Cap,
It's hard to follow the thread with all the uhmm..interruptions.
Let me see if I can go back and figure out your question but please keep in mind that I am speaking in very general terms about the seeming illogical and potentially harmful prescribing of any pain medication that contains acetaminophen to patients who have long standing chronic pain with opiate dependance.
That being said there will always be patients who do just fine on Lortab/ Vicodin and so it is a good choice for them. MS Contin is pure morphine;( Morphine Sulfate CONTINuously released over approx 8 hours ) so the issue does not apply
I don't know why a Dr would prescribe MS contin over AVINZA or Embeda etc which are once a day morphine other than cost consideration but MSContin IS considered a long acting opiate.
Thanks Cycler..... I'm on the same page as you now. Right now his Oncologist is prescribing and not his PM Dr. who isn't worth a crap. Percocet for 6 years. 25 mg. of Fentynal once and he couldn't stand it so had to be weaned off. His oncologist at least tries different things and although not all of his pain, is not related to his cancer we really appreciate his help.
Limbo....funny you said bandaid. The first time I injured my back I was told to put a bandaid on it and go back to work. Nice HUH?
My PM Dr. doesn't believe in covering up. He knows I know short acting narcotics won't help me so we have gone the route of Cymbalta and Neurontin. I do take something for pain on occassion but can honestly say I have never been nor will I ever be pain free since the DOI>
Limbo,
I think that's a fair assessment of the situation whereby a patients pain levels are of such debilitating intensity despite all reasonable efforts for care that their physician makes the decision to begin what is formally termed chronic opiate analgesic therapy or COAT. I am not speaking about those patients whose medication support includes an opiate narcotic on an as needed basis or prn.
Once a physician makes the decision to have what SHOULD be a long, informative discussion with the patient concerning COAT and the myriad complications and issues both medical and social that it portends, including accidental death, the goals should be made very clear, even in writing as part of the REQUIRED" COAT Dr./Patient contract, of what the specific goals of COAT are to be and then do everything in his or her power to achieve those goals.
I share the opinion of the various professional Pain Societies that to expose the patient to the very real risks of COAT and not achieve meaningful functional improvement via the administration of narcotic analgesics is unethical.
All too often patients with moderate to severe debilitating pain are prescribed an NSAID for what has long ceased to be a post injury inflammatory response yet 60,000 deaths per year are attibutable to complications from prolonged NSAID use in the US.
They are prescribed a short acting Schedule II narcotic and told to take it 4 to 6 times per day, day in and day out, month after month and year after year despite all that is known about the dangers of long term low dose acetominophen.
The patents pain waxes and wanes throughout the day around their medications schedule in and endless see-saw where they are in pain more hours per day than not.
Why you might ask ? My view of the matter is because the Dr. is afraid to prescribe more or properly or lacks the training and education in COAT therapy. But it's not rocket science not all that difficult. Remember, the whole concept is derived form cancer patients and there are decades of knowledge and experience is treating pain in the terminally ill and the same concepts AND drugs apply. ( Except Actiq)
And lets talk about that idea of "as needed". An Rx for a narcotic is to be taken "as needed" or "for breakthrough pain" when used in conjunction with a long acting opiate does NOT mean on a regularly scheduled basis such as every four hours or every six hours and if that is what the patient is doing or what the Dr is allowing then there is a serious problem, either with the low dose of the long acting opiate or with the intentions and behavior s of the patient because all that a the regular use of a short acting opiate is doing is raising the daily opiate requirement of the patient which OUGHT to be incorporated into the long acting dosage. It's a mistake.
Wow.
In this state some very smart pain Drs with the state's help had Actiq removed from the WC medication formulary as the dollars being billed to WC were through the roof as within 6 months of the drugs release and then sales forces hitting the Drs. offices.
Bummer Knees Wrote:Cycler
If the doctors are found guilty it will be life in prision, but then Robin's son's no longer have a mother.
I was supeoned and gave a deposition on this case last week.
I counted 6 attorneys present at the time of my deposition.
Eight law firms are listed on the papers I was served.
Actually that's about the best scientific advice a Dr. can give. Norman Hadler MD, very very famous medical researcher has just published a book about the "medicalization" of a common everyday worldwide consequence of living. BAck pain is universal, has little if anything to do with job exposure in the vast majority of cases and there is no effective treatment other than time and maintaining normal activity in most cases. The US experience over the past 3 decades has pretty much proven him right. This is what the SPORT study says also.
you had a smart Dr.
Limbo....funny you said bandaid. The first time I injured my back I was told to put a bandaid on it and go back to work. Nice HUH?
I dont know that Bentham will offer much.
The Clinical Journal of Pain is very good.
PubMed is a good resource as it will accept Boolean search strings so you can get pretty specific once you learn the lingo.
There are some journal watch services that send updates every week from any journal you select:
I use Amedeo for muc of my research
http://www.amedeo.com/medicine/pai.htm
http://www.amedeo.com
Cycler, now your talking for me, by suppling web links I and others can use. That's what I am talking about, support your opinions and views with web links. I like that....
Cycler, are you from Ohio?
