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Abandoned Practices for Chronic Pain???

A lawyer asked me a couple thought-provoking questions: Lawyer: "Doctor, is there a professional consensus on the use of opioids for chronic pain?" Me: "No." Lawyer: "Doctor, has the field of pain management abandoned using opioids for treating chronic pain?" Me: "No." So, it got me thinking. What have we abandoned? How will we ever know that there is a consensus about the appropriate use of a modality based upon evidence? Everything (chiro, acupuncture, opioids, PT, psych, etc)... Abandoned Practices for Chronic Pain???
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Source Type: forums

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A while back, I covered the updated evidence-based treatment guidelines for acute (less than four weeks) and subacute (less than twelve weeks) low back pain. I promised a post on chronic (more than twelve weeks) back pain. Well, as I write this, I am suffering from a recurrence of my own low back pain, which radiates down my right leg at times. This has been literally and figuratively a pain in my rear end, for years. Being a doctor who practices what I preach, I am putting all the advice I dispense to good use. First, look for possible triggers This fall, I had gotten away from my regular core-strengthening routine (night...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Back Pain Health Pain Management Source Type: blogs
This article offers a brief critical review of integrative medical therapies used to treat chronic pain, including nutritional supplements, yoga, relaxation, tai chi, massage, spinal manipulation, and acupuncture. The goal of this article is to identify those treatments that show evidence of efficacy and to identify gaps in the literature where additional studies and controlled trials are needed. An electronic search of the databases of PubMed, The Cochrane Library, EMBASE, PsycINFO, and Science Citation Index Expanded was conducted. Overall, weak positive evidence was found for yoga, relaxation, tai chi, massage, and mani...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Mrs. Smith is an 81-year-old female. She worked a long time doing very physical work and is now on a fixed income and comes to my office with chronic pain. X-rays show she has degenerative arthritis in her hips, knees and lumbar spine. She has taken Norco twice a day for years and has been able to be very stable on this. She has always been compliant with her medications. She has not lost them or had them stolen. She lives with her husband, and they use a safe where they keep their medications. The patient has done well with acupuncture and massage in the past but is not able to afford these, and her insurance doesn’...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Meds Pain Management Primary Care Source Type: blogs
CONCLUSIONS: There is no evidence for the efficacy or safety of methods for reducing prescribed opioid use in chronic pain. There is a small number of randomised controlled trials investigating opioid reduction, which means our conclusions are limited regarding the benefit of psychological, pharmacological, or other types of interventions for people with chronic pain trying to reduce their opioid consumption. The findings to date are mixed: there were reductions in opioid consumption after intervention, and often in control groups too. PMID: 29130474 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
There is a saying that being poor is expensive. From personal experience, I know this to be true. But I think it also needs to be said that, especially in the United States, chronic illness can be quite expensive as well. In fact, there is a huge intersection between poverty and disability/illness. As with many intersections, it is a chicken-or-egg scenario, difficult to determine which is begetting which. But one thing is clear: there are often blind spots about these expenses in the medical community and how they can impact chronically ill people already struggling with finances. Recently I attended a seminar on the topi...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Health Health care Health policy Pain Management Source Type: blogs
On September 8, 1854, acting on the advice of Dr. John Snow, London municipal authorities removed the pump handle from the Broad Street well in an effort to halt a major outbreak of cholera. Although an anesthesiologist by profession, Snow had methodically mapped the homes of new cases of cholera. He found that many clustered around the Broad Street pump. Snow’s findings, still regarded as a classic example of epidemiology, established the principle: “that the most important information to have about any communicable disease is its mode of communication.” Dr. Snow did not establish the biologic mechanism ...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Featured Public Health Quality Department of Veterans Affairs military health care Opioid Addiction opioid epidemic Source Type: blogs
An open letter to doctors still prescribing opioid medication when necessary: Thank you so much for standing up for us pain patients. My chronic pain comes from a genetic connective tissue disorder (Ehlers-Danlos Syndrome), so there is no treatment or cure for my slow, but relentless, physical deterioration as the collagen holding my body together falls apart. I, like so many other pain patients, spent years (1982-1995) trying other therapies (yoga, acupuncture, chiropractic, diets, supplements, PT, lots of exercise) and non-opioid drugs (anti-epileptics and antidepressants) with horrible intolerable side effects. Continue...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Patient Pain management Source Type: blogs
Follow me on Twitter @RobShmerling It’s a question that has challenged generations of patients and their doctors. The answer has changed over the years. When I was in medical school in the early 1980s, bedrest for a week or more was often recommended for severe back pain. This sometimes included hospital admission. Then, research demonstrated that prolonged bedrest was actually a bad idea. It was no better (and often worse) than taking it easy for a day or two followed by slowly increasing activity, including stretching and strengthening the back. Medications, including pain relievers, non-steroidal anti-inflammatory...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Back Pain Complementary and alternative medicine Health Injuries Pain Management Source Type: blogs
CONCLUSION: There is a need for more evidence about interventions for CPSP. High-quality trials of multimodal interventions matched to pain characteristics are needed to provide robust evidence to guide management of CPSP. PMID: 28681962 [PubMed - as supplied by publisher]
Source: The British Journal of Surgery - Category: Surgery Authors: Tags: Br J Surg Source Type: research
Sarah Fishman exudes vivaciousness and warmth. When describing her favorite activities, mainly swimming and rugby, her energy is infectious. It is hard to imagine that someone as lively as Sarah has been suffering from chronic pain her whole life. Since she was little, Sarah has struggled with Irritable Bowel Syndrome (IBS), a common intestinal disorder that causes stomach pain and colon issues. However, it wasn’t until her junior year of college that she started experiencing symptoms that were no longer recognizable. “My local gastroenterologist kept giving me treatments that weren’t doing anything,&rdqu...
Source: Thrive, Children's Hospital Boston - Category: Pediatrics Authors: Tags: Our Patients’ Stories Alyssa Lebel dysautonomia headaches irritable bowel syndrome Source Type: news
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