Rethinking Persistent Pain - Lorimer Moseley

“Once upon a time, all the lands were fraught with persistent pain. So widespread was this affliction that one in four people experienced it. The pain lasted more than 3 months. It shadowed their daily lives…”

Excellent new video from Lorimer Moseley.  Very effective explanations with great animations. (5 minutes)

It MAY be all in your head!

What you feel is real — and your brain may be to blame when a disease isn’t.  Read about Bill’s story.

Health problems always seemed to be more drastic for Bill than for others. He wouldn’t just get a cold — he’d get bronchitis. While other kids were skinning knees or bruising elbows, he was breaking bones. Then six years ago a car accident changed his life.  Read more. . .

"Junk" - a short documentary about drug addiction and recovery

“Junk” is a short documentary about Kyle Simpson-a college student, who fell into opiate addiction, and his path to sobriety. Now, with over 3 years of recovery, he examines opiate addiction in Jackson County, interviewing key stakeholders in the community to question how this epidemic started and what is being done to solve it.

You Draw It: Just How Bad Is the Drug Overdose Epidemic?

How does the surge in drug overdoses compare with other causes of death in the U.S.? Click on the link to draw and compare your guesses on the charts below.
You Draw It: John Katz, NY Times Apr 14, 2017

Three Short Patient Education Videos from the CDC

Prescription opioids can be prescribed by doctors to treat moderate to severe pain, but can also have serious risks and side effects. Refer to the CDC Guideline for Prescribing Opioids for Chronic Pain to minimize patient risk.

Link to 3 short videos

Dentists challenged to use less opiods

A 2011 study in the Journal of the American Dental Association estimates that dentists are responsible for 12 percent of prescriptions for fast-acting opioid pain relievers — just below general practitioners and internal medicine doctors as top prescribers of common opioids. Roughly 23 percent of opioids in the U.S. are used non-medically, according to the study.
Listen: NPR Feb 26, 2017

Revised ADA Statement re Management of Dental Pain

Nurse Practitioners can now prescribe buprenorphine

The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced its waiver process for NPs who have completed the 24 hrs. of medication assisted treatment of substance abuse disorder under the CARA legislation.
Buprenorphine Waiver Management–SAMHSA Website

Surgeons told to stop prescribing so many painkillers

The head of general surgery at Dartmouth-Hitchcock Medical Center had a remarkably simple idea not long ago: What if the department suggested that surgeons limit prescriptions of narcotic pain pills to a specific number for different kinds of operations?

Even veteran surgeons really had no idea how many opioids to send home with their patients. The results were dramatic: The number of pills prescribed by doctors for five common outpatient surgeries dropped by 53 percent, and patients didn’t consume all the pills they were given. The total number of pills prescribed dropped from 6,170 before the education initiative to 2,932 afterward.

Read more : The Washington Post Mar 7, 2017

American College of Physicians New Guidelines for Back Pain

Doctors at the renowned Dartmouth-Hitchcock Health System are recommending continuing normal activities, and not taking pills or seeing a doctor for most people with lower back pain. Dr. James Weinstein, a back pain specialist and chief executive of Dartmouth-Hitchcock Health System, has some advice for most people with lower back pain: Take two aspirin and don’t call me in the morning. Read more: NY Times Feb 13, 2017

Pain Expert: 'I Haven't Prescribed an Opioid in a Decade'

Daniel Clauw, MD, professor of medicine, anesthesia, and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center. Despite treating patients with a range of chronic pain issues, from fibromyalgia to interstitial cystitis to low back pain, Clauw says, “I haven’t prescribed an opioid for chronic pain in at least a decade.” With that phrase, he has thrown down the gauntlet to other docs who feel that opioids are an acceptable, if lamentable, option for chronic pain treatment. View Video

Tools for Tapering

There are many reasons why prescribers may want to taper a patient’s opioids: substance use disorder, diversion, risk of harm. Increasingly prescribers may determine tapering opioids  is appropriate if there is no improvement in pain reduction or function. Tapering a patient who has been on opioids long term can be very challenging. Fortunately we now have many tools and guidelines to help:

Naloxone—A Potential Lifesaver

Naloxone (Narcan) is available to laypeople in Oregon, and can be prescribed to them by pharmacists. But most patients don’t believe they’re at risk. Lives can be saved if risk can be destigmatized, and training normalized.  Naloxone can help if it is where the opioids are.

Dr. Phil Coffin, SF Dept of Public Health, Assist Professor, UCSF:

Talking about naloxone in primary care

Learn about Naloxone and Local Community Plans >>

What to do about Marijuana

Providers are uncertain whether to forbid or endorse their patient’s use of marijuana for chronic pain. Even within the same clinic, providers can take completely opposing stances. Unfortunately, there is a shortage of evidence based studies. Recent studies however have gotten positive results.  Below is a recent paper summarizing recent research.  The Oregon Medical Association is having a full day forum Oct. 22 on Marijuana (see Upcoming Events)

New Guidelines from the CDC

Over prescribing is driving an epidemic of opioid addiction. CDC guidelines urge doctors to be more cautious prescribing opioids for pain and try non-opioid treatments initially. If opioids are the best choice, start with the lowest possible dose and duration and evaluate benefits and harms before continuing with opioid therapy.

Key messages:

  • Don’t use opioids first. Try other methods such as Tylenol, ibuprofen or ice.
  • When using opioids to treat acute pain, 3 days of medication will usually suffice.
  • Never start with the long-acting opiates and use the lowest possible dose.
  • Make sure the patient knows the risks and that 100% pain-free may not be realistic or desirable.

CDC Resources

Change the Conversation About Opioid Use Disorders

Opioid addiction is a national epidemic according to the Centers for Disease Control and Prevention, (CDC). Medical research has found a connection between the chemistry of the brain and this type of addiction. It turns out its the chemistry of the brain not the character of the individual which makes them an addict.

All on the Same Team

Personal experiences of patients with pain who are working with their providers to reduce their dependence on opioids. When providers and patients work together as a team, they get better results. This video was created by Oregon Pain Guidance and KOBI TV.

New Guidelines from OPG

The Oregon Pain Guidance group (OPG) just released a major update to their guidelines. These are practical guidelines and tools for everyone who manages patients with pain: prescribers, behavioral professionals, those who dispense pain medications, and those who pay for them. The guidelines >>

Key additions:

  • Incorporates the CDC recommendations
  • Includes treatment of acute pain and special populations
  • Expanded coverage of substance abuse
  • Additional screening tools
  • Citations of relevant research

Who we are

The Oregon Pain Guidance group (OPG) is a diverse group of healthcare professionals from Jackson and Josephine Counties. The group was formed to engage healthcare professionals and community partners on the current opioid problem, to learn best practices for managing complex, chronic non-cancer pain (CCNP) and to bring them into standardized, general use in Southern Oregon. MORE >>

Death Rate Rising for Middle-Aged Whites

White, middle-aged Americans are dying at a rising rate, a new study shows, a startling reversal that suggests addiction and mental-health issues are setting back decades of gains in longevity. Suicide, alcohol abuse, drug overdoses and chronic liver diseases largely drove the rise, which occurred between 1999 and 2013, according to the report published Monday in the Proceedings of the National Academy of Sciences.

New York Times article

Atlantic article

NPR - Heroin Epidemic in Southern Oregon

NPR reporter Liam Moriarty has a series of interviews with Dr. Jim Shames and other healthcare professionals about the alarming rise in heroin use and related overdose deaths. The addicts are not the stereotypes you might think. They are the professional next door. And many of them started by becoming dependent on opioids.

Chronic Pain Explained in 2.5 minutes

The team from Hunter Integrated Pain Service (HIPS), University of South Australia, University of Washington and Hunter Medicare Local (Hunter ML) have released a follow-up shorter video after their popular “Pain Explained in 5 Minutes” video. SEE MORE VIDEOS >>