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Managing pain is a focus of medicine today. Here’s why.
The scope of the problem Chronic pain is a health epidemic. Estimates suggest that up to a third of adults or a hundred million Americans live with chronic pain conditions that interfere with their work and life. From back pain to headaches to diabetic neuropathy, chronic pain is widespread and debilitating. These patients suffer tremendously, and societal consequences are significant; back pain is one of the most common causes of missing work and prescription drug abuse is a consequence of our struggle to manage these chronic conditions. Pain syndromes span a wide spectrum of diseases Patients who come to a pain clinic in...
Source: Kevin, M.D. - Medical Weblog - July 11, 2015 Category: Journals (General) Authors: Tags: Conditions Pain management Source Type: blogs

239 Using real-world data to predict pain recording and pain severity in the pre-hospital emergency setting - an observational analysis of 212,401 episodes of care
ConclusionUsing a large real-world dataset, we have demonstrated patient and care episode characteristics that are associated with recording and severity of self-reported pain. We have identified actionable improvements that will strengthen the prediction accuracy of routinely collected data and ultimately improve pain management for our patients.Conflict of interestNone to declare.FundingNo specific funding received or sought for this study.
Source: BMJ Open - May 1, 2022 Category: General Medicine Authors: Quinn, R., Masterson, S., Willis, D., Hennelly, D., Deasy, C., ODonnell, C. Tags: Open access Pain and trauma Source Type: research

There may be no bigger mystery than chronic pain
An excerpt from Multidisciplinary Management of Chronic Pain: A Practical Guide for Clinicians. In all of medicine there may be no bigger mystery than chronic, nonmalignant pain — especially to those of us who treat it.  Pain usually serves a biological purpose, yet in chronic pain patients, pain symptoms seems to exist with little biologically useful purpose. We know that pain can be ignored by soldiers and first responders in crises, yet chronic pain improbably exists in limbs that are amputated or paralyzed. We know that pain that is considered debilitating in one culture can be barely acknowledged in another cu...
Source: Kevin, M.D. - Medical Weblog - November 28, 2015 Category: Journals (General) Authors: Tags: Conditions Pain management Source Type: blogs

Now is the time for acute pain medicine specialists
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Since September is Pain Awareness Month, it’s time to recognize that not all pain is equal. Chronic pain can be alleviated, but “acute” pain (sudden onset, brief in duration, often with an identifiable cause) must be eliminated. This requires a systems-based approach led by physicians dedicated to understanding the physiological processes associated with acute pain and investigating new ways to treat it. The solution is definitely not to give patients more and more opioids. As our understanding of pain mechanisms has ...
Source: Kevin, M.D. - Medical Weblog - September 12, 2015 Category: Journals (General) Authors: Tags: Conditions Pain management Source Type: blogs

Can we break the cycle of chronic pain in patients following orthopedic injury?
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. “You are the only one who truly understands your own pain.” As one trauma survivor from the University of Maryland Shock Trauma Center in Baltimore told us: “The pain is with you 24/7. It is nonstop. And that is the hard part, you cannot escape it.” Pain is classified into two general categories: acute and chronic. While acute pain is sudden in onset and relatively short-lived, chronic pain is usually defined as pain that lasts longer than three months. Both types of pain can affect a person physically and emotionally. ...
Source: Kevin, M.D. - Medical Weblog - August 30, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/melissa-yu-and-maureen-mccunn" rel="tag" > Melissa Yu and Maureen McCunn, MD < /a > Tags: Conditions Orthopedics Pain management Source Type: blogs

You ’re wrong. Pain is not a vital sign.
After years of exaggeration, misinformation and a national epidemic of opioid and heroin abuse, the nation is finally coming to terms with the fact that pain is not the fifth vital sign. This heresy, as I understand it, has existed for close to three decades and, in my opinion, has been directly responsible for the deaths of thousands of patients and lethal drug overdoses of hundreds of thousands of American citizens. The misguided acceptance of pain as the fifth vital sign has been and still is the single biggest mistake in the history of modern medical pain management. In the early 1990s, the American Pain Society opined...
Source: Kevin, M.D. - Medical Weblog - May 25, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/myles-gart" rel="tag" > Myles Gart, MD < /a > Tags: Conditions Pain management Source Type: blogs

The pain scale shares the blame for the opioid crisis in America
If you have ever had surgery or told your doctor about physical pain, no doubt you have heard the question: “How would you rate your pain on a scale of zero to 10, with zero being no pain and 10 being the worst pain you can imagine?” That sounds like a reasonable question, but everyone has a different pain tolerance. In extreme cases, there are individuals who are born with no feeling of pain at all. Therefore, one patient’s two could be another patient’s nine, and both could be telling the truth. There are no other evidence-based findings for pain, especially for patients experiencing non-cancer pain syndrome. The...
Source: Kevin, M.D. - Medical Weblog - March 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/vijay-rajput" rel="tag" > Vijay Rajput, MD < /a > Tags: Conditions Pain Management Primary Care Source Type: blogs

The key to living with less pain is understanding what relieves pain, why it works, and how to achieve it
An excerpt from The Pain Solution: 5 Steps to Relieve and Prevent Back Pain, Muscle Pain, and Joint Pain without Medication. In a one-year period, more than 54 percent of Americans report musculoskeletal pain, including arthritis pain, low back pain, and neck pain. The search for relief has created a different kind of epidemic. The opioids Read more… The key to living with less pain is understanding what relieves pain, why it works, and how to achieve it originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - September 1, 2022 Category: General Medicine Authors: Tags: Conditions Pain Management Source Type: blogs

Education as an intervention for the chronic pain epidemic
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Chronic pain is a silent epidemic Chronic pain is a significant public health burden, but one that is not talked about enough. In 2011, the Institute of Medicine estimated that approximately 100 million Americans suffer from chronic pain. But chronic pain is not just a national problem. The 2016 World Health Organization (WHO) Global Burden of Disease report named back pain as the leading cause of years lived with disability (YLD), or more simply stated, years not being able to live your best life. Chronic pain is a complex disease req...
Source: Kevin, M.D. - Medical Weblog - July 1, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/talal-khan" rel="tag" > Talal Khan, MD < /a > Tags: Conditions Pain Management Primary Care Source Type: blogs

The misguided expectation of eliminating pain
I am against all forms of bodily pain, both foreign and domestic. I wish the world were pain-free. When I am suffering from even a routine headache, I want immediate relief just like everyone else. The medical approach to pain control has changed dramatically even during my own career. When I started practicing a few decades ago, the strategy was pain reduction. We gave narcotics for very few indications such as kidney stones, heart attacks and severe abdominal pain after a surgeon evaluated the patient. (The reason for this was so the surgeon could obtain an accurate assessment of the patient’s belly before pain medicin...
Source: Kevin, M.D. - Medical Weblog - July 31, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/michael-kirsch" rel="tag" > Michael Kirsch, MD < /a > Tags: Physician Medications Pain Management Source Type: blogs

Medical students need exposure to chronic pain patients
Pain. It permeates every aspect of medicine, crawls into the deepest corners of our practices, sinks its claws in and stays put. Opiates are at the center of a vicious national debate, and our patients are trapped in its clutches. But my thoughts are less on medications, protocols, and procedures and more on how we approach the patient who cries pain. Through everything I have observed, as a caretaker and student physician, I have come to a concerning conclusion: The burden is on the patient to prove his or her pain. A patient recently repeated a remark made by her previous doctor, who had declared she was not in “that m...
Source: Kevin, M.D. - Medical Weblog - September 27, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/sarah-cohen" rel="tag" > Sarah Cohen < /a > Tags: Education Pain management Source Type: blogs

Making pain a vital sign caused the opioid crisis. Here ’s how.
I remember the first time I experienced the paradigm shift when it came to pain management. Sometime around the late nineties while I was on call, I received a phone call from a floor nurse stating that a patient that had their ankle operated on that day by another surgeon was having increased pain that was not controlled by the pain medication that had been ordered. As I had been doing for many years,  I inquired as to what procedure was done, what pain meds were ordered, any allergies, any associated symptoms such as numbness or tingling and, most important, whether the patient had a splint on with tight bandages. Mo...
Source: Kevin, M.D. - Medical Weblog - October 6, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/thomas-d-guastavino" rel="tag" > Thomas D. Guastavino, MD < /a > Tags: Physician Pain management Source Type: blogs

There is something wrong with a system that punishes legitimate patients in pain
Overwhelmed by the insanity of the bureaucratic bungle surrounding the dispensing of narcotic pain medication, I’m not sure where to begin. So I will begin with my experience. I am a licensed physician in the state of Nevada.  I retired from full-time practice in California and moved to Las Vegas, where I work part time.   I have a friend who recently underwent a nephrectomy.  She was discharged with a prescription phoned in for oxycodone, which was filled at her local pharmacy. I accompanied her to an urgent care facility today because of a cough.  She took her last oxycodone this morning.  I asked the doctor seei...
Source: Kevin, M.D. - Medical Weblog - November 13, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/judy-salz" rel="tag" > Judy Salz, MD < /a > Tags: Physician Pain management Source Type: blogs

Pain assessment in neonates and infants in the post-operative period following cardiac surgery
Conclusions There was poor agreement between the COMFORT scale and CAAS for detection of pain in neonates and infants who had undergone cardiac surgery. A reduction in systemic systolic blood pressure and a rise in pulmonary artery pressure were observed during painful stimulation on the first post-operative day. For this population, a pain scale scoring physiological parameters according to their variation to higher and lower values should be developed.
Source: Postgraduate Medical Journal - January 21, 2013 Category: Journals (General) Authors: Cury, M. R. J., Martinez, F. E., Carlotti, A. P. C. P. Tags: Pain (neurology), Hypertension, Interventional cardiology, Pain (palliative care), Pain (anaesthesia), Mechanical ventilation, Drugs: musculoskeletal and joint diseases, Cardiothoracic surgery Original article Source Type: research

Evidence-based guidelines on the use of opioids in chronic non-cancer pain--a consensus statement by the Pain Association of Singapore Task Force.
CONCLUSION: Due to insufficient evidence, the task force does not recommend the use of opioids as first-line treatment for various CNCP. They can be used as secondor third-line treatment, preferably as part of a multimodal approach. Additional studies conducted over extended periods are required. PMID: 23604503 [PubMed - indexed for MEDLINE]
Source: Ann Acad Med Singapo... - March 1, 2013 Category: Journals (General) Authors: Ho KY, Chua NH, George JM, Yeo SN, Main NB, Choo CY, Tan JW, Tan KH, Ng BY, Pain Association of Singapore Task Force Tags: Ann Acad Med Singapore Source Type: research