Sources and Impact of Time Pressure on Opioid Management in the Safety-Net

Conclusions: Time pressure was identified as a major barrier to safer opioid prescribing. Efforts, including changes to reimbursement structures, are needed to relieve time stress on primary care clinicians treating medically and socially complex patients with CNCP in safety-net settings.
Source: Journal of the American Board of Family Medicine - Category: Primary Care Authors: Tags: Original Research Source Type: research

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As physicians, many of our daily practices involve administration of substances that are shrouded in mystery. Certain medications, specifically opioids, have been part of tragic news stories, and have turned young children into orphans, happy spouses into widows and widowers, and once-aspirational youth into memories. The CDC reports that on average, 130 people die each day from an opioid overdose. With such harrowing statistics, why take opioids in the first place? Well, if used appropriately, opioids can significantly improve pain with relatively tolerable side effects. A short-term course of opioids (typically 3 to 7 da...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Addiction Pain Management Source Type: blogs
Publication date: Available online 18 June 2019Source: Anesthesiology ClinicsAuthor(s): Josianna Schwan, Joseph Sclafani, Vivianne L. Tawfik
Source: Anesthesiology Clinics - Category: Anesthesiology Source Type: research
In this study, we determined whether spinal SGK1 signaling contributes to the development of morphine analgesic tolerance. Chronic morphine administration markedly induced phosphorylation of SGK1 in the spinal dorsal horn neurons. Intrathecal injection of SGK1 inhibitor GSK-650394 reduced the development of morphine tolerance with a significant leftward shift in morphine dose-effect curve. Furthermore, spinal inhibition of SGK1 suppressed morphine-induced phosphorylation of nuclear factor kappa B (NF-κB) p65 and upregulation of NMDAR NR1 and NR2B expression in the spinal dorsal horn. In contrast, intrathecal administ...
Source: Neuroscience - Category: Neuroscience Source Type: research
We describe a case of a 70-year old man with sensorimotor chronic inflammatory demyelinating polyneuropathy (CIDP) with small-fibre involvement resulting in severe diffuse neuropathic pain which was refractory to immunotherapy and anti-neuropathic medication. His pain was successfully treated with implantation of a spinal cord stimulation (SCS) system comprising bilateral cervical and lumbar epidural leads. Following SCS programming, he experienced a 50% reduction in average pain severity with substantial improvement in quality of life, persisting at 18 months after surgery. SCS has been employed to treat a variety of ne...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
No abstract available
Source: Topics in Pain Management - Category: Anesthesiology Tags: CONTINUING EDUCATION ACTIVITY Source Type: research
Background: Chronic headache is one of the most common pain conditions, often leading to symptomatic drug overuse. The aim of this study was to provide data on symptomatic drug consumption in an Italian outpatient population, and to describe how the clinical picture of headache may change after headache experts take charge of the care of affected individuals. Methods: 199 adults complaining of chronic headache were recruited through 32 pharmacies in the Pavia health district. Participants underwent four evaluations: a baseline assessment (T0) and three follow-up evaluations performed by a neurologist at 3, 6 and 12 months...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
The Journal of Alternative and Complementary Medicine, Ahead of Print.
Source: The Journal of Alternative and Complementary Medicine - Category: Complementary Medicine Authors: Source Type: research
In the June 14thWall Street Journal, Johns Hopkins University bioethicist Travis Rieder, in an excellent  essay, shared with readers his battle with pain resulting from a devastating accident, the effectiveness of opioids in controlling the pain, and the hell he went through when he was too rapidly tapered off of the opioids to which he had become physically dependent. Like most patients requiring long term pain management with opioids, he developed a physical dependence, which is often  mistakenly equated with addiction by policymakers and many in the media. The aggressive schedule launched me into wit...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs
Learning is perceived as a process of personal and social construction where people are actively involved in making sense of information they interact with, rather than passively receiving it (Kuhthau 2004). This cumulative and developmental process involves the whole person in thinking, acting, reflecting, discovering ideas, making connections, and transforming prior knowledge, skills, attitudes, and values into new knowledge (Dewey 1933). I’m an educator for much of my time. When I think about it, I’ve been an educator for most of my clinical career – after all, when I helped people learn how to show...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Coping strategies Education Education/CME Professional topics data information knowledge meaning Source Type: blogs
In conclusion, for schoolchildren of higher elementary school grades, the risk of OSD is higher among girls with the epiphyseal stage. Cartilage thickness may not contribute to the diagnosis of OSD, since thick cartilage is not very common in OSD. However, cartilage thickness may reflect the status of OSD.
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Article Source Type: research
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