Pain treatment complicated by doctors' opioid fears - The Washington Post

I felt a shake and opened my eyes. The clock read 1:30 a.m.

"We need to go to the hospital," my mother whispered in my ear, clutching her stomach.

She knew; it was the same pain she had experienced many times before.

We were in California, many miles from home, many miles from my father (a doctor), who always knew what to do. At the time, I was early in my medical school training, although I knew all the intricate details of my mother's medical history and realized she needed to get medical attention.

When we arrived at the local emergency room in an affluent neighborhood, my mother was placed in a wheelchair and taken to the waiting room. She curled up on the cold barren hospital floor, the only position she could find comfortable. Although my mother usually puts on lipstick and high heels to go to the grocery store, this time, her hair was unkempt and her pajamas worn out. Her knees were tucked into her chest and her belly was distended.

It should have been clear to onlookers that she was in agonizing pain, but people were hesitant, skeptical even.

"Ma'am," someone yelled. "Ma'am, we can't have you lying on the floor. Get up."

My mother lay still.

"Get up, ma'am," she was told again, again more forcibly.

They helped her back into the wheelchair.

"Help me," she said. "The pain is unbearable."

Reluctantly, they put her in a stretcher and prepared to place an IV in her arm. To convince them the pain was real, we asked them to call my father, who could fill in all of the medical details: her multiple prior hospitalizations, surgeries and diagnoses.

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https://www.washingtonpost.com/national/health-science/my-mother-was-in-unbearable-pain-but-the-er-staff-didnt-seem-to-believe-her/2018/09/28/1acf1404-abae-11e8-8a0c-70b618c98d3c_story.html?

Illusions as Painkillers: the Analgesic Value of Resizing Illusions in Knee Osteoarthritis - Scientific American

Research has shown that the experience of pain is highly subjective: people feel more or less pain, in identical physical situations, as a function of their mood and attention. This flexibility showcases the potential for cognitive manipulations to decrease the pain associated with a variety of pathologies. As an example, the virtual-reality game "Snow World" (in which game in which players shoot snowballs to defeat snowman Frosty and his penguins) reportedly works better than morphine at counteracting the pain of patients in burn units. Other studies have indicated that virtual reality manipulations of the patient's own body can also help ameliorate pain: an experiment conducted by neuroscientist Maria Victoria Sanchez-Vives and her team at the University of Barcelona in Spain showed that heat applied to experimental participants' wrists felt more painful when their virtual arms turned red than when they turned blue or green.

Following on this tradition, a study published PeerJ last month showed that visuotactile illusions can help the pain experienced by patients suffering from knee osteoarthritis.

According to lead author Tasha Stanton, from the University of South Australia, the idea for the study originated from her observation that "people with knee osteoarthritis have an altered perception of their own body. [Their affected knee] often feels too big, and they also have changes to the way that touch and movement information is represented in the brain." She hypothesized that patients may "respond to illusions that change the way their knee looks."

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https://blogs.scientificamerican.com/illusion-chasers/illusions-as-painkillers-the-analgesic-value-of-resizing-illusions-in-knee-osteoarthritis/

Pain Narrative Videos | Pain Education and Advocacy | University of New England

UNE's Center for Excellence in Neurosciences and Interprofessional Education Collaborative have partnered to create this collection of pain narrative videos as part of a group of interprofessional training materials. These materials were crafted to aid future practitioners in providing the highest quality of care to patients experiencing chronic pain. They highlight the importance of working interprofessionally and approaching the patient as a whole person when in treatment. Included are outcomes from a project funded in part by the Maine Cancer Foundation to examine cancer pain from an interprofessional perspective and shed light on a wide variety of obstacles that cancer pain patients face over the course of their treatment and life after treatment.

The pain narrative videos collected here give unique insight into the lives of patients experiencing chronic pain. Their intended use is as educational material or for patient advocacy, in pieces or as a whole.

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https://dune.une.edu/pain_videos/

Too Good to Be True? A Nonaddictive Opioid without Lethal Side Effects Shows Promise - Scientific American

With nearly 50,000 drug overdose deaths from opioids last year and an estimated two million Americans addicted, the opioid crisis continues to rage throughout the U.S. This statistic must be contrasted with another: 25 million Americans live with daily chronic pain, for which few treatment options are available apart from opioid medications.

Opioid drugs like morphine and Oxycontin are still held as the gold standard when it comes to relieving pain. But it has become brutally obvious that opioids have dangerous side effects, including physical dependence, addiction and the impaired breathing that too often leads to death from an overdose. Researchers have long been searching for a drug that would relieve pain without such a heavy toll, with few results so far.

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https://www.scientificamerican.com/article/too-good-to-be-true-a-nonaddictive-opioid-without-lethal-side-effects-shows-promise/

Body in Mind - Research into the role of the brain and mind in chronic pain - University of South Australia

Here is our vision: To provide a credible and reliable channel through which clinical pain scientists can bring their scientific discoveries straight into the real world. We reckon that the communication bit of science is the bit that often drags the chain of knowledge development and transfer. We want to communicate our science better. We want to side-step, or perhaps leap-frog, the arduous journey that new discoveries make before they have the opportunity to influence the real world. We want people to share in our fascination with the fearful and wonderful complexity of the human; we want people to understand the scientific discoveries as they occur, not 20 years later, to grasp their significance and potential relevance to everyday life, but to also become astute sifters of the wheat from the chaff. We want to be a reliable go-to web space for the latest developments in the science of pain.

https://bodyinmind.org/

Most Doctors Are Ill-Equipped to Deal With the Opioid Epidemic. Few Medical Schools Teach Addiction. - The New York Times

To the medical students, the patient was a conundrum.

According to his chart, he had residual pain from a leg injury sustained while working on a train track. Now he wanted an opioid stronger than the Percocet he'd been prescribed. So why did his urine test positive for two other drugs — cocaine and hydromorphone, a powerful opioid that doctors had not ordered?

It was up to Clark Yin, 29, to figure out what was really going on with Chris McQ, 58 — as seven other third-year medical students and two instructors watched.

"How are you going to have a conversation around the patient's positive tox screen results?" asked Dr. Lidya H. Wlasiuk, who teaches addiction awareness and interventions here at Boston University School of Medicine.

Mr. Yin threw up his hands. "I have no idea," he admitted.

Chris McQ is a fictional case study created by Dr. Wlasiuk, brought to life for this class by Ric Mauré, a keyboard player who also works as a standardized patient — trained to represent a real patient, to help medical students practice diagnostic and communication skills. The assignment today: grappling with the delicate art and science of managing a chronic pain patient who might be tipping into a substance use disorder.

How can a doctor win over a patient who fears being judged? How to determine whether the patient's demand for opioids is a response to dependence or pain?

Addressing these quandaries might seem fundamental in medical training — such patients appear in just about every field, from internal medicine to orthopedics to cardiology. The need for front-line intervention is dire: primary care providers like Dr. Wlasiuk, who practices family medicine in a Boston community clinic, routinely encounter these patients but often lack the expertise to prevent, diagnose and treat addiction.

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https://www.nytimes.com/2018/09/10/health/addiction-medical-schools-treatment.html