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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AbstractThe prefrontal cortex (PFC) is not only important in executive functions, but also pain processing. The latter is dependent on its connections to other areas of the cerebral neocortex, hippocampus, periaqueductal gray (PAG), thalamus, amygdala, and basal nuclei. Changes in neurotransmitters, gene expression, glial cells, and neuroinflammation occur in the PFC during acute and chronic pain, that result in alterations to its structure, activity, and connectivity. The medial PFC (mPFC) could serve dual, opposing roles in pain: (1) it mediates antinociceptive effects, due to its connections with other cortical areas, a...
Source: Molecular Neurobiology - Category: Neurology Source Type: research
CONCLUSIONS: Based on the findings of moderate quality evidence, this review found that some non-pharmacological interventions such as acupuncture and extracorporeal shockwave therapy are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse event. The QoE for most other comparisons was predominantly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes. PMID: 29757454 [Pub...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Publication date: Available online 1 March 2018 Source:EXPLORE Author(s): Heather Tick, Arya Nielsen, Kenneth R. Pelletier, Robert Bonakdar, Samantha Simmons, Ronald Glick, Emily Ratner, Russell L. Lemmon, Peter Wayne, Veronica Zador Consortium Pain Taskforce White Paper Summary Evidence-based Nonpharmacologic Strategies for Comprehensive Pain Care Supplementary information can be found in the online version at https://doi.org/10.1016/j.explore.2018.02.001. Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addict...
Source: EXPLORE: The Journal of Science and Healing - Category: Complementary Medicine Source Type: research
Chronic pain syndromes associated with cancer treatment are common but difficult to manage. The American Society of Clinical Oncology recently published a practice guideline to address the unmet needs of cancer survivors, Management of Chronic Pain in Survivors of Adult Cancers, which stresses the importance of implementing integrative therapies including acupuncture. This review focuses on randomized clinical trials of acupuncture for chronic pain in cancer survivors, including its use in chemotherapy-induced peripheral neuropathy, aromatase inhibitor-associated arthralgia, and post neck dissection pain, and provides futu...
Source: Hematology/Oncology Clinics of North America - Category: Cancer & Oncology Authors: Source Type: research
We describe the protocol for a randomized controlled trial for investigation of the efficacy and safety of thread embedding acupuncture combined with conventional acupuncture for chronic low back pain. Methods: This randomized, controlled, assessor-blinded, 2-armed, parallel, multicenter clinical trial will include 38 outpatients with chronic low back pain recruited from 4 traditional Korean Medicine hospitals. The patients will be randomly allocated to a treatment group (conventional acupuncture + thread embedding acupuncture) and a control group (only conventional acupuncture) in a 1:1 ratio. The treatment group patie...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Study Protocol Clinical Trial Source Type: research
Conclusion Chairman Burgess indicated that he is still deciding whether to combine numerous opioid-related bills into a single legislative package or try to move the bills through committee individually. Chairman Burgess noted that it is possible to put all of the legislation together in one package, but added that part of him “wants to consider them as individual bills so that, as we go through at least the subcommittee markup and the full committee markup, there will be ample opportunity for people’s ideas to be heard.”        
Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs
Publication date: Available online 1 March 2018 Source:EXPLORE Author(s): Heather Tick, Arya Nielsen, Kenneth R. Pelletier, Robert Bonakdar, Samantha Simmons, Ronald Glick, Emily Ratner, Russell L. Lemmon, Peter Wayne, Veronica Zador Medical pain management is in crisis: from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care has prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain...
Source: EXPLORE: The Journal of Science and Healing - Category: Complementary Medicine Source Type: research
Chronic pain affects at least 116 Million U.S. adults at an estimated cost of $650 billion annually in direct medical treatment and lost productivity. Approximately 25%-50% of community-dwelling older adults and 45%-80% of nursing home residents have substantial pain. Pain management is commonly medication-based and opioids are still widely used to treat pain. Although opioids may have some benefit for acute pain management, habitual use of these drugs for chronic pain carries many risks. In 2010, a Joint Task Force evaluated pain management in the military and veteran ’s health care and found that there is a paucity...
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Tags: Quality Improvement Source Type: research
ConclusionGuidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of recommended conservative treatments must be finalized through discussion with the involved community and based on a biopsychosocial approach. Decision determinants for selecting recommended treatments include costs, availability of interventions, and cultural and patient preferences.Graphical abstractThes...
Source: European Spine Journal - Category: Orthopaedics Source Type: research
CONCLUSION: We found similar rates of preference for acupuncture versus medication among breast cancer survivors for pain management. Specific attitudes and beliefs predicted such preferences, highlighting the importance of a patient-centred approach to align patient beliefs and preferences with therapeutic options for more effective pain management. TRIAL REGISTRATION NUMBER: NCT01013337; Results. PMID: 29440043 [PubMed - as supplied by publisher]
Source: Acupuncture in Medicine : journal of the British Medical Acupuncture Society - Category: Complementary Medicine Authors: Tags: Acupunct Med Source Type: research
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