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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Discussion The plantar fascia consists of 3 bands of dense connective tissue that originates in the medical calcaneal tubercle and inserts into the base of each of the 5 proximal phalyanxes in a fan-shaped distribution. It acts as a shock absorber and reinforces the medial longitudinal arch as the foot undergoes forward propulsion. The -itis in plantar fasciitis (PF) is a misnomer as it is not an acute inflammation but is a chronic degenerative process involving the plantar fascia aponeurosis of the foot usually at the medial tubercle of the calcaneous. Repetitive strain seems to cause microtearing which then causes a repa...
Source: - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Arthritis&Rheumatology,Volume 0, Issue ja, -Not available-.
Source: Arthritis and Rheumatology - Category: Rheumatology Authors: Source Type: research
Publication date: Available online 11 August 2018Source: Prostaglandins &Other Lipid MediatorsAuthor(s): Sindhu G, Shyni G. L, Chithra K Pushpan, Bala Nambisan, Helen AAbstractRheumatoid arthritis is a chronic inflammatory joint disease characterized by synovial proliferation and tissue destruction. Pro-inflammatory cytokines like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) play a key role in the disease process and elevate energy expenditure, which further increases the joint pain and stiffness. The present study was undertaken to explore the anti-arthritic potential of fenugreek mucilage in adj...
Source: Prostaglandins and Other Lipid Mediators - Category: Lipidology Source Type: research
Publication date: Available online 31 July 2018Source: Neuroscience LettersAuthor(s): Longfei Ma, Hongmei Liu, Guowu Chen, Mingtai Chen, Lina Wang, Xu Zhang, Daiqiang Liu, Chunyang MengAbstractNeuropathic pain is a severe and chronic neurological disease caused by injury or disease of the somatosensory system. Currently, there are no effective treatments for neuropathic pain. Neuroinflammation, characterized by activation of spinal glial cells and increased production of pro-inflammatory cytokines (for example, IL-1β, TNF-α and IL-6), is a pathophysiological process closely related to neuropathic pain. The anti-...
Source: Neuroscience Letters - Category: Neuroscience Source Type: research
Conclusion. Established risk factors for back pain may be largely a reflection of shared risk factors with co-occurring conditions. The high frequency of co-occurring conditions likely reflects diverse mechanisms related to heterogeneity of back pain. The extent of association of co-occurring conditions with back pain has implications for clinical management and need for further research to characterize subgroups. Level of Evidence: 2
Source: Spine - Category: Orthopaedics Tags: Epidemiology Source Type: research
Ankylosing spondylitis (AS) is an extreme form of inflammatory arthritis which always leads to bony fusion of vertebral and chronic pain of back. A lot of genes including interleukin, matrix metalloproteinases (MMPs), and endoplasmic reticulum aminopeptidase were found associated with AS. MMP family members were involved in the autoimmune disease and orthopedic diseases such as rheumatoid arthritis and osteoarthritis, while few studies concentrated on the correlation between single-nucleotide polymorphisms (SNPs) in MMP and AS. In addition, there is no report on the relationship between MMP-8 and AS. To investigate the ass...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
ConclusionFifty two percent of Chikungunya infected patients in the American continent are expected to develop the chronic stage of the disease. Chikungunya fever needs to be dealt as a major world health problem.
Source: Joint Bone Spine - Category: Orthopaedics Source Type: research
Chronic pain is pain that lasts for more than 3-6 months. It is a complex health condition that is difficult to treat. Chronic pain is stressful, and can lead to serious and costly physical and mental health problems. Many people affected by chronic pain can become addicted to pain medications, like opioids. It can also lead to depression and loss of income from days out of work. The most common causes are low back pain, arthritis, and headaches.
Source: Archives of Physical Medicine and Rehabilitation - Category: Rehabilitation Authors: Tags: Organization News Source Type: research
Publication date: Available online 14 March 2018Source: Brain, Behavior, and ImmunityAuthor(s): Nicholas Beazley-Long, Catherine Elizabeth Moss, William Robert Ashby, Samuel Marcus Bestall, Fatimah Almahasneh, Alexandra Margaret Durrant, Andrew Vaughan Benest, Zoe Blackley, Kurt Ballmer-Hofer, Masanori Hirashima, Richard Phillip Hulse, David Owen Bates, Lucy Frances DonaldsonAbstractChronic pain can develop in response to conditions such as inflammatory arthritis. The central mechanisms underlying the development and maintenance of chronic pain in humans are not well elucidated although there is evidence for a role of micr...
Source: Brain, Behavior, and Immunity - Category: Neurology Source Type: research
ConclusionSeptic arthritis of costovertebral joints should be considered when a patient presents with back pain, fever and elevated inflammatory markers. The diagnosis of septic arthritis of costovertebral joints remain a challenge to clinicians. CT is important to confirm a diagnosis and guide costovertebral biopsy and culture. Early and appropriate antibiotic therapy is important for a required outcome.
Source: The Egyptian Rheumatologist - Category: Rheumatology Source Type: research
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