Chronic pain patients interviewed in hospital closet

CTV British Columbia
Published Tuesday, Nov. 20, 2012 4:43PM PST
Last Updated Tuesday, Nov. 20, 2012 7:24PM PST

Chronic pain sufferers are being interviewed in a supply closet and asked to wait years for treatment at one Vancouver clinic, a CTV News investigation has revealed.

Anesthesiologist Jill Osborn works in the acute and chronic pain division at St. Paul’s Hospital, one of few non-private providers of multidisciplinary assessment, consultation and treatment in the Lower Mainland.

But Osborn said a lack of funding has led to wait lists of between one and three years at the facility, depending on the severity of a patient’s condition.

“They are suffering and it’s not acceptable for them to be waiting that long for treatment,” she said, adding that extended periods of pain can affect a person’s emotions, social life, family and career.

“By the time a person’s had chronic pain for six years they are very depressed and have many social issues as well.”

Adding insult to injury, when patients arrive at St. Paul’s hospital for an assessment they have the option of being interviewed within earshot of other patients or, if they prefer privacy, being sat down at a wood table in a narrow supply closet.

“If nurses need something from the closet, they will knock on the door and the interview will be interrupted,” Osborn said. “They will go in and get what they need and they’ll leave and then we’ll start the interview again.”

“My concern is that we are not providing the right message to the patient – that they’re important to us – when they’re interviewed in a closet.”

Osborn said the hospital’s in-patient psychiatrists and rehabilitation medicine specialists also use the closet for interviews.

The problem for chronic pain patients extends far beyond the South Coast as well, as resources are even scarcer in B.C.’s Interior.

Eighty-three-year-old Sture Kallman recently drove eight hours to access a specialist at St. Paul’s after spending years on a waiting list.

“Two to three years seems like 10 to 15 years,” Kallman said. “It would have been nice if I would have been able to get in sooner… and maybe things would be better for me today.”

Different studies have pegged the number of Canadians suffering from pain disorder at anywhere from 10 to 44 per cent of the population, but B.C. doctors say their funding is falling far behind patients’ needs and there aren't enough specialists trained in the area of chronic pain.

Health Minister Margaret MacDiarmid acknowledged the “extremely difficult” wait time for pain patients and said the province is working on a solution.

“There have been some additional financial resources put in for the doctors who practice in this area… and some of that may be able to go to this,” MacDiarmid said.

She also said the planned redevelopment of St. Paul’s Hospital could result in shorter wait times and, potentially, a larger space that would eliminate the need for closet-space consultation.

“The end of that development is years away, but it will get started, and as the site is redeveloped there will be some moving around as services,” she said.

The minister could not say with certainty that chronic pain patients would be moved to a better facility, or when the move might take place.

MacDiarmid added that while the physical space at St. Paul’s may be lacking, “the standard of care that’s being provided is fantastic.”

With a report from CTV British Columbia’s Mi-Jung Lee


If you have a tip for CTV’s Investigators, call  604-609-6333  or email investigate@ctv.ca

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MD Trainees Wary of Ordering Opioids for Chronic Pain

ISSUE: NOVEMBER 2012 | VOLUME: 38:11
by Dana Hawkins-Simons


Many physicians-in-training are reluctant to prescribe opioid analgesics for long-term pain management, a recent study has found.

“Most surveys are done with family medical practitioners,” said Ike I. Eriator, MD, MPH, professor of anesthesiology and pain management at the University of Mississippi Medical Center in Jackson, who led the study. “But if we look at how physicians-in-training think, it gives us a clue as to what a practitioner of the future might do.” The study results were presented at the 2012 annual meeting of the American Pain Society (abstract 242).

The researchers queried 93 trainees from the areas of emergency medicine, general surgery, psychiatry, internal medicine, family medicine and neurology, as well as 16 medical students about their pain treatment practices. Nearly half (45%) said they treated chronic pain on a regular basis. Twenty-one percent of respondents stated they felt comfortable treating chronic pain, whereas 34% felt it depended on the situation. However, 81% reported feeling uncomfortable prescribing long-term narcotics for chronic pain patients.

There was no significant relationship between treating chronic pain on a regular basis and comfort with prescribing long-term narcotics among the physicians. Women were more likely than their male colleagues to feel uncomfortable prescribing long-term narcotics. Trainees who felt comfortable managing chronic pain also were significantly more likely to feel comfortable prescribing long-term narcotics.

The most common concern with prescribing long-term narcotics was the risk for chemical dependency or addiction (37%), closely followed by escalating opioid doses (35%); 3.4% of respondents cited legal considerations.

“A few decades ago, the legal environment was the main impediment to prescribing opioids,” Dr. Eriator said. “Maybe that has changed because law enforcement has relaxed its prosecution over recent years of medical practitioners who prescribe opioids.” 

Dr. Eriator said the results of the study could be used to help focus pain management training in the areas where residents are most deficient.

“At an anesthesiology meeting several years ago, we presented data that showed residents’ knowledge of acute pain treatment varied across specialties,” he said. “For instance, orthopedic residents were more likely to attribute increasing requests for medication to the development of tolerance, while family medicine residents would attribute it to addiction. We could focus their education on the areas where they need more knowledge.”

Dr. Eriator said he would like to use the same questionnaire to survey medical students on their comfort level and concerns regarding pain management and how it changes when they become physicians.

A healthy respect for how complicated it is to treat pain is a good thing, said Steven Passik, PhD, professor of psychiatry and anesthesiology at Vanderbilt University School of Medicine in Nashville.

“Medical education on pain and addiction is sorely lacking, and training about the interface between pain and addiction is virtually nonexistent,” he said. “We should teach the physicians-in-training to use their discomfort to seek training throughout their career.”

Anesthesiology News 
 

Wanted to share with you all ....

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----------------------------------------------------

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Here is the info & link for the show:

Show Name:  Winning Life Through Pain
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Show Time:  1:00pm CST

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**Make It An Amazing Day .... Every Day!**

~God Bless!~
Coach Marla

Pain Care LLC owner: ‘I think we’re very much victims like the patients’

By JOSEPH G. COTE

Staff Writer 

MERRIMACK – The CEO and owner of Pain Care LLC worries his clinics will be painted with the same brush as the pharmacy responsible for the tainted steroids administered at pain clinics in New Hampshire.

“We simply administered the drug that we thought was perfectly fine,” Dr. Michael O’Connell said Thursday. “I think we’re very much victims like the patients.”

As many as 740 people with chronic pain were exposed to the tainted steroids, but a majority of those are at lower risk of infection because of the type of injection they received.

O’Connell said 215 patients received spinal injections of the tainted steroids produced by New England Compounding Center, a compounding pharmacy in Massachusetts.

A total of 13,000 patients received the drug nationwide. The drug has been blamed for 119 cases of fungal meningitis, 11 of which have been fatal. No cases have been reported in New Hampshire.

O’Connell said Pain Care, which has 11 clinics in New Hampshire, has contacted all 215 patients who received the drug as an epidural, and has contacted most of the 525 patients who received injections of the drug in muscle or a joint. Those type of injections carry a lower risk of infection, he said. 

“Our hearts go out to the victims and we’re doing everything we can to stay on top of this. I think we’re on top of this soon enough that we’ll be able to prevent the most serious manifestations.”

O’Connell said business at his clinics has not dropped off but phone calls and worry has definitely increased. He encouraged anyone who received the injections to contact the clinic if they haven’t already, particularly if there have been symptoms that may indicate a meningitis infection, including severe headache, fever, nausea, dizziness, loss of balance or slurred speech. 

About 50 patients have had spinal taps either at Pain Care’s urging or to reassure themselves. Most have tested negative but a “handful” have shown elevated white blood cell counts, O’Connell said.

“Those could be problematic and could turn into the definition of a case of meningitis,” he said.

Only three of Pain Care’s clinics – in Merrimack, Somersworth and Newington – received shipments of the drug, methylprednisolone, from NECC, O’Connell said, and only patients in Merrimack and Somersworth received spinal injections.

Compounding pharmacies make their own drug products, and an Oct. 4 news analysis in the The New York Times said the meningitis outbreak “was a calamity waiting to happen,” because compounding pharmacies are lightly regulated and the legal status of compounded drugs is unclear.

O’Connell said pain management clinics routinely use compounded drugs and his clinics use several medications from a number of distributors.

He said his clinics used what turned out to be tainted drugs, in part, because they were alcohol-free. It’s difficult to find comparable drugs from pharmaceutical companies that don’t include alcohol as a preservative. That alcohol can damage nerves, O’Connell said, and the pain injections are made particularly close to nerves in many cases of chronic pain.

O’Connell said patients who received the spinal injections mostly suffer from bulging or herniated disks in their back which can cause sciatica. “These are people that are in severe pain chronically,” he said.

Joseph G. Cote can be reached at 594-6415 or jcote@nashuatelegraph.com. Also follow Cote on Twitter (@Telegraph_JoeC).

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As luck would have it, Deb is a seamstress who has worked in the fashion industry, so she focused her 35 years of experience on helping her brother. She sewed a zippered, fleece jacket for him, and RonWear was born. The warmth, comfort, and convenience of this new jacket instantly improved Ron’s dialysis experience. He wasn’t cold during treatments anymore, and most important, he didn’t have to worry about messing around with short-sleeve shirts or hospital gowns. As other patients at the treatment center began noticing what Ron was wearing, they asked if they could get zippered jackets too.

                                 

                                        

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And listen to the interview we had with Deb today below:

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Explanation: How Brain Training Can Make You Significantly Smarter

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While seemingly innocent, this loss of mental focus can potentially have a detrimental impact on our professional, social, and personal well-being.

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Now, a new San Francisco Web-based company has taken it a step further and developed the first "brain training program" designed to actually help people improve and regain their mental sharpness.  Called Lumosity, it was designed by some of the leading experts in neuroscience and cognitive psychology from Stanford University.
Lumosity, is far more than an online place to exercise your mental skills.  That's because they have integrated these exercises into a Web-based program that allows you to systematically improve your memory and attention skills.  The program keeps track of your progress and provides detailed feedback on your performance and improvement.  Most importantly, it constantly modifies and enhances the games you play to build on the strengths you are developing--much like an effective exercise routine requires you to increase resistance and vary your muscle use.

Does it work?
Apparently it does. In randomized, controlled clinical trials, Lumosity was shown to significantly improve basic cognitive functions. One study showed students improved their scores on math tests by 34 percent after using Lumosity for six weeks, significantly greater gains than those made by other students in the same class, who were not training with the Lumosity program.
The company says its users have reported clearer and quicker thinking, improved memory for names, numbers, directions, increased alertness and awareness, elevated mood, and better concentration at work or while driving.
While many of the games at Lumosity are free, a modest subscription fee is required to use the full program over the long term.
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Evidence Mounts: Methadone Risky in Chronic Pain

By Kristina Fiore, Staff Writer, MedPage Today

Published: July 03, 2012

 

The opioid-treatment drug methadone is culprit in almost one in three prescription painkiller overdose deaths, even though it only accounts for a fraction of scripts for pain, CDC researchers said.

About 5,000 patients died from methadone overdose in 2009, about six times more than 10 years earlier, Thomas Frieden, MD, PhD, director of the CDC, and colleagues said in a Vital Signs report.

"Methadone is riskier than other prescription painkillers ... and we don't think it has a role in the treatment of acute pain," Frieden said during a call with reporters.

He emphasized that most of these accidental deaths are tied to the drug's use in chronic pain -- a condition for which there is little evidence of its benefit, he noted -- and are not associated with its indication for the treatment of substance abuse.

In 2009, methadone accounted for only 2% of all painkiller prescriptions in the U.S., though it makes up a greater proportion of painkiller scripts in some states than others, particularly the Pacific coastal states as well as Maine, Vermont, and New Hampshire.

Frieden said that proportion has risen over the years, as insurers have increasingly made it a top-tier drug for chronic pain given its low cost per pill.

"All of the evidence suggests that the increase in methadone-related deaths is related to the increased use of methadone to treat pain," he said.

He added that using methadone in this situation "is penny wise and pound foolish ... with higher societal costs in terms of death and other problems that can be avoided," he said, adding that there are other, safer opiates that can be used for pain.

Methadone can cause more respiratory depression and disruption of heart rhythm than these other opiates, he said.

And he cautioned that there's limited evidence for the effectiveness of opiates as a class in chronic pain that's not related to cancer, and the drugs have been related to a rising number of overdoses and deaths in recent years.

In 2009, for instance, there were 15,500 prescription painkiller overdose deaths in the U.S., and these drugs now account for more deaths than heroin and cocaine combined, Frieden said.
Government agencies have put forward many efforts to curb that tide, he said, noting that his agency has been working with states to create more effective prescription drug management programs (PDMPs), which are in place in 49 states.

They're of varying levels of quality, however, and agents have been working to make them more real-time and easier for doctors to access, Frieden said.

He added that recent campaigns by the FDA and the DEA appear to be having an impact on methadone overdose and deaths, as preliminary figures for 2009 have shown a slight decrease in methadone scripts.

"I think this shows that it's possible to make further decreases in the number of people who overdose or die from methadone," Frieden said.

Chronic pain can be predicted by pattern in brain, scientists find

By Rosie Mestel, Los Angeles Times / For the Booster Shots blog

July 3, 2012, 1:37 p.m.

Pain is a hard thing to measure, and also quite mysterious: Two people may experience very similar injuries and similar levels of initial pain, but where one may recover the other may go on to experience a crippling chronic condition.
Why does pain persist for some but not others?

Scientists at the Northwestern University Feinberg School of Medicine took an interesting look at this. Their work, just published in the journal Nature Neuroscience, tracked brain activity in 40 people with new back injuries and found a pattern of activity that could predict -- with 85% accuracy -- which patients were destined to develop chronic pain and which weren't.

Study subjects, all of whom had an episode of back pain that had lasted four to 16 weeks, were tracked for one year. Images of their brains were taken at the study start and then several more times over the year. After one year, they were divided into two groups: ones whose pain appeared to be resolving and those whose pain was persisting.

At the start, there wasn't much difference between the levels of pain reported by the two groups. However, the persistent-pain group did differ from the recovering group in terms of their emotional feelings about the pain.

And when senior author neuroscientist A. Vania Apakarian and colleagues looked at the brain patterns in these two groups, they found differences that had been there right from the start.
Two parts of the brain -- the nucleus accumbens and the medial prefrontal cortex -- were key in the pattern. The more connected these two regions were, the more likely a person in the study was to develop chronic pain later on, the authors found.

The nucleus accumbens "trains the whole rest of the brain as to values, judgments and motivations," Apakarian said in a phone interview. And the medial prefrontal cortex includes regions known to be involved in both acute and chronic pain.

The scientists speculate that strong connections between the nucleus accumbens and the medial prefrontal cortex might somehow teach the brain to develop chronic pain -- and that this process deserves more attention from researchers trying to develop better pain therapies. They note that most of the focus on chronic pain to date has been on damage in the peripheral nervous system and spinal cord that might set up nerves to send “I’m hurting” signals long past the time when an injury actually happened.

The scientists also found  -- as had others before them -- that people with chronic pain lost more gray matter in their brains over time compared with healthy controls and the people whose pain was getting better.

There are two ways in which the new findings could be useful, Apakarian says.
One is with prediction: "If you could tell a patient, 'Don't worry, your pain will go away in a few weeks,' that would be fantastic," he said.

And the people whose brain scans portend chronic problems?
Doctors could focus therapeutic efforts on them -- although, Apakarian said, treatments are not yet very good.

Which brings us to his second hope -- that the findings in his lab could help improve matters. Identifying the crucial brain regions offers clues to neurotransmitters that might be involved in setting up chronic pain, and therefore ways to potentially interfere with targeted medications.

Apakarian has received money from the National Institutes of Health to investigate potential drug therapies, first in animal studies.

WebMD and the National Institute of Neurological Disorders and Stroke offer additional resources on chronic pain management.

Copyright © 2012, Los Angeles Times