Pain expert: Judge the opioid treatment, not the patient

With medications that carry significant risks, such as opioids, appropriate prescribing practices are critical to patient safety. One physician in Boston lives by a mantra that puts patients first: Judge the treatment, not the patient. We need to start re-conceptualizing chronic pain as a chronic disease, said Daniel P. Alford, MD, associate professor of medicine at the Boston University School of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program. “Acute pain is a symptom, and it’s life-sustaining—and you need to feel acute pain in order to survive,” Dr. Alford said. But “there is no advantage to chronic pain. Chronic pain really is a malfunctioning of the nervous system and requires, like other chronic diseases, a multimodal approach.” Assessing whether opioids are the appropriate course of treatment Many potential physical, psycho-behavioral, procedural and pharmacologic options exist for managing chronic pain. Dr. Alford follows a process that helps him to make the appropriate clinical judgment regarding whether or not opioids are an appropriate course of treatment for each individual patient: 1.  Determine whether the patient has a pain process that is likely to respond to opioid therapy. For a lot of chronic pain disorders, opioids are probably not the answer, Dr. Alford said. “For example, chronic migraine headaches, fibromyalgia and back pain … tend t...
Source: AMA Wire - Category: Journals (General) Authors: Source Type: news

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Source: Journal of Pain and Symptom Management - Category: Palliative Care Source Type: research
Source: Journal of Pain and Symptom Management - Category: Palliative Care Source Type: research
Abstract Cystoscopy and histology are the gold standards for detection of bladder cancer. However, these methods are highly subjective, expensive, and invasive. We have developed a non-invasive method for the diagnosis of bladder cancer by detecting telomerase activity in human urine. Telomerase substrate (TS) primer is elongated with repeating sequences of (TTAGGG)n in the presence of telomerase. The elongated primer can trigger hybridization chain reaction between two hairpins H1 and H2, result in the aggregation of AuNPs due to the hybridization between the tail sequence on H1 (or H2) and DNA-AuNPs probe, and a...
Source: Analytica Chimica Acta - Category: Chemistry Authors: Tags: Anal Chim Acta Source Type: research
Conclusions: Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction. PMID: 31006184 [PubMed - as supplied by publisher]
Source: Archives of Plastic Surgery - Category: Cosmetic Surgery Tags: Arch Plast Surg Source Type: research
We describe a case of a patient with severe intellectual disability and an open fracture of the distal lower limb. After fracture management and debridement of devitalized tissues, the resultant soft tissue defect was covered with a free gracilis flap. On postoperative day 7, the patient ripped out the newly transplanted flap. The flap was too traumatized for salvage, so a contralateral free gracilis muscle flap was used. The patient showed good aesthetic and functional outcomes at a 1-year follow-up. When planning the postoperative management of patients with psychiatric illness, less complex and more robust procedures ma...
Source: Archives of Plastic Surgery - Category: Cosmetic Surgery Tags: Arch Plast Surg Source Type: research
It's the first generic nasal spray version of Narcan, a drug that reverses opioid overdoses
Source: Health News: CBSNews.com - Category: Consumer Health News Source Type: news
Bacteria that are difficult or impossible to treat are being spread around the world, fueled by everything from flippant doctors to lax regulation, sewage, anti-vaxxers and international travel, experts warn.
Source: the Mail online | Health - Category: Consumer Health News Source Type: news
The article “The search, coagulation, and clipping (SCC) method prevents delayed bleeding after gastric endoscopic submucosal dissection”, written by Motoi Azumi, Manabu Takeuchi, Youhei Koseki, Masaru Kumagai, Yoko Kobayashi, Masafumi Takatsuna, Aiko Yoshioka, Seiichi Yoshikawa, Tsutomu Miura, and Shuji Te rai, was originally published electronically on the publisher’s internet portal (currently SpringerLink) on 28 September 2018 without open access.
Source: Gastric Cancer - Category: Gastroenterology Source Type: research
ConclusionsAll three H3K27me modifier genes are individually associated with gastric cancer susceptibility with synergistic triad interaction. Not only two enzymes with the same function (KDM6A and KDM6B), but also those with opposite functions (EZH2 versus KDM6A or KDM6B) synergistically affect H3K27me consequences such as gastric cancer susceptibility.
Source: Gastric Cancer - Category: Gastroenterology Source Type: research
AbstractBackgroundWe recently reported the clinical significance of intratumoral HER2 heterogeneity on trastuzumab efficacy using surgical specimens; patients with homogeneously HER2 positive gastric cancer benefitted more from trastuzumab. However, the majority of patients are diagnosed by endoscopic biopsy, and surgical specimens are not available in these patients. The aim of this study is to verify clinical significance of HER2 heterogeneity on trastuzumab efficacy using biopsy specimens.MethodsEighty-seven patients, who received trastuzumab-based chemotherapy and whose endoscopic biopsy specimens were available for HE...
Source: Gastric Cancer - Category: Gastroenterology Source Type: research
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