Don ’t let the opioid crisis affect the treatment course for your patients

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’t cover these services. The main reason she was referred to our clinic is that her primary care provider is refusing to prescribe her medications as they do not want to prescribe long-term opioids. I work in interventional pain management, and we provide a lot of interventional services that can help decrease pain for a lot of patients. We also take care of people who are on chronic pain medications. With the opioid “crisis” there have been a lot of providers who no longer believe in pain. Pain has gone from the fifth vital sign to a non-existent symptom which has left a lot of patients who are in pain to suffer. We’ve come to a point where we have found that there is an issue with opioid medications, but no one wants to come up with a solution. We have options for alternative treatments that have been found to help people with chronic pain...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Meds Pain Management Primary Care Source Type: blogs

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This study compared utilization patterns of high-cost services and medications for patients receiving care from Accountable Care Organization (ACO)-participating physicians and those receiving care from non-ACO physicians during the initial phases of ACO development in a commercially insured environment. Patients ≥18 years (≥40 years for chronic obstructive pulmonary disease [COPD]) with prevalent rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, type 2 diabetes, COPD, or chronic low back pain between January 1, 2012, and August 31, 2014 were identified in the HealthCore Integrated Research Databa...
Source: Pain Physician - Category: Anesthesiology Authors: Tags: Popul Health Manag Source Type: research
  I previously shared Tammy’s Wheat Belly success story that illustrates just how far you can take back health and reverse numerous chronic health conditions. Besides losing over 70 pounds in weight, she also: Reversed type 2 diabetes, reducing HbA1c from the diabetic range of 8.4% to 4.9%—an ideal level. Reversed hypertension Reversed gastroesophageal reflux Reversed irritable bowel syndrome Reversed rheumatoid arthritis She has also been able to discontinue a list of toxic medications, including metformin, Prilosec, and Remicade. And, as you can readily see, turned the clock back 20 years in appearance...
Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: News & Updates autoimmune blood sugar diabetes gastroesphageal gerd Gliadin gluten gluten-free grain-free grains high blood pressure hypertension Inflammation irritable bowel its Weight Loss wheat belly Source Type: blogs
Abstract PURPOSE: Handgrip strength provides a clinically validated marker of overall health and mortality risk. There are however, no multi-national population-based studies investigating the associations between handgrip strength, chronic physical conditions, and physical multimorbidity (i.e., ≥2 chronic conditions). We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six in low- and middle-income countries (LMICs). METHODS: Cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organ...
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
Publication date: Available online 22 November 2018Source: Annals of Medicine and SurgeryAuthor(s): Deepthi ManiAbstractA 49-year-old lady with history of polysubstance use disorder, recurrent cutaneous abscesses, spinal diskitis and septic thrombophlebitis presented to the emergency room with complaints of intermittent fevers, worsening right hip pain and bilateral lower extremity edema. A month before the presentation, she had left another hospital against medical advice after being diagnosed with Methicillin-resistant Staphylococcus aureus bacteremia and right hip septic arthritis. Post discharge, she was off antibiotic...
Source: Annals of Medicine and Surgery - Category: General Medicine Source Type: research
Publication date: Available online 19 November 2018Source: Brain, Behavior, and ImmunityAuthor(s): Sarah A. Woller, Cody Ocheltree, Stephanie Y. Wong, Anthony Bui, Yuya Fujita, Gilson Gonçalves dos Santos, Tony L. Yaksh, Maripat CorrAbstractIn rheumatoid arthritis, joint pain can persist despite resolution of swelling. Similarly, in the murine K/BxN serum transfer model, a persistent tactile allodynia is observed after the resolution of joint inflammation (post-inflammatory pain) in male mice. Here, we found female wild type (WT) mice show inflammatory, but reduced post-inflammatory tactile allodynia. The transition...
Source: Brain, Behavior, and Immunity - Category: Neurology Source Type: research
Abstract In rheumatoid arthritis, joint pain can persist despite resolution of swelling. Similarly, in the murine K/BxN serum transfer model, a persistent tactile allodynia is observed after the resolution of joint inflammation (post-inflammatory pain) in male mice. Here, we found female wild type (WT) mice show inflammatory, but reduced post-inflammatory tactile allodynia. The transition to the post-inflammatory phenotype is dependent on TLR4 signaling. At the spinal level, we found differences in TNF and IFNβ mRNA expression in WT and TLR4 deficient males. In wild type male and female mice, there is differe...
Source: Brain, Behavior, and Immunity - Category: Neurology Authors: Tags: Brain Behav Immun Source Type: research
CONCLUSIONS: Apart from acute monoarthritis of the lower extremities, the chronic arthritis should be kept on mind among FMF patients with articular involvement. The JSpA should be considered in FMF patients with oligoarthritis, inflammatory back pain and enthesopathy complaints with onset over 6 years. Newly proposed JSpA criteria can be used to spondyloarthropathies in childhood FMF. PMID: 30418123 [PubMed - as supplied by publisher]
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
ConclusionsIgA anti ‐CD74 may be a useful tool for identifying axSpA. The diagnostic value of the test needs to be further proven in daily practice.This article is protected by copyright. All rights reserved.
Source: Arthritis and Rheumatology - Category: Rheumatology Authors: Tags: Full Length Source Type: research
AbstractThis systematic review and meta-analysis aims to evaluate the effectiveness of internet-delivered cognitive behavioural therapy (ICBT) on anxiety and depression among persons with chronic health conditions. A systematic database search was conducted of MEDLINE, CINAHL, PsycInfo, EMBASE, and Cochrane for relevant studies published from 1990 to September 2018. A study was included if the following criteria were met: (1) randomized controlled trial involving an ICBT intervention; (2) participants experienced a chronic health condition; (3) participants ≥ 18 years of age; and (4) effects of ICBT on anxie...
Source: Journal of Behavioral Medicine - Category: Psychiatry Source Type: research
By Dr. Binita Ashar, director of the division of surgical devices in the FDA’s Center for Devices and Radiological Health Choosing to obtain a breast implant, whether for augmentation or reconstruction, is a deeply personal choice, from the initial decision to undergo breast implant surgery to the size, material and surface texture. These types of decisions should be discussed between a patient and their provider in a transparent and balanced way with clear information about the benefits and risks of the breast implants and the procedure. As a public health agency, we play an important role in ensuring that patients ...
Source: Mass Device - Category: Medical Devices Authors: Tags: Blog FDA Voice Source Type: news
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