CDC Chronic Pain Guidelines: Not so bad, but...

by Tom QuinnIn case you didn’t notice, the US Centers for Disease Control published their long-awaited (dreaded?) “CDC Guideline for Prescribing Opioids for Chronic Pain.” It made a pretty big splash: Five editorials plus the full Guideline in the online Mar 15 JAMA, front page New York Times feature article, the first hour on NPR’s “Diane Rehm Show,” (Mar 17) and multiple others. It is specifically aimed at primary care prescribers, who write about half of the scripts for opioids in the US. It is intended to “support clinicians caring for patients outside the context of active cancer care or palliative or end-of-life care.” The Guideline was published in the Mar 15 Weekly Morbidity and Mortality Report and is the first US Government guideline to address treatment of chronic pain; it is 52 pages long. A good “Cliff Notes” version of the Guideline is the JAMA piece by CDC Director Thomas Frieden, MD and Debra Houry, MD. I should point out that the document was prepared by the CDC’s Division of Unintentional Injury Prevention. The Guideline is intended to address the epidemic of opioid-related deaths, not the pandemic of chronic pain. On its face, the Guideline promotes good, standard prescribing practices, especially for potentially high-risk agents: history and diagnosis of the painful disorder, prognosis of the painful state, history of prior interventions, establishing clear treatment goals, careful selectio...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: CDC ethics opioids pain quinn The profession Source Type: blogs

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Authors: Koehler LA, Hunter DW Abstract Axillary web syndrome (AWS) is a frequently overlooked problem that causes morbidity in the early post-operative period following cancer surgery with axillary lymph node removal (1-3). AWS, also known as “cording” was first described in 2001 by Moskovitz as “a visible web of axillary skin overlying palpable cords of tissue that are made taut by shoulder abduction” (1). Over a decade has passed since Moskovitz’s seminal article was published, and we still lack a good understanding of AWS. This condition has been suboptimally studied using widely d...
Source: Lymphology - Category: Internal Medicine Tags: Lymphology Source Type: research
Authors: Iwakiri K, Sotoyama M, Takahashi M, Liu X, Koda S, Ichikawa K Abstract Many care workers at elderly care facilities in Japan suffer occupational low back pain (LBP) despite the utilization of welfare equipment. When introducing welfare equipment such as hoists and sliding boards, education on appropriate care methods using welfare equipment is usually conducted, but the effect of education diminishes with time. This intervention study aimed to examine the effect of re-education on appropriate care methods using welfare equipment on the prevention of care workers' LBP at an elderly care facility. At the int...
Source: Industrial Health - Category: Occupational Health Tags: Ind Health Source Type: research
Authors: Guan Q, Khuu W, Martins D, Tadrous M, Chiu M, Do MT, Gomes T Abstract INTRODUCTION: Ontario delisted high-strength fentanyl, hydromorphone and morphine from the public drug formulary for non-palliative care prescribers on 31 January, 2017. Our aim is to assess the early impact of this policy on prescribing patterns and to examine whether this impact varied by prescriber type, opioid type and opioid strength. METHODS: We conducted a population-based, cross-sectional study on palliative and non-palliative care patients dispensed fentanyl, hydromorphone or morphine through the Ontario public drug program ...
Source: Health Promotion and Chronic Disease Prevention in Canada - Category: International Medicine & Public Health Tags: Health Promot Chronic Dis Prev Can Source Type: research
Authors: Bozat-Emre S, Marshall SG, Zhong C, Reimer J Abstract The Government of Manitoba launched the provincial Take-Home Naloxone Program in January 2017. By the end of September 2017, there were over 60 sites operating in Manitoba. These sites distributed 765 kits to people at risk of opioid overdose, and 93 of these kits were replacement kits used in overdose events. Most of these events occurred among males (60.2%) and in a private residence (72.0%). Fentanyl and carfentanil were the most common substances reported during overdose events. Take-Home Naloxone Program data provide important information about the...
Source: Health Promotion and Chronic Disease Prevention in Canada - Category: International Medicine & Public Health Tags: Health Promot Chronic Dis Prev Can Source Type: research
Authors: Ye X, Sutherland J, Henry B, Tyndall M, Kendall PRW Abstract We quantified the contributions of leading causes of death and drug overdose to changes in life expectancy at birth over time and inequalities by sex and socioeconomic status in British Columbia. From 2014 to 2016, life expectancy at birth declined by 0.38 years and drug overdose deaths (mainly opioid-involved) contributed a loss of 0.12 years of the decrease. The analysis also demonstrated that the higher drug overdose mortality among males and among those in lower socioeconomic status communities contributed to a differential decrease in life e...
Source: Health Promotion and Chronic Disease Prevention in Canada - Category: International Medicine & Public Health Tags: Health Promot Chronic Dis Prev Can Source Type: research
Authors: Tam T PMID: 29911817 [PubMed - in process]
Source: Health Promotion and Chronic Disease Prevention in Canada - Category: International Medicine & Public Health Tags: Health Promot Chronic Dis Prev Can Source Type: research
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Source: International Journal of Circumpolar Health - Category: International Medicine & Public Health Tags: Int J Circumpolar Health Source Type: research
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