50 among those who experienced serious psychological problems during childhood than among those who did not experience such problems…

Cleansing the soul by hurting the flesh: The guilt-reducing effect of pain

Cleansing the soul by hurting the flesh: The guilt-reducing effect of pain

From the March 8, 2011 Science Daily news item

ScienceDaily (Mar. 8, 2011) — Lent in the Christian tradition is a time of sacrifice and penance. It also is a period of purification and enlightenment. Pain purifies. It atones for sin and cleanses the soul. Or at least that’s the idea. Theological questions aside, can self-inflicted pain really alleviate the guilt associated with immoral acts? A new study published in Psychological Science, a journal of the Association for Psychological Science, explores the psychological consequences of experiencing bodily pain.