Power Over Pain: Home Care Management

Julius Caesar said “it is easier to find men who will volunteer to die than endure pain with patience.” Dealing with pain takes more than enduring; for chronic pain, it requires strategy and persistence. Pain relief is a marathon, not a sprint, but with an understanding of the nature of pain and new tools home pain management can actually be easier than in a healthcare setting. Understanding Pain: The experience of pain is not just nerves firing and signaling the brain. Instead, pain is a complex array of causes and consequences. As an alarm system, pain notifies the brain of danger, just like an alarm system around a vulnerable basement window. With persistent threats, more and more alarms are installed in an attempt to keep the location safe. Once the cause of the danger is gone, alarms may be so sensitive that they still go off. While physical alarms can be uninstalled, dismantling the alarms from chronic pain is less straightforward but just as necessary. Chronic pain physically changes the brain itself: before knee replacement, the size of the thalamus enlarges from processing pain. Within 6 months after the bad knee (and pain) are gone, it returns to normal size.

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Weaning Off Acute Opioid Prescribing

    “Three to Take or Throw”, “Four to Fill or Flush” – how and why we wean off acute opioid prescribing.     Unlike other drug crises, 80% of opioid addiction starts with a pill prescribed by a physician or dentist. 76 Billion pills, it seems, prescribed in the 6 years that led to 100,000 deaths. The late 1990’s ushered in a perfect storm for prescribing: humanitarian good will, the desire to correct pain treatment inequities (that persist), the rise of the HMO and “patient as customer”, and a giant push from pharma accompanied by overt and covert teaching that “opioids aren’t addictive if you’re really in pain.” We know more now. We know 10-15% of people are susceptible to addictive highs beyond pain relief due to genetic speed of metabolism. We know 5.8% of young adults who got opioids for wisdom tooth removal are addicted within a year, compared to 0.4% who did not. Most importantly, we know that for most outpatient injuries and surgeries, OPIOIDS ARE INFERIOR TO OVER THE COUNTER CARE. It is time to wean ourselves off of writing for opioids. Considering risk, efficacy, and why we prescribe, we can change our habits of writing opioids for acute

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What Works for Pain

Power Over Pain: Migraines

One of the hard parts of determining what works for migraines is that the same pain can be brought on by a lot of different causes. Different solutions can work for different people.

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