Overview of Fibromyalgia (FMS), Chronic Fatigue Syndrome (CFS) & Central Sensitivity Syndrome (CSS)


Fibromyalgia Syndrome (FMS) is a progressively recognized chronic pain syndrome, which is characterized by it’s constellation of musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle and hands, but any body part can be implicated. Fibromyalgia patients confront an array of symptoms of varying intensities that are fluxional over time such as; morning stiffness, headaches, irritable bowel syndrome, anxiety, cognitive disorders such as concentration, memory problems, attention deficit disorder, and anxiety. It is estimated that approximately 3-6% of the U.S. population has FM.
To read more please click this link: http://css.dewarlorx.com/

Predictors of Suicidal Ideation in Chronic Pain Patients


Predictors of Suicidal Ideation in Chronic Pain Patients
DECEMBER 17, 2013 BY BIM

This blog post relates to an article entitled Predictors of Suicidal Ideation in Chronic Pain Patients: An Exploratory Study that Dr. Manon Choinière, Dr. Warren Nielson and I have recently published in The Clinical Journal of Pain [4]. (To read this same blog post in French please click here).

Suicide has always been a very sensitive topic to touch upon, whether it be about “suicidal ideations” (SI), “suicide attempts” (SA) or — god forbid — suicide completion. According to the World Health Organization, death by suicide is one of the leading causes of mortality rate every year (16 per 100, 000 individuals) [6]. The worldwide lifetime prevalence for passive (without plan) and active (with a plan) SI, and SA have been estimated to be 9.2%, 3.1% and 2.7% respectively [3]. In many cases, there is a progression from passive suicidal thoughts to more active thoughts, which may be followed by SAs and in some unfortunate cases, death.

Please click on this link to view more:
http://www.chronicintractablepainandyou.net/apps/forums/topics/show/12874633-predictors-of-suicidal-ideation-in-chronic-pain-patients-

All About Opioids and Opioid-Induced Constipation (OIC)


All About Opioids and Opioid-Induced Constipation (OIC)

Treatment options for OIC
Although opioids are very effective for treating and managing pain, their use frequently results in opioid-induced constipation (OIC). Treatment options for OIC may be as simple as changing diet or as complicated as requiring several medicines and laxatives.
How can changing lifestyle factors treat OIC?
Changing lifestyle factors is usually the first recommendation that physicians make for the prevention or treatment of constipation. This includes:

Increasing dietary fiber
Increasing fluid intake
Increasing exercise or physical activity
Increasing time and privacy for toileting
Changes in lifestyle, however, may not be possible for many patients. In addition, these changes may be ineffective in treating OIC. If there is a concurrent underlying disease or medicine that is causing constipation, the disease may need to be treated separately or another treatment regimen may have to be considered.

Please click on this link to view more:
http://www.chronicintractablepainandyou.net/apps/forums/topics/show/13141814-all-about-opioids-and-opioid-induced-constipation-oic-

Daily Pain Journal


Daily Pain Journal
This is another useful practice to get into, and can be therapeutic in dealing with your pain. Describing and recording your pain each day helps you in recognizing any patterns and being aware if anything new is occurring in your body. It will also help you immensely in being able to quickly & accurately describe your pain to your doctor(s).

Please click on this link to view more:

http://www.chronicintractablepainandyou.net/apps/forums/topics/show/12894495-daily-pain-journal-instructions

How does the weather affect your pain or pain syndrome(s)?


How does the weather affect your pain or pain syndrome(s)? Please share with us daily so that you can see, read and comment on how the weather affects your pain and those around you! You may be surprised to see that you are not alone in this area also!

Please click on this link to view more:
http://www.chronicintractablepainandyou.net/apps/forums/topics/show/12894470-how-does-the-weather-affect-your-pain-or-pain-syndrome-s-

Risk Evaluation and Mitigation Strategy (REMS)


Risk Evaluation and Mitigation Strategy (REMS)

A Risk Evaluation and Mitigation Strategy (REMS) is a strategy to manage known or potential serious risks associated with a drug product and is required by the Food and Drug Administration (FDA) to ensure that the benefits of a drug outweigh its risks.

The FDA has required a REMS for extended-release and long-acting (ER/LA) opioid analgesics.

Under the conditions specified in this REMS, prescribers of ER/LA opioid analgesics are strongly encouraged to do all of the following:

Train (Educate Yourself) – Complete a REMS-compliant education program offered by an accredited provider of continuing education (CE) for your discipline

To read more please click this link: http://www.chronicintractablepainandyou.net/apps/forums/topics/show/13140570-risk-evaluation-and-mitigation-strategy-rems-

Pain Care Advocacy in an Era of Opioid Abuse Part 2


Pain Care Advocacy in an Era of Opioid Abuse Part 2
By Jennifer Van Pelt, MA
Social Work Today Vol. 12 No. 5 P. 16

Prescribing opioids responsibly is a tricky balance since every patient and his or her pain is unique. In addition to being evaluated for symptoms and the potential for adverse side effects, pain sufferers must be evaluated for substance abuse potential, Barrett says.

As a result of media attention on increasing rates of prescription pain medication abuse, those with chronic pain who had previously found improved functioning, psychological health, and quality of life with appropriate opioid use began to face increased difficulties receiving effective treatment. For the last few years, social workers involved in pain management have been seeing their patients and clients endure the effects of this antiopioid sentiment and are experiencing challenges in advocating for those living with chronic pain. Health insurers may have stopped covering opioids, providers stopped writing prescriptions, and/or pharmacies did not stock the medications. “The glimmer of hope that they had experienced for managing their pain and participating more fully in society was extinguished,” Colón says.

Efforts intended to address opioid abuse have adversely affected quality of life for those with chronic pain. The growing fear and stigma linked to opioid use have led to unintended consequences for patients with chronic pain who could appropriately use opioids with substantial overall benefit. “Policy, healthcare payer rulings, and professional behaviors in response to antiopioid media coverage continue to erode access to effective pain management for those who suffer from chronic pain,” Colón says.

Medication Misconceptions
So much misunderstanding about opioid pain medications has been generated by the negative media focus, healthcare providers, patients, family caregivers, and community members, according to Shirley Otis-Green, MSW, ACSW, LCSW, OSW-C, senior research specialist in nursing research and education at City of Hope, a Comprehensive Cancer Center in Duarte, CA, and coeditor of the Oxford Textbook of Palliative Social Work. She has been involved in national research and education programs on state-of-the-art pain management as a component of palliative cancer care.

“Patients receive mixed messages about prescribed opioids … that they are needed for effective pain relief, yet they should ‘just say no’ to drugs,” she explains. Family caregivers may have misconceptions and fears about loved ones using strong medications and express concerns about dependence or addiction. The resulting layers of guilt and confusion can circumvent even the best pain management strategies, she says.

Among healthcare practitioners, there is enormous fluctuation in clinical perspectives on opioid prescription, Otis-Green notes. “Some are not comfortable prescribing an opioid for joint pain but will prescribe one for cancer pain. Others will not even prescribe opioids at all until they perceive the patient is in the last days of life,” she explains.

At one point, Otis-Green was involved in state and national movements to advocate for more informed palliative pain care to better meet the needs of cancer patients. “It was a huge effort just to get pain management guidelines for this patient group,” she says.

Recently published studies report that misconceptions remain, and palliative pain management is often suboptimal despite new guidelines for end-of-life pain care (Gardiner, Gott, Ingleton, Hughes, Winslow, & Bennett, 2012; Shaheen et al., 2010). For patients with chronic noncancer pain, opioid prescription remains highly controversial, and even in the wake of prescription guidelines and educational efforts, primary care physicians continue to practice under misconceptions about appropriate opioid use vs. addiction, leading to patient undertreatment (Wolfert, Gilson, Dahl, & Cleary, 2010; Hooten & Bruce, 2011). Surveys of physician knowledge about opioid prescriptions indicate that overall pain management expertise is lacking; knowledge and comfort with opioid pain management is low; medical training in appropriate opioid use is inadequate; pain management referral options are lacking; pain management reimbursement is limited; and concerns regarding patient addiction are common (Keller, Ashrafioun, Neumann, Van Klein, Fox, & Blondell, 2012; Barry et al., 2010).

Negative language associated with prescription opioids further contributes to ongoing misconceptions. “Terminology for these drugs should be finessed to minimize repercussions in perception,” Otis-Green says. “Use ‘opioids’ or ‘pain medication,’ not ‘painkiller’ or ‘narcotic.’”

To read more please click here: http://www.chronicintractablepainandyou.net/apps/forums/topics/show/13137800-pain-care-advocacy-in-an-era-of-opioid-abuse-part-2

Pain Care Advocacy in an Era of Opioid Abuse Part 2


Pain Care Advocacy in an Era of Opioid Abuse Part 2
By Jennifer Van Pelt, MA
Social Work Today Vol. 12 No. 5 P. 16

Prescribing opioids responsibly is a tricky balance since every patient and his or her pain is unique. In addition to being evaluated for symptoms and the potential for adverse side effects, pain sufferers must be evaluated for substance abuse potential, Barrett says.

As a result of media attention on increasing rates of prescription pain medication abuse, those with chronic pain who had previously found improved functioning, psychological health, and quality of life with appropriate opioid use began to face increased difficulties receiving effective treatment. For the last few years, social workers involved in pain management have been seeing their patients and clients endure the effects of this antiopioid sentiment and are experiencing challenges in advocating for those living with chronic pain. Health insurers may have stopped covering opioids, providers stopped writing prescriptions, and/or pharmacies did not stock the medications. “The glimmer of hope that they had experienced for managing their pain and participating more fully in society was extinguished,” Colón says.

Efforts intended to address opioid abuse have adversely affected quality of life for those with chronic pain. The growing fear and stigma linked to opioid use have led to unintended consequences for patients with chronic pain who could appropriately use opioids with substantial overall benefit. “Policy, healthcare payer rulings, and professional behaviors in response to antiopioid media coverage continue to erode access to effective pain management for those who suffer from chronic pain,” Colón says.

Medication Misconceptions
So much misunderstanding about opioid pain medications has been generated by the negative media focus, healthcare providers, patients, family caregivers, and community members, according to Shirley Otis-Green, MSW, ACSW, LCSW, OSW-C, senior research specialist in nursing research and education at City of Hope, a Comprehensive Cancer Center in Duarte, CA, and coeditor of the Oxford Textbook of Palliative Social Work. She has been involved in national research and education programs on state-of-the-art pain management as a component of palliative cancer care.

“Patients receive mixed messages about prescribed opioids … that they are needed for effective pain relief, yet they should ‘just say no’ to drugs,” she explains. Family caregivers may have misconceptions and fears about loved ones using strong medications and express concerns about dependence or addiction. The resulting layers of guilt and confusion can circumvent even the best pain management strategies, she says.

Among healthcare practitioners, there is enormous fluctuation in clinical perspectives on opioid prescription, Otis-Green notes. “Some are not comfortable prescribing an opioid for joint pain but will prescribe one for cancer pain. Others will not even prescribe opioids at all until they perceive the patient is in the last days of life,” she explains.

At one point, Otis-Green was involved in state and national movements to advocate for more informed palliative pain care to better meet the needs of cancer patients. “It was a huge effort just to get pain management guidelines for this patient group,” she says.

Recently published studies report that misconceptions remain, and palliative pain management is often suboptimal despite new guidelines for end-of-life pain care (Gardiner, Gott, Ingleton, Hughes, Winslow, & Bennett, 2012; Shaheen et al., 2010). For patients with chronic noncancer pain, opioid prescription remains highly controversial, and even in the wake of prescription guidelines and educational efforts, primary care physicians continue to practice under misconceptions about appropriate opioid use vs. addiction, leading to patient undertreatment (Wolfert, Gilson, Dahl, & Cleary, 2010; Hooten & Bruce, 2011). Surveys of physician knowledge about opioid prescriptions indicate that overall pain management expertise is lacking; knowledge and comfort with opioid pain management is low; medical training in appropriate opioid use is inadequate; pain management referral options are lacking; pain management reimbursement is limited; and concerns regarding patient addiction are common (Keller, Ashrafioun, Neumann, Van Klein, Fox, & Blondell, 2012; Barry et al., 2010).

Negative language associated with prescription opioids further contributes to ongoing misconceptions. “Terminology for these drugs should be finessed to minimize repercussions in perception,” Otis-Green says. “Use ‘opioids’ or ‘pain medication,’ not ‘painkiller’ or ‘narcotic.’”

To read more please click here: http://www.chronicintractablepainandyou.net/apps/forums/topics/show/13137800-pain-care-advocacy-in-an-era-of-opioid-abuse-part-2