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e risk of addiction shows a struggle that was waged both as a guerrilla war among doctors and a high powered drug industry initiative it was also an effort that while seeking a laudable goal inaccurately portrayed science modern views about the threat posed to patients by narcotics were shaped in the mid 1980 s when pain treatment experts reported that cancer patients treated with such drugs did not exhibit the type of euphoria displayed by people who abused narcotics that led some physicians to argue that strong long acting narcotics could also be used safely to treat patients with serious pain unrelated to cancer like persistent back pain or nerve disorders one leader of this initiative known as the pain management movement was dr russell portenoy who is now chairman of the pain medicine and palliative care department at beth israel medical center in new york and soon dr portenoy and others were pointing to studies that they said backed up their contention that the risk of powerful narcotics to pain patients was scant there is a growing literature showing that these drugs can be used for a long time with few side effects and that addiction and abuse are not a problem dr portenoy said in a 1993 interview with the new york times drug companies amplified that theme in materials sent to doctors and pharmacists for example janssen pharmaceutica the producer of duragesic called the risk of addiction relatively rare in a package insert with the drug endo termed the risk very rare in presentations to hospital pharmacists purdue pharma the manufacturer of the powerful narcotic oxycontin distributed a brochure to chronic pain patients called from one pain patient to another contending that it and similar drugs posed minimal risks some patients may be afraid of taking opioids because they are perceived as too strong or addictive the brochure stated but that is far from actual fact less than 1 percent of patients taking opioids actually become addicted the trouble however was that studies that looked at the experience of pain patients who used long acting narcotics for extended periods of time did not exist so narcotics advocates like dr portenoy and drug companies like purdue pharma had looked elsewhere at surveys of patients whose use of narcotics was limited and those reports were not always put into proper context a frequently cited survey of narcotics use taken in 1980 found only four cases of addiction among 11 882 hospitalized patients a director of that survey dr hershel jick an associate professor of medicine at boston university said his study did not follow patients after they left the hospital and did not address the risk of narcotics when they were prescribed in outpatient settings in another case advocates of increased narcotics use also misstated a study s results it involved a study of chronic headache sufferers conducted at the diamond headache clinic in chicago that some pain care specialists repeatedly claimed had found only three problem cases among some 2 000 patients while the diamond headache clinic did treat 2 369 patients in the study period just 62 were studied because they met the criteria of having used painkillers alone or in combination with barbiturates for six months before entering the clinic and the report s findings were far different from the way they were characterized by narcotics advocates it concluded there is a danger of dependency and abuse in patients with chronic headaches dr seymour diamond the clinic s director said in a recent interview that neither pain experts nor narcotics manufacturers like purdue pharma who cited his study contacted him to discuss how they planned to use it and he added that he believed that it was mischaracterized it distorts the picture and it clearly underplays the risks dr diamond said in a recent interview dr portenoy said he now had misgivings about how he and other pain specialist used the research he said that he had not intended to mischaracterize it or to mislead fellow doctors but that he had tried to counter claims that overplayed the risk of addiction still he and others acknowledge the campaign by pain specialists and drug companies has had consequences in our zeal to improve access to opioids and relieve patient suffering pain specialists have understated the problem drawing faulty conclusions from very limited data dr steven d passik a pain management expert wrote in a 2001 letter published in the journal of pain and symptom management in effect we have told primary care doctors and other prescribers that the risk was so low they essentially could ignore the possibility of addiction today some narcotics manufacturers like endo have changed or are changing the way they present abuse and addiction information for example purdue pharma while maintaining the accuracy of its past position now states in patient information that it does not know how often patients with continuing chronic pain become addicted to narcotics but the risk has been reported to be small ligand pharmaceuticals which manufactures a time released form of morphine under the brand name avinza makes a similar statement for its part a spokeswoman for the federal food and drug administration kathleen k quinn said the agency believed that the risk of addiction to chronic pain patients treated with narcotic analgesics has not been well studied and is not well characterized in a letter to the new york times purdue stated that it had found no cases of iatrogenic addiction in a recently completed long term study of chronic pain patients suffering from osteoarthritis diabetes and low pain back purdue did not identify where it planned to submit the study for publication although the company said it involved an older group of patients whose average age was 55 such results are encouraging but several pain experts said that the full risks of narcotics will not be fully known until these drugs are tested in a wide range of pain patients of different ages and conditions you may have a study telling how uncommon these problems are in patients over 50 dr portenoy said but what does that tell you about the risks to younger patients or those patients who walk into a doctor s office with a history of substance abuse or psychological problems link posted by adam at 6 53 pm labels drug policy opiates opioids pain treatment undermedication 17 february 2017 stoics on pain brennan describes the stoic conception of pain as one of the four basic kinds of emotion pain is an opinion that some present thing is a bad of such a sort that we should be downcast about it cambridge companion to the stoics p 270 posted by adam at 12 30 am labels notable quotables philosophy 07 february 2017 why so little attention to physical evil one hypothesis on why medieval and other early writers ignore pain to a large degree in these centuries prior to the development of medicine and its pain killing or controlling drugs and when very severe penalties imposed by church and state alike were commonly acceptable the problems of physical evil do not appear to have been taken as seriously as they are by contemporary thinkers connellan why does evil exist p 9 posted by adam at 3 03 am 04 january 2017 doonsbury on pain medication http www druglibrary org schaffer asap db 1 gif posted by adam at 12 00 am 19 november 2016 abnormal sensory states from the iasp a helpful summary of some of the terms which describe altered thresholds responses and perceptions of pain allodynia lowered threshold stimulus and response mode differ hyperalgesia increased response stimulus and response mode are the same hyperpathia raised threshold stimulus and response mode may be the increased response same or different hypoalgesia raised threshold stimulus and response mode are the same lowered response the above essentials of the definitions do not have to be symmetrical and are not symmetrical at present lowered threshold may occur with allodynia but is not required also there is no category for lowered threshold and lowered response if it ever occurs link posted by adam at 6 00 pm labels terminology 05 october 2016 more on pain rating scales xkcd weighs in following up on hyperbole and a half s critique of the wong baker scale xkcd weighs in on anchors of common assessment scales his mouseover caption presses the point if it were a two or above i couldn t answer because it would mean a pause in the screaming this reminds me of a conversation with a friend about the pragmatics of rating the pain which brought you to the doctor s office our consensus rating the pain a 6 is high enough that the doctor will take you seriously but not so high that they think you re lying or make the wrong diagnosis posted by adam at 2 17 pm labels assessment measurement ethics 10 august 2016 catrastrophizing in pain paper blackwell synergy pain medicine onlineearly articles article abstract jo nijs phd karen van de putte msc fred louckx phd steven truijen phd kenny de meirleir phd 2007 exercise performance and chronic pain in chronic fatigue syndrome the role of pain catastrophizing doi 10 1111 j 1526 4637 2007 00368 x exercise performance and chronic pain in chronic fatigue syndrome the role of pain catastrophizing abstract objectives this study aimed to examine the associations between bodily pain pain catastrophizing depression activity limitations participation restrictions employment status and exercise performance in female patients with chronic fatigue syndrome cfs who experience widespread pain design cross sectional observational study setting a university based clinic patients thirty six female cfs patients who experienced widespread pain outcome measures patients filled in the medical outcomes short form 36 health status survey the chronic fatigue syndrome activities and participation questionnaire the beck depression inventory and the pain catastrophizing scale and underwent a maximal exercise stress test with continuous monitoring of electrocardiographic and ventilatory parameters results pain catastrophizing was related to bodily pain r 0 70 depression r 0 55 activity limitations participation restrictions r 0 68 various aspects of quality of life r varied between 0 51 and 0 64 and exercise capacity r varied between 0 41 and 0 61 based on hierarchical multiple regression analysis pain catastrophizing accounted for 41 of the variance in bodily pain in female cfs patients who experience chronic widespread musculoskeletal pain among the three subscale scores of the pain catastrophizing scale helplessness and rumination rather than magnification were strongly related to bodily pain neither pain catastrophizing nor depression was related to employment status conclusions these data provide evidence favoring a significant association between pain catastrophizing bodily pain exercise performance and self reported disability in female patients with cfs who experience widespread pain further prospective longitudinal studying of these variables is required posted by adam at 10 00 am no comments 28 may 2016 the almost discovery of anesthesia npr here s an npr story on the discovery of nitrous oxide the transcript and podcast are here no thank you we like pain the almost discovery of anesthesia npr today s quantified self practitioners take note you ve got nothing on young humphry davy posted by adam at 10 45 am labels analgesia history 07 march 2016 placebo ethics related papers sciencedirect pain don t ask don t tell revealing placebo responses to research participants and patients an nimh perspective on the use of placebosbiological psychiatry biological psychiatry volume 47 issue 8 15 april 2000 pages 689 691steven e hyman and david shore the placebo in modern medicine gastrointestinal endoscopy volume 43 issue 2 part 1 1996 pages 76 79 stephen e silvis classical conditioning and the placebo effect pain volume 72 issues 1 2 august 1997 pages 107 113 guy h montgomery and irving kirsch abstract stimulus substitution models posit that placebo responses are due to pairings of conditional and unconditional stimuli expectancy theory maintains that conditioning trials produce placebo response expectancies rather than placebo responses and that the expectancies elicit the responses we tested these opposing models by providing some participants with information intended to impede the formation of placebo expectancies during conditioning trials and by assessing placebo expectancies although conditioning trials significantly enhanced placebo responding this effect was eliminated by adding expectancies to the regression equation indicating that the effect of pairing trials on placebo response was mediated completely by expectancy verbal information reversed the effect of conditioning trials on both placebo expectancies and placebo responses and the magnitude of the placebo effect increased significantly over 10 extinction trials these data disconfirm a stimulus substitution explanation and provide strong support for an expectancy interpretation of the conditioned placebo enhancement produced by these methods placebo and nocebo in cardiovascular health implications for healthcare research and the doctor patient relationshipjournal of the american college of cardiology volume 49 issue 4 30 january 2007 pages 415 421 brian olshansky abstract despite treatments proven effective by sound study designs and robust end points placebos remain integral to elicit effective medical care the authenticity of the placebo response has been questioned but placebos likely affect pain functionality symptoms and quality of life in cardiology placebos influence disability syncope heart failure atrial fibrillation angina and survival placebos vary in strength and efficacy compliance to placebo affects outcomes nocebo responses can explain some adverse clinical outcomes a doctor may be an unwitting contributor to placebo and nocebo responses placebo and nocebo mechanisms not well understood are likely multifaceted placebo and nocebo use is common in practice a successful doctor patient relationship can foster a strong placebo response while mitigating any nocebo response the beneficial effects of placebo generally undervalued hard to identify often unrecognized but frequently used help define our profession the role of the doctor in healing above the therapy delivered is immeasurable but powerful an effective placebo response will lead to happy and healthy patients imagine instead the future of healthcare relegated to a series of guidelines tests algorithms procedures and drugs without the human touch healthcare rendered by a faceless uncaring army of protocol aficionados will miss an opportunity to deliver an effective placebo response wise placebo use can benefit patients and strengthen the medical profession the placebo in modern medicine gastrointestinal endoscopy volume 43 issue 1 january 1996 pages 76 79 stephen e silvis abstract view more related 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