HuffPo: "War on opioids feels like war on pain patients..."

[drusso]

The Government’s Solution To The Opioid Crisis Feels Like A War To Pain Patients | HuffPost

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[Gauss]

“I ask people to imagine the very worst pain they’ve ever experienced in their lives,” Kline said. “And then that they’re denied relief by a doctor with the one medicine proven effective for pain control for 50 centuries.” (Historical records show that people in ancient Mesopotamia cultivated the poppy plant for medical use.)

beautiful
give this man the Pulitzer!

 

[Ducttape]

odd...

another article had the exact same patient with the exact same story of killing himself with a handgun while his wife held his hand. oh wait, that's because its the primary sob story that Kertesz tells in all his lectures.


Kertesz is a noted critic of opioid reduction, but has shabby evidence to back his claims. he also prescribes no medications to Medicare or Medicaid patients, as I believe he works primarily in the VA system - coincidentally the Alabama one which was #2 in opioid prescribing the last few years.

and almost all the links supporting data come from Kertesz's previous lectures, some of the data of which it seems he takes quite a bit of liberal interpretation.

 

[244913]

Funny, I had a follow up yesterday for a guy with chronic pancreatitis who had been on PO dilaudid for 10 years with progressively worsening flares, ER visits for IV meds..

He was tapered slowly (not happy about it) and started on appropriate adjunctive meds

Today, opioid free for 3 months, looking for part time jobs, no ED visits

Chronic pancreatitis- worst pain on earth!!??- cured

Or was it opioid induced hyperalgesia??

 

[Orin]

Chronic pancreatitis- worst pain on earth!!??- cured

Or was it opioid induced hyperalgesia??

Opioid induced pancreatitis is not unreasonable

It's the wrong disease state to use opioids for chronic management

 

[Biohazard685]

Funny, I had a follow up yesterday for a guy with chronic pancreatitis who had been on PO dilaudid for 10 years with progressively worsening flares, ER visits for IV meds..

He was tapered slowly (not happy about it) and started on appropriate adjunctive meds

Today, opioid free for 3 months, looking for part time jobs, no ED visits

Chronic pancreatitis- worst pain on earth!!??- cured

Or was it opioid induced hyperalgesia??

What was the adjunct therapy?

We had one chronic pancreatitis patient that was never offered digestive enzymes!

 

[244913]

What was the adjunt therapy?

We had one chronic pancreatitis patient that was never offereded digestive enzymes!

low dose TCA and PRN tizanidine

 

[Biohazard685]

low dose TCA and PRN tizanidine

What's your preference among TCAs?

 

[244913]

What's your preference among TCAs?

I like nortryptyline for most. Dose at night. For young, robust people who can stand some more anticholinergia or really need a sleep aid I'll occasionally use Elavil.

 

[Ducttape]

be careful with the elderly. i stop nortrip and amitriptyline on patients over 60 (with 2 exceptions) due to SE profile and warnings.

 

[bronchospasm]

Opioid induced pancreatitis is not unreasonable

It's the wrong disease state to use opioids for chronic management

Opioid inducedbiliary spasm can mimic pancreatitis or cholelithiasis

 

[painfree23]

be careful with the elderly. i stop nortrip and amitriptyline on patients over 60 (with 2 exceptions) due to SE profile and warnings.

What do you use instead? Over 60?? Really? I feel like over 70, ok but 60 isa little young

 

[lobelsteve]

10mg dose at any age. 100mg dose at <70 or with mmc.

 

[Biohazard685]

10mg dose at any age. 100mg dose at <70 or with mmc.

What's mmc?

 

[DOctorJay]

Multiple medical conditions/comorbidities


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