MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'acute pain'. Sat, 03 Sep 2011 02:54:37 +0100 http://www.medworm.com/index.php?rid=5008671&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fi2yELjH7SyI%2F This is a repost from my blog on PsychCentral: There are changes afoot in the use of opioid agonists for chronic pain treatment. This blog has described the epidemic of opioid dependence that has killed tens of thousands of people across the country over the past few years, and the changes are directed toward reducing the harm caused by this epidemic. A number of interventions have been proposed. Vicodin, the number one-selling medication in the country, contains the opioid hydrocodone combined with acetaminophen, the agent in Tylenol. Hydrocodone and Vicodin are currently ‘Schedule III’ medications, and will likely move to Schedule II, where oxycodone, Oxycontin, and Percocet are currently assigned. The change will have significant impact on the use of Vicodin and hydrocodone, since m... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=5008671 Wed, 06 Jul 2011 01:05:01 +0100 5008671 http://www.medworm.com/index.php?rid=4893927&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F8pitPCKr9a4%2F Ah yes…. another post about my book… Over the past few years, I’ve taken posts from this blog, posts from other sources that I’ve written, some sections of a ‘memoir’ that I have not gotten around to writing… and combined them in a book about addiction. The book does not hold together as well as it should, and it is way too long– so instead of a ‘sit and read’ book it is more like a reference, similar to the blog itself. If you like this blog, you’ll like it; I’ve taken the more important posts and cleaned them up and organized them. I’ve added some new material as well, including a section about my own background. If you have a loved one on Suboxone, or have an interest in the medication yourself, you will know... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4893927 Fri, 03 Jun 2011 14:07:39 +0100 4893927 http://www.medworm.com/index.php?rid=4622509&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FJUCM1S6JwUs%2F I recently resumed writing for the expert forum on addiction at MedHelp.Org. One result of writing for MedHelp is that I receive a number of e-mails from people with questions about specific issues related to buprenorphine. The most common questions are from people on buprenorphine undergoing surgery, asking about the safety of anesthesia and about postoperative pain control. There are very significant problems with medical coverage for patients on buprenorphine undergoing surgery. Patients on buprenorphine will occasionally need surgery, and in such cases there are often no doctors willing and/or competent to manage postoperative pain. Psychiatrists, frankly, have little knowledge or experience in this area. Before psychiatry residency, medical school graduates generally complete a medica... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4622509 Wed, 23 Mar 2011 01:35:08 +0100 4622509 http://www.medworm.com/index.php?rid=3934618&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FcmYI8zhgHaw%2F I haven’t gone anywhere in case you’re wondering… but I recently started writing a blog on Psych Central, called ‘an epidemic of addiction.’   Please add it to your reading list!  This is my favorite time of year and the time I am most likely going to be outdoors, so watch for posts to pick up a bit as things get colder outside. I’m probably in the wrong state of mind to be blogging, so consider this more along the line of venting.  I had an encounter with a local physician a couple days ago that left me shaing my head–  I have a solo practice so I have forgotten just how misguided medicine can sometimes be.  I was asked to speak with an orthopedist for a patient who takes buprenorphine, who was having major knee surgery.  The orthopod start... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3934618 Sat, 04 Sep 2010 17:55:25 +0100 3934618 http://www.medworm.com/index.php?rid=3920782&cid=t_215147_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F08%2F31%2Fnursing-times-2010-vol-106-no-29%2F This article examines the assessment of acute pain in olde rpeople, as well as different approaches to and challenges in pain management. Contact the Library for a copy of this article. Filed under: Current Awareness, Journals Tagged: Acute Pain Management, Older People, Pain, Pain Assessment (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=3920782 Tue, 31 Aug 2010 09:57:06 +0100 3920782 http://www.medworm.com/index.php?rid=3119075&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2Fmedinteractions.pdf A note of follow up:  According to TMZ, a variety of medications were found in Brittany Murphy’s apartment under her name and under the name of her husband and mother.  Of course it is possible that the medications actually belonged to her husband and to her mother– but as you read in my last post, I am not surprised that opiates were included on the list.  THe medication list:   Was her death related to dangerous medication combinations? 1.  Topamax.  Topamax is an anticonvulsant that is also used to treat migraine headaches, and sometimes prescribed as a mild ‘mood stabilizer’–  say for someone who has symptoms of bipolar disorder but who instead has borderline personality or just ‘mood swings’ that don’t quite qualify as full blow... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3119075 Thu, 24 Dec 2009 01:30:05 +0100 3119075 http://www.medworm.com/index.php?rid=3108563&cid=t_215147_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F12%2F21%2Fgetting-through-it%2F This study is a qualitative study of women’s experiences after cardiac surgery – some points to note right off.  Firstly, more women than men complain of post-operative pain than men – curious but not unexpected.  More women than men complain of pain at all ages from puberty until menopause.  Secondly, pain experiences depended on what women’s expectations of pain after cardiac surgery were.   Thirdly, early discharge requires increased patient participation in pain management.  It’s that one that I think could be much more emphasised! The findings indicated that women described four aspects of the pain experience – location, quality, consequences and cognitive aspects – the latter dealing with ‘expected pain’, ‘unexpected pain&... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3108563 Mon, 21 Dec 2009 01:01:10 +0100 3108563 http://www.medworm.com/index.php?rid=2762156&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F_8WoDtll8Rw%2F Today I received a call from a patient who has been taking Suboxone for about six months, asking for help with a pain issue.  Before getting into the specific details I’ll mention something that I have mentioned many times before; some people do very well on Suboxone maintenance for opiate dependence, and others do less well.  Some people take their daily morning dose of Suboxone and then live life almost as non-addicts, rarely even thinking about opiates as they go about the business of life.  But others will remain in an addictive relationship with opiates.  The Suboxone bails them out of jams, or even prevents the jams from happening in the first place.  They don’t spend all of their money on oxycodone or heroin, and in most cases they will manage to avoid taking opiate agonist... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2762156 Thu, 03 Sep 2009 04:34:08 +0100 2762156 http://www.medworm.com/index.php?rid=2528172&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FqMa0hQ26IYo%2F You’ll notice a link to a company that makes medical ID jewelry in the sidebar and below–  not a bad idea to wear one if you are taking Suboxone.  I think that a year ago it was less important, only because many EMT’s didn’t know what the heck Suboxone was!  But realize that if you have been in an accident and are in pain, it will take significantly higher doses of narcotic (usually morphine in an ambulance or ER) to get any pain reduction– sometimes as much as 10-fold higher doses!  Even if you are able to speak, a bracelet or necklace with the name of the drug will likely be taken more seriously than whatever words you are able to put together in the confusion of an accident scene.  I think an imprint of either ‘Suboxone’ or ‘buprenorp... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2528172 Sat, 27 Jun 2009 01:41:01 +0100 2528172 http://www.medworm.com/index.php?rid=2463309&cid=t_215147_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F08%2Fmore-pain-sites-over-time-greater-risk-of-work-disability%2F It struck me today, as I spent a little time with two people who have been returned to Pain Management Centre for a review of their progress, that something we don’t do very well is help people distinguish between an acute or new problem and what might be a flare-up of the old chronic problem. And by ‘we’ I mean all health providers. Ok, so that the problem is there is not really so surprising – after all, helping clinicians work out that chronic pain doesn’t respond to acute pain management is quite a change of focus (from short-term cure to long-term management), but I guess I hadn’t really thought through how to help people deal with new pain problems as they arise. Let me illustrate what I mean. Gary (not his real name, and other details are also dis... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2463309 Mon, 08 Jun 2009 04:42:58 +0100 2463309 http://www.medworm.com/index.php?rid=2341900&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F3vHWFoXQFnE%2F Thanks, all of you who wrote comments to my last post.  I remind everyone once again to consider taking your comments here and after writing them, also taking them to SuboxForum.com.  I am going to put up a new category to discuss topics that were initiated here;  it would be great to get a spirited, respectful ‘give and take’ on some of these topics.  As I have mentioned before, the only thing that I will block on that site would be debating whether people on Suboxone are ‘in Recovery’– just because there are plenty of other sites for that, and I want the forum to be for people who have made their decision– and don’t want to be harassed over it.  I will be upgrading that site shortly and changing the hosting account;  hopefully I will pull i... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2341900 Mon, 13 Apr 2009 04:27:30 +0100 2341900 http://www.medworm.com/index.php?rid=2131685&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FEvzJOH4NYc8%2F A question about Suboxone and Surgery: Hi-this is in reply to your message back to me. I am the girl who is soon to have surgery. You said that 3 days would be good to be off the suboxone, but you said the worst withdrawal takes about 3 days to hit, so it’s a bit of a compromise. But, won’t the withdrawal be halted once the pain medication gets into my body? Are you just saying that I will have to deal with some detox discomfort during the 3 day period? I, unlike many people, know quite a bit about suboxone (it is so surprising how many people are clueless), but the one thing I am not clear on is how long it would take to “feel” opiates after stopping suboxone (thank God I am ignorrant in this area!). On one of your blogs you said that opiates would work as short as... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2131685 Sun, 25 Jan 2009 05:21:00 +0100 2131685 http://www.medworm.com/index.php?rid=2122105&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F516238041%2F I answered a post today that is similar to many prior posts– a patient with significant pain is no longer getting good pain relief from the pain pills he has taken for the past three years, and he asked whether it was a good idea to change from one narcotic– let’s say oxycodone– to another narcotic– let’s say Duragesic, the fentanyl skin patch. I often come across this question in one form or another.  For a person in pain, opiate pain medications are wonderful– at least initially.  The problem is that the medications lose their potency over time through a process called ‘tolerance’.  In order to continue to get relief, the person with pain has to keep increasing the dose of the medication.  This leads to problems; often the doctor... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2122105 Mon, 19 Jan 2009 03:32:07 +0100 2122105 http://www.medworm.com/index.php?rid=2101604&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F510460709%2F A question from a reader about taking Suboxone for chronic pain, and about physical dependence vs. addiction: Thanks for the web page. It gave me a lot of information that I had been searching for. Most of your blog deals with addiction. Will Suboxone work for dependence? I have been on Oxycontin for 7 years due to nerve damage in my back and Fibromyalgia. I have been able to get down to 30 mg per day with the help of RF ablations but unfortunately there aren’t any pain doctors in my area that will take medicare anymore. RFA’s don’t last forever and I’m being forced to increase the Oxycontin again to manage the back pain. The severe cold with snow has made this a very miserable winter which is why I’m looking for a different answer. From what I’ve read, ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2101604 Tue, 13 Jan 2009 04:13:34 +0100 2101604 http://www.medworm.com/index.php?rid=2078894&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F503100328%2F The questions: I am having surgery and my doc was unaware of some things and I thought that you could confirm them for him?  Could you advise him to take me off the Suboxone 10-14 days prior to surgery?  I have been researching this religously and I have come to the conclusion that it would take 2 weeks to get the Bupenepherine 100% out of my system so that there is no blockage, unless you think otherwise?  Also could you tell him about the oxycodone to keep me out of withdrawal and to help me cope with the pain? Note: I had also received a note from the doctor, saying that he was going to change the patient from Suboxone to Subutex before the surgery, and then back again at a later point.  This is fine, but not enough– the naloxone isn’t the problem– the buprenorphi... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2078894 Mon, 05 Jan 2009 05:36:44 +0100 2078894 http://www.medworm.com/index.php?rid=2067994&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F496111412%2F I write for a couple of medical sites– not the ones I have mentioned here, but sites where they actually allow doctors to identify themselves so that the person asking the question knows the credentials of the person providing the reply.  Oh, what the heck– I think it is OK to name them…  I answer questions ‘formally’ for MedHelp.com and for DoctorsLounge.com.  Go ahead and check them out if you like– if you do, be sure to give me good feedback!!  They are unpaid positions–  as I have whined about many times, I cannot find a way to make money as a doctor on the internet!  But I do them for the publicity– although what the publicity does for me, I’m not really sure… Here is something I wrote recently about chronic pain;  I f... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2067994 Sat, 27 Dec 2008 06:07:39 +0100 2067994 http://www.medworm.com/index.php?rid=2011731&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F473247309%2F I’m in a bad mood tonight– squabbling with my 13-y-o daughter will do that to me– so I’m going to cheat and copy an e-mail that I recently sent to a reader.  She takes Suboxone and will be having surgery;  she did everything correctly, tapering her dose and then stopping the Suboxone for a few days before surgery.  Ideally her addiction doc or her surgeon would prescribe her a large dose of oxycodone to treat the post-op pain, but instead she was told that she is already treated for pain from being on the Suboxone, so she doesn’t need anything more.  After her appropriate objection, he told her that he would recommend that the surgeon prescribe– of all things– fentanyl patches.  Never mind that fentanyl patches have a ‘Black Box Warning&... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2011731 Wed, 03 Dec 2008 05:16:03 +0100 2011731 http://www.medworm.com/index.php?rid=2006602&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F470991446%2F An entirely logical question: Soboxdoc, I am taking 16mg of Suboxone a day - 8mg in the morning and 8mg at night. You state above that Suboxone has a ceiling effect of about 4mg. Does that mean I could take a half of an 8mg tab once a day and it would have the same effect as the 16mg that I am currently taking? Even after the three day half-life? Or should I still cut it down by 2mg a week until I get to 4mg? That would be great if I could do it right away with the same benefit! Either way I am still left speechless on how much this medication has changed life for me. Thanks again for all the wonderful info. My Best Guess: Thanks for writing! The 4 mg level for the ‘ceiling’ is an average for patients overall, and assumes that you are taking the Suboxone in an effective way. My... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2006602 Mon, 01 Dec 2008 06:28:01 +0100 2006602 http://www.medworm.com/index.php?rid=1999433&cid=t_215147_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F468629807%2F The topic of post-op pain control on buprenorphine is important enough to get top billing Many thanks to Dr. J Walsh in Seattle for the following post: I am a physician in Seattle.  In two c-section cases we have found that high affinity opiates (fentanyl or hydromorphone) delivered by PCA can provide adequate anesthesia even while sublingual buprenorphine is continued. To clarify, patients taking Suboxone, Subutex, or any other form of buprenorphine face a problem when they need pain control, particularly if the need is acute– after injury or surgery.  Buprenorphine is a ‘partial agonist’ at the mu opiate receptor;  it has a ‘ceiling’ to its effects, so that increases in dose of buprenorphine will not provide increased analgesia.  This is great for addic... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=1999433 Fri, 28 Nov 2008 19:22:16 +0100 1999433