Part 2 - We Were Wrong 20 Years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid Doses

by Drew Rosielle (@drosielle)This is the second in a series of several posts about many aspects of my current thinking about opioids.The first post is here:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Over-prescribing fueled the current drug overdose epidemic, and many of us who thought we were stamping out needless suffering contributed to the epidemic.A lot of what I read and believed about opioids early on in my career was wrong.I ’m old enough to remember those heady days in which there was a pretty large and ‘successful’ movement in American medicine to greatly liberalize opioid use for all sorts of pain syndromes...pain as the 5th vital sign, discussions of there being a tort for undertreating pain, etc. In my own wa y, I was part of the movement, although I was trained at the beginning of the end of the movement.There was a utopian feeling in the air at the time:pain is a terrible scourge, it ’s under-diagnosed and under-treated, it’s this huge cause of all this disability and needless suffering, and liberalizing the availability of opioids would be a key intervention to transform all these suffering people’s lives for the better.We were wrong.Opioid prescribing and availability did increase markedly, but population levels of pain and disability didn ’t improve. Most people’s lives were not transformed for the better, and at least some were ruined via iatrogenic opioid use diso...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs

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In this study, we show that LOC389641 is involved in PTC, which suggests that it may be a target for TC therapies. PMID: 32940082 [PubMed - in process]
Source: Future Medicine: Biomarkers in Medicine - Category: Internal Medicine Tags: Biomark Med Source Type: research
Conclusion: STAT6 may act as a prognostic biomarker and provide useful information for immunotherapy in thyroid carcinoma. PMID: 32940081 [PubMed - in process]
Source: Future Medicine: Biomarkers in Medicine - Category: Internal Medicine Tags: Biomark Med Source Type: research
Authors: Moll SA, Wiertz IA, Vorselaars AD, Zanen P, Ruven HJ, van Moorsel CH, Grutters JC Abstract Aim: Cancer antigen 15-3 (CA 15-3) is a baseline biomarker in idiopathic pulmonary fibrosis (IPF), but its value during follow-up is unknown. Materials and methods: Associations between serum CA 15-3 and pulmonary function tests during 1-year follow-up were evaluated by a mixed model in 132 IPF treated with pirfenidone or nintedanib. Results: Increased baseline (median: 56 kU/l) and follow-up CA 15-3 levels were inversely associated with forced vital capacity and diffusing capacity of the lung for carbon monoxid...
Source: Future Medicine: Biomarkers in Medicine - Category: Internal Medicine Tags: Biomark Med Source Type: research
Biomarkers for immune checkpoint inhibitors in non-small-cell lung cancer. Biomark Med. 2020 Jul;14(11):929-932 Authors: Fuschillo S, Battiloro C, Rocco D, D Gravara L, Motta A, Maniscalco M PMID: 32940076 [PubMed - in process]
Source: Future Medicine: Biomarkers in Medicine - Category: Internal Medicine Tags: Biomark Med Source Type: research
Conclusion: Metabolite biomarker candidates for PC are useful for detecting high-risk IPMN, which can progress to PC. PMID: 32940075 [PubMed - in process]
Source: Future Medicine: Biomarkers in Medicine - Category: Internal Medicine Tags: Biomark Med Source Type: research
Conclusion: This study indicated that approximately a third of the CRC patients are diagnosed with EMAST, hereupon EMAST as a prognostic and predictive biomarker should be more studied clinically. PMID: 32940074 [PubMed - in process]
Source: Future Medicine: Biomarkers in Medicine - Category: Internal Medicine Tags: Biomark Med Source Type: research
This article aims to review current advances in revealing relationship between tumors and abnormal N-glycosylation and discuss leading-edge applications of N-glycosylation in developing novel tumor biomarkers. PMID: 32940073 [PubMed - in process]
Source: Future Medicine: Biomarkers in Medicine - Category: Internal Medicine Tags: Biomark Med Source Type: research
CONCLUSIONS: An improved coordinated individual plan (CIP) process emerged, based on the active participation of users and caregivers. This process is a familiar and transparent process for users and caregivers, reflecting the needs and preferences of users at all stages. It requires careful preparation and collaboration with the users, as well as caregiver flexibility. PMID: 32940581 [PubMed - in process]
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The objectives of this article are the following: 1) to examine fibromyalgia and somatic symptom disorder analogy. 2) to discuss stress-evoked neuropathic pain sexual dimorphism, and 3) to propose a neuropathic pathogenesis that may explain how stressed women could develop fibromyalgia. Recent research demonstrates a clear link between fibromyalgia and small fibre neuropathy. Dorsal root ganglia contain the small nerve fibre nuclei. In rodents, physical, chemical, or environmental stressors lead to dorsal root ganglia phenotypic changes and to hyperalgesia. This phenomenon is much more frequent in females. Prolactin, oestr...
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
Authors: van Campen C(MC, Rowe PC, Verheugt FWA, Visser FC Abstract OBJECTIVES: Muscle pain and fibromyalgia (FM) are common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We recently demonstrated that during orthostatic stress testing, adults with ME/CFS reported increased pain. In the current study, we hypothesised that pain pressure thresholds (PPT) would decrease and temporal summation (windup) would increase after head-up tilt testing (HUT), and that the presence of co-morbid FM would be associated with greater change in both measures. METHODS: We studied adult ME/CFS p...
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
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