A work in progress written and illustrated by Sam Ioannidis
A new brief opioid stigma scale to assess perceived public attitudes and internalized stigma: Evidence for construct validity |
The Challenges of the Inherited Pain Patient on Polypharmacy - Part 1 |
| This video delivers a dark warning related to the management of
an inherited chronic pain patient. Drs Gourlay and Heit are
dressed appropriately in black suits. Dr Heit: "The first person
you take a history and physical when the patient comes in is
yourself ...The first person you take a pulse of is your own". Part
2 here |
The Neuroscience of Addiction - with Marc Lewis |
| Although most of this video is technical and discusses various
parts of the brain, there are some important points that I find
useful in understanding the drug addicted person. There is a
reduction in the connection of the part of the brain responsible
for control to that responsible for impulses when cues are around.
Marc Lewis points out that "Just say NO!" doesn't work and talks
about reappraisal. |
The Brain and Recovery: An Update on the Neuroscience of Addiction |
| Dr Kevin McCauley has a personal history of oxycodone addiction.
I found it useful to listen to his description of how it felt like
to have cravings. |
How to Say ‘No!’ to Drug Seekers: A Conversation with Dr Nick Carr |
| I found this story one of the more useful on the topic of
how to say no. I like the idea of putting a sign on the window
stating ‘The
doctors in this practice prefer not to prescribe drugs of
addiction, such as…’. |
| The Drug-Seeking Patient in the Emergency Room George R. Hansen, MD |
| Although published in 2005, this is an excellent, concise and
useful review of opioids, addiction, drug seeking and management
strategies. |
RACGP: Prescribing drugs of dependence in general practice, Part B Benzodiazepines |
| Quite a comprehensive guide to
prescribing benzodiazepines based on the available evidence at the
time. The one paragraph I found particularly useful:
"Benzodiazepines have evidence of benefit for GAD, social anxiety disorder and panic disorder, but not for OCD or PTSD[64,94]. Trials have been conducted with clonazepam, diazepam and lorazepam, which have demonstrated the efficacy of these compounds in managing panic disorder clonazepam for SAD, diazepam and bromazepam for GAD[3]" |
Long‐term opioid management for chronic noncancer painCochrane Systematic Review - Intervention Version published: 20 January 2010 |
| There is generally no strong evidence
for the use of opioids from chronic noncancer pain. According to
this Cochrane review there is some weak evidence for use of
opioids in this group. |
How to Say No to Unreasonable Patient Requests |
| Dr Girgis's approach is short and
complete "Just say
no... Explain why... Offer alternatives... Don't argue... Be
kind... Be consistent... Understand why a patient is making a
request... Set policies up front" |
Three persistent myths about heroin use and overdose deaths (Professor Shane Darke's blog) |
|
"What
does kill heroin users is polydrug use. More specifically,
the use of heroin with other central nervous system
depressants, such as alcohol and the benzodiazepines."
|
Opioid Treatment Agreement (Hunter Integrated Pain Service) |
| This treatment agreements starts by listed potential benefits
and potential problems. It appears to be a great tool for reducing
expectations of opoiod treatment and setting up realistic goals.
My favorite line is: ".
. . the expected reduction of chronic pain is only about 20%
at the beginning of the treatment period."
|
Opioid Risk Tool |
To assess risk of aberrant behaviors in general practice before starting opioids for chronic pain. |
Access to Pain Management - a Fundamental Human Right (Pain Australia) |
|
"Management
of acute pain is inadequate for more than 50 percent of
people in developed countries and 90 percent of people in
developing countries, while chronic non-cancer pain occurs
in at least one in five people worldwide, including
Australia."
|
| Pain in Residential Aged Care Facilities - Management Strategies |
|
"Research
shows that unrecognised and untreated pain, especially
non-cancer pain, is widespread among aged care residents.
Because many residents have impaired cognition,more than 40
per cent of the Australian nursing home (high-level
residential care) population is unable to even report pain."
"The
Abbey Pain Scale is recommended as a useful standard pain
assessment tool for residents with severe cognitive
impairment." Abbey
pain scale
Page 19 shows the "Sterotypic Pain
Face".
|
Naloxone: What should GPs know? |
| Dr Paul Grinzi answers questions
related use of naloxone in the community setting for preventing
opioid overdose. I found the most important statement was: "I
would prescribe it for any patient or family member who
requests it, and any patient who:
|
Understanding Australia's new opioid overdose rescue treatment(TGA) |
| Nyxoid nasal spray is a new emergency
treatment for opioid overdose available over the counter. |
Information sheet on opioid overdose(WHO) |
This information sheet has a list of
risk factors for opioid overdose. The following I found the most
frightening. When a dependent person has gone without opioids for
some time and has regained tolerance then the lethal dose is low."People at higher risk of opioid overdose
|
AJP.com.au News: Forced tapering and cessation: opioid consequences |
| This news article communicates some
messages from the FDA against sudden withdrawal of opioid pain
medicine. We also hear from Pain Australia and Chronic Pain
Australia regarding Australia's response to opioid prescribing and
the now "... general reluctance across the medical community
to prescribe opioids, ...". |
| Landmark Lancet series reveals poor management of surgery pain key contributor to global opioid crisis |
| "...
it is possible to detect those patients whose pain is
“transitioning” from acute to chronic ... The transitioning
phase is distinctive from the post-surgical pain and can
include sensations like burning, hyper-sensitivity to pain,
and itching, all symptoms that can be used as hallmarks for
early intervention." |
Tapering Long-term Opioid Therapy in Chronic Noncancer Pain (Mayo Clinic Proceedings) |
| This article covers many aspects of
taper management including indications for tapering of long-term
opioid treatment, withdrawal issues and management of these
issues, taper speed, taper failure, psychological management and
management of medicolegal risks. It also deals with alternatives
to tapering. There is extensive reference to the quality of
evidence taken into account in making recommendations. |
How Frequently are “Classic” Drug-Seeking Behaviors Used by Drug-Seeking Patients in the Emergency Department? |
| This study looked at how frequently
"classic" drug seeking behaviours such as 10+ pain, lost/stolen
medication, back pain, request medication by name presented to the
emergency department and concludes: "Drug-seeking
patients appear to exhibit “classically” described
drug-seeking behaviors with only low to moderate frequency,
with each of the studied behaviors in this study being
recorded as present in less than one third of all ED visits"
|
A Neurologist’s Guide to Acute Migraine Therapy in the Emergency Room |
|
"Opioids
may also render acute migraine medications, such as triptans,
less effective and may impair the effectiveness of migraine
preventives. ... opioids have the potential to promote chronic
migraine and probably medication overuse headache."
"It may be reasonable to consider opioid use for pregnant patients who are refractory to first-line migraine therapies such as fluids and antiemetics, as nonsteroidal anti-inflammatory drugs (NSAIDs) can only be used in certain trimesters of pregnancy, ergots are contraindicated, and in general triptans are contraindicated." |
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