Pain Awareness Month

The following appeared in the PainEDU.com earlier this month. 

"September is Pain Awareness Month. This busy month is marked by a variety of different initiatives and activities, all with the goal of promoting education, advocacy and awareness about chronic pain in order to break down the barriers to effective pain management.

Under-treatment of pain is a significant public health issue with far-reaching impact. With over 100 million people in the U.S. affected by chronic pain, it is no surprise that the societal burden of chronic pain is simply staggering. The Institute of Medicine in 2012 reported that the economic burden of pain exceeds $500 billion per year in the U.S., including health care utilization costs and lost workforce productivity."

I'll be attending the annual meeting of the American Academy of Pain Management later this month, for three days, for continuing medical education. Learning is a life-long experience, and I to get as much out of this meeting as possible.

Credentialed by the American Academy of Pain Management

The following appeared in the Summer 2013 edition of The Pain Practitioner, a publication of the American Academy of Pain Management, under the title Newly Credentialed Members: 

"Open to all pain practitioners, the Academy's credential demonstrates that a clinician is knowledgeable about interdisciplinary/integrative pain management; has practiced in the field of pain management for at least two years; remains in good standing with federal and state regulatory agencies; has passed a rigorous exam; and is committed to ongoing education in the field of pain. The Academy welcomes the following credentialed pain practitioners who have met the Academy's requirements and demonstrated proficiency in the management of pain."

Bruce Coplin, M.D., Toms River, NJ
Joseph A. Locke, DO, Germantown, Wisconsin
Mary Mcneill, MD, Buford, Georgia
Richard Randovich, DO, Boise, Idaho, and
Yours truly, with the following "bio"

Igal Staw, PhD, MD, has been in private practice for over 30 years. His introduction into the life sciences started at Columbia University, where he was the first student to graduate with a PhD in Biomedical Engineering, in 1968. He then continued to do biomedical research work at Columbia University and joined the faculty of the Polytechnic Institute of Brooklyn (now part of NYU). Dr. Staw graduated from the Medical University of South Carolina in 1974, and preceded with a pulmonary fellowship at a Yale affiliated Connecticut hospital, where he also ran the respiratory intensive care unit for over 10 years. During that time he also held a chaired professorship at the University of Bridgeport, CT, teaching biomedical engineering and directing special student projects.
Dr Staw developed a particular interest in health risk reduction, and in doing so developed computerized algorithms for early detection and prevention of chronic and other diseases. Recently, Dr. Staw has been focusing on pain management, which had been neglected for many years, but which is becoming an increasingly important part of medical care, especially at a time of opioid use and abuse.  

It's the lifestyle

“Civilization” takes a toll

(copied from bellybillbord.com)

It’s what we eat and don’t eat

It’s the cigarettes we smoke

It’s the exercise we don’t do

It’s the weight we didn't lose

It’s the extra alcohol we drink

More than 40% of premature deaths in the US occur because of faulty lifestyles.

I believe that almost 50% of the cost of today’s medical care can be eliminated by changing our lifestyles, so that we need less medical care.

The decision is yours...

Pain: Are Narcotics the Answer?

Just back fro the annual meeting of the American Academy of Pain Management in Phoenix, AZ. It was a meeting well worth attending, with many experts from a variety of related fields sharing their knowledge and experience. Here is a very brief overview of some of the current issues in pain management.

Approximately 110 million Americans suffer from acute or chronic pain; of these 100 million suffer from chronic pain, which generally lasts more than 6 months. Examples of pain which can become chronic include sciatica, neck strain, myofascial pain, osteoarthritis, knee and hip arthritis, fibromyalgia and migraine headaches. The cost to the economy of chronic pain alone is more than 600 billion dollars a year, almost equally divided between actual medical cost and the cost of loss of productivity. According to an article in The Journal of Pain this is more than the yearly costs for cancer, heart disease and diabetes.

Many people have felt that the mainstay of treating chronic pain is narcotics. Some of the better known ones include Percocet, Vicodin, oxycodone and Oxycontin. But many others exist, Opana, Dilaudid, Duragesic (fentanyl), tramadol, Nucynta, and Butrans, to name just a few.

While the use of opioids is sometimes necessary, this should hardly ever remain the only mode of treatment (an exception to the rule might be the terminal cancer patient). Long term use of opioid medication frequently leads to opioid-tolerance and addiction, and sometimes to dreadful medical and legal consequences. Furthermore, long term use of opioids can, by itself, lead to an increased awareness of pain, where a person begins to have more pain without actually having a worsening of his/her physical condition.

Occasionally, pain becomes chronic because it was not immediately treated. There are numerous cases where pain was inadequately treated just because of a law suit, or just because an insurer refused to allow, delayed, or limited the treatment. Or maybe someone just decided to “drag the case.”

The answer to the treatment of chronic pain is simple in principle. It involves a multidisciplinary approach. There is no one treatment that fits all. Each patient must be individually evaluated, and a course of treatment designed. Treatment may involve one or more elements of physical therapy, massage therapy, acupuncture, chiropractic, yoga, nutrition and special diet design, psychologic/psychiatric support, drug counseling, and the use of non-narcotic medications.

And, yes, as the pain subsides, the use of opioids has to be adjusted. And if tolerance and addiction interfere, then these have to be carefully handled in order to help prevent relapses and uncomfortable narcotic withdrawal.

One great way to treat the opioid addiction is the use of Suboxone. Prescription of Suboxone is by special license. To my knowledge, I am the only internist between Darien and Bridgeport who is licensed to do so. For information about Suboxone click here.

Weight loss - the old and the new

We all know the facts: Over two thirds of Americans are overweight. Half of them (one third of Americans) are medically obese, which places them at high risk for the development of premature heart attacks and a variety of other serious medical conditions.

The main cause of obesity is overeating, even more so than lack of physical activity.

The most effective way to lose weight is portion control, and with it comes the control of caloric intake.

But portion and calorie intake control is a tough job. It’s a “full time job,” and it takes willpower and discipline.

So what do you do when the brute force approach doesn’t work for you?

The New York Times Business section of February 16^th had an interesting article on the possible approval by the FDA of a new appetite suppressant, Qnexa (U.S. to Review Diet Treatment Once Rejected).

The use of appetite suppressants for the treatment of obesity has a long history. Medications like phentermine, Tenuate and Xenical have been used for years (we all remember the fen-phen period, of which phentermine emerged as the surviving drug…).

More recently, metformin (used in diabetes) has been used in some cases, and a combination of phentermine and certain antidepressants has been shown to be more effective than phentermine alone.

What’s new about Qnexa is not really new. The proposed drug is a combination of two well known medications now widely used: phentermine, the familiar appetite suppressant, and topiramate (Topamax) which is most commonly used for migraine prophylaxis.

Topamax, like most other drugs has a long list of side effects, one of which is weight loss. So physicians who treat obesity, have now begun using Topamax “off label” for it’s weight loss side effect, in combination with phentermine. The combination appears to be very effective.