Answer Addiction

Tag: pain patients and opioids

  • Medical Schools Rethink Training Amid Opioid Epidemic

    Medical Schools Rethink Training Amid Opioid Epidemic

    Some medical schools around the country have begun to change the conversation around pain management.

    Medical schools are rethinking how they train doctors in pain management and addiction treatment, in hopes of graduating a generation of medical professionals that are better able to serve the needs of patients living amid the opioid epidemic. 

    In a recent role-play exercise at the Warren Alpert Medical School of Brown University, students talked to a patient about her back pain, and learned to ask an important question: “Have you ever taken any medications that weren’t prescribed to you?” 

    “To be perfectly honest I stopped buying the Percs because they were too expensive, and I started buying heroin, because it was cheaper. I’ve been doing the heroin for the past 5 months,” the woman playing the patient replied. 

    Dr. Paul George, associate dean of medical education at Brown, told WBUR that the exercise is a realistic representation of what pain doctors may face. “The point of that workshop is for the students to work together to show it really does take a team to care for folks who are using substances inappropriately,” he said. 

    Recently, Brown and the University of Massachusetts (UMass) were both recognized by the Association of American Medical Colleges for their proactive approaches to teaching medical students about pain management and addiction. 

    At UMass, Jill Terrien teaches graduate-level nursing students to talk to their patients about pain. Rather than treating pain as the fifth vital sign and aiming to mitigate it, Terrien encourages nurses to tell patients that they should expect some pain after undergoing major procedures like surgery. 

    “In our curriculum now, we’re more deliberate about [telling patients] ‘you’re going to have pain,’” she said. “That way patients don’t expect that a) they’re going to get opioids because that’s what they’ve always gotten, and b) that might not be the best treatment for them.”

    In addition to changing the conversation around pain management, UMass and Brown both provide all medical students the training they will need to prescribe buprenorphine, a medication commonly used for medication-assisted treatment.

    Currently, under 7% of doctors hold the waiver needed to prescribe buprenorphine, and the medical schools feel that needs to change. 

    “They can prescribe Oxycontin, they can prescribe morphine. It seems almost unfair they can’t prescribe a medication that is used to treat some of the consequences of prescribing opioids,” said Sarita Warrier, associate dean of medical education at Brown.

    Paul Wallace, who recently graduated from medical school at Brown, agreed. 

    He said, “It helps dispel the notion that treating opioid use disorder is purely the domain of addiction specialists or primary care doctors, when truly all different types of physicians are going to encounter patients with opioid use disorder, whether it’s an emergency physician seeing a patient after an overdose or an obstetrician working with a patient with opioid use disorder.”

    View the original article at thefix.com

  • Pain Patients Express Hope Amid Revised Opioid Policies

    Pain Patients Express Hope Amid Revised Opioid Policies

    Some medical professionals are finally starting to understand that cutting pain patients off opioids abruptly causes more harm than good. 

    After years of having their access to opioids restricted, some chronic pain patients feel that they are finally being heard, as the medical community becomes more open to the idea that tapering opioids, especially after long-term use, needs to be done slowly and carefully. 

    In April, the FDA warned that cutting off patients’ opioids too quickly could be detrimental to their health. The organization went so far as to recognize that not being able to control pain could lead to suicide in chronic pain patients. The Centers for Disease Control and Prevention (CDC) made a similar change in policy. 

    Andrew Kolodny, who co-directs Brandeis University’s Opioid Policy Research Collaborative at the Heller School for Social Policy and Management, recently told OZY that it is “exceptionally cruel to abruptly withdraw a patient from opioids.”

    Many pain patients feel that the medical community and regulatory commissions are just now beginning to talk about that openly.

    Lelena, a woman who was given opioids to deal with pain from fibromyalgia, was dismissed from her pain clinic after testing positive for heroin, a result that was later proved to be a false positive. Despite that, she was not able to access pain medications and had to go through opioid withdrawal, in addition to coping with her pain. 

    Laura Mills, who works with Human Rights Watch, said that experiences like Lelena’s are unnecessary and discriminatory. 

    “We always emphasize that the risk for harm [from suddenly stopping opioid medication] is huge, given that an approximate 13 million Americans are still on opioids long-term,” she said. 

    That’s why people like Kate Nicholson, a civil rights attorney who previously worked at the U.S. Department of Justice, turned their attention to helping people with legitimate medical needs access opioid medications. Although Nicholson said that the government’s new, more nuanced approach is needed, she also feels that there is a lot of work still to be done. 

    “It was hard in some ways to get the CDC to change,” she said. “And in some ways, it was the easiest first step.”

    Still, many people who have seen the negative impacts of opioids feel that it is only natural for prescribers to be extra cautious. Kolodny pointed out that Lelena, like many people on opioids, should never have been given the pills in the first place. 

    “There’s no debate,” he said. “You don’t give opioids for fibromyalgia. It’s the fault of this campaign that encourages people to prescribe opioids, a highly addictive drug you become easily dependent on.”

    View the original article at thefix.com

  • Can Hypnosis Help Chronic Pain Patients Find Relief?

    Can Hypnosis Help Chronic Pain Patients Find Relief?

    A new review examined whether hypnotic intervention could provide “meaningful” pain relief.

    Undergoing hypnosis could significantly reduce pain that people experience, but it’s too early to tell whether this could be used to treat chronic or acute pain, experts say. 

    A review recently published in the journal Neuroscience and Biobehavioral Reviews found that study participants who were exposed to painful stimuli like heat or cold were able to reduce the amount of pain they experienced by 29-42% by using methods of hypnosis. 

    “These findings suggest that hypnotic intervention can deliver meaningful pain relief for most people and therefore may be an effective and safe alternative to pharmaceutical intervention,” study authors wrote. Yet, they warned, “High quality clinical data is, however, needed to establish generalisability in chronic pain populations.”

    Lead study author Trevor Thompson, a psychologist based at the University of Greenwich, England, noted that “experimental pain”—that created by heat, cold or other stimuli in a lab—is not a direct comparison to real-life pain from injury or chronic pain, or “clinical pain.” 

    “It is important, of course, to acknowledge that clinical pain isn’t quite the same thing as experimentally induced pain,” he told Medical Express. That’s because injuries and ongoing pain “involve more negative emotional states, less sense of control over pain, and adverse effects on quality of life,” he said. 

    Still, the fact that hypnosis provided such significant relief to people who were being hurt was significant. 

    “If hypnosis is effective at reducing experimental pain, there’s reason to be optimistic it would have the same effect on clinical pain,” he said.

    Mark Jensen, professor at the University of Washington in Seattle and editor of the Journal of Pain, said that previous research has indicated that hypnosis techniques can reduce the amount of pain that patients experience. How effective it is depends on the root cause of the pain, he said. He added that it’s important that people be informed consumers, and use hypnosis as one of many strategies for managing their pain. 

    “Anyone can hang out a shingle and call themselves a ‘hypnotist,’” he said.

    Jensen said that hypnosis uses a combination of relaxation and imagery to tap into the body’s natural pain-relief systems. Other research has indicated that hypnotherapy techniques change the body’s perception of pain. It’s often much more subtle than many people think, he added, and it’s certainly not a way to immediately remove all pain. 

    “It’s not all-powerful magic that will eliminate pain,” he said. “It’s not the hocus-pocus you see on TV.”

    View the original article at thefix.com

  • Discontinuing Opioids Too Quickly Can Be Harmful, FDA Warns

    Discontinuing Opioids Too Quickly Can Be Harmful, FDA Warns

    The FDA issued guidance to help address the issue of opioid-dependent patients discontinuing or tapering off too quickly and becoming sick. 

    Since the national crackdown on prescription opioids, many pain patients have been forced to taper their dose of painkillers. Now, the Food and Drug Administration is warning doctors that tapering too quickly can have unintended and dangerous consequences. 

    “The U.S. Food and Drug Administration (FDA) has received reports of serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased,” the agency said in a statement. “These include serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.”

    The FDA issued guidance to help address the problem. 

    “These changes will provide expanded guidance to health care professionals on how to safely decrease the dose in patients who are physically dependent on opioid pain medicines when the dose is to be decreased or the medicine is to be discontinued,” the agency wrote. 

    The agency said that providers should make an individualized plan for patients who need to taper off opioids, and should never stop the pain pills suddenly. The plan should take into consideration the type of opioid and dosage, as well as the patient’s pain and psychological concerns. 

    “Create a patient-specific plan to gradually taper the dose of the opioid and ensure ongoing monitoring and support, as needed, to avoid serious withdrawal symptoms, worsening of the patient’s pain, or psychological distress,” the FDA wrote. 

    The agency also warned that patients should not discontinue opioids without talking to their providers. They should be candid about any side effects they have as their dose of opioids is being tapered. 

    “Even when the opioid dose is decreased gradually, you may experience symptoms of withdrawal,” the agency warned. “Contact your health care professional if you experience increased pain, withdrawal symptoms, changes in your mood, or thoughts of suicide.”

    Although many public health officials applaud efforts to reduce the amount of opioids prescribed, pain patients say that the regulations have gone too far, and have left vulnerable pain patients unprotected. 

    Speaking with The Fix last fall, Lauren DeLuca, a pain patient and founder of the Chronic Illness Advocacy and Awareness Group, said that not being able to access pain medications can be devastating for patients. She said she regularly hears from pain patients who are not able to access enough medications to alleviate their symptoms. Sometimes, these people begin to consider suicide.

    “It is borderline genocide,” she said. “You are allowing them to go home and essentially suffer until they kill themselves.”

    View the original article at thefix.com