Discover and read the best of Twitter Threads about #PAIN

Most recents (24)

Recapping @AmCollegeGastro's #VirtualGrandRounds on #IBS! Let's begin!
🟣IBS can be diagnosed with the Rome criteria
🟣Making a positive diagnosis is very helpful to patients, many of whom have gone years without a name for their symptoms
#IBS is heterogeneous, and so are its pathogenesis and pathophysiology.
🟣Identifying underlying factors in patients can help target treatment!

Important principles when diagnosing and treating #IBS.

Read 34 tweets
0.1% = rate of fatal #OD in the medical use of #opioids acc'g to 2019 research from Kaiser Permanente (link below).

Bwn 2006-2014, 41 of 31,142 died of OD, a rate of 5 per year. Risk stratification did not lower OD rates. Dose reductions were "inconsistent" (VonKorff). /thread
2,887 #vets died by #overdose or #suicide after their #opioid medicine was stopped by the VHA in FY2013 (90 fewer than on 9/11) (Oliva et al 2020).

Patients whose rx opioid was stopped were 3 times MORE likely to die by OD than those whose medicine continued (James 2019).
4.9% of discontinued patients died of OD.
1.7% of continued patients died of OD.

Discontinuation of rx #opioids was associated with 1.35 times the risk of death & 2.94 times the risk of fatal OD compared to patients whose rx continued (James et al 2019).
Read 12 tweets
#Pain impacts all areas of ones lives. It’s difficult to address. The current climate around those with #chronicpain is full of stigma & biases. The narrative that #opioids are bad & do not assist those w #pain or that there are a plethora of non-opioid 1/
continues to impact those that have #chronicpain negatively. IF you have #chronicpain you are acutely aware that care for those in #pain is poor in the USA. There may be ‘pockets’ where one can access superb care but I believe it is few & far between. We did NOT need the #CDC 2/
guidelines. They were Honecker by an ‘expert’ group whose sole focus was on #SUD NOT the treatment of pain. I believe they took the guidelines and encouraged the misapplication of these guidelines. Instead work should have been done to focus on better treatment options 4 those 3/
Read 11 tweets
I’m gonna use this Tweet as a way to illustrate how to get a simple data project up and running in R studio while also cross-checking the results listed in this Tweet.

1. All materials will be free and easily available online.

2. I have pretty severe dyscalculia, so I'm probably not going to get the numbers right the first couple times.😅

3. There is no course fee. I hate people who charge others to learn the basics of programming.😒
Ok, so, first off, let's click a NON-amp link >:P to the USA Today article.…
Read 90 tweets
Unfortunately in USA 🇺🇸 different States have different Laws and Availability (or level of forbidding). My #Pain from #MultipleSclerosis is equally difficult to explain. My response to #MedicalCannabis is Very positive and a Very Effective Pain agent.Vermont: I got home delivery.
In Virginia I got a card a year ago for “low thc oil only”. Not one dispensary open for“Cannabis Lite”. Can’t get a Drop! My Doctors at UVA not allowed to certify I have Severe Pain from Multiple Sclerosis. Had to pay @Veriheal 🙏🏼❤️ for Doctor. Our @GovernorVA is a Doctor....
Federally Cannabis is scheduled as equivalent to Heroin.
@LevarStoney trying to get Law here changed to make Cannabis responsible use Legal in Virginia. Imagine not having criminal records for a substance Legal in Washington DC (residents only!) I hurt.
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⭐️ HUGE⭐️ victory for people with #ChronicPain in #NewHampshire AND their doctors. New bill protects the right of #pain patients to #opioid medicines AND protects the doctors who prescribe them.

Bill is MODEL legislation for other states. /thread…
New NH law: If people "on a managed and monitored regimen of #opioid analgesic treatment" have "increased functionality and quality of life as a result of said treatment," the "treatment shall be continued if there remains no indication of misuse or diversion.”
Under the new law, "physicians & pharmacists are required to consider the 'individualized needs' of #pain patients, treat them with dignity, & ensure that they are 'not unduly denied the medications needed to treat their conditions,'" including (specifically) #opioids.
Read 12 tweets
Study found that head pain (#migraine & #headache) has the "strongest association with suicidality" of all types of #pain. The risk is independent of depression & likely linked to altered functioning of serotonergic systems, not poor coping (Ilgen et al).…
"People with chronic #headache or #migraine were 4.3 times more likely to think about suicide, 4.6 times more likely to plan suicide, & 6.5 times more likely to have attempted suicide in the past 12-months than those without chronic headaches" (Ilgen).
Multiple studies report a particularly strong relationship between #migraine & #suicide. But "even after controlling for depression, anxiety disorders, & substance use disorders," most types of severe &/or #ChronicPain are "associated with suicidal thoughts and attempts" (Ilgen).
Read 6 tweets
Risk of OD in medical use of #opioids is highest in doses ≥100 MME but still less than one quarter of 1% (0.23%).

Canadian Guideline for Opioid Therapy (2017)

thread: 3 studies on #suicide, OD, & rx opioids…
2009 study: moderate to severe #pain triples the risk of #suicide even in otherwise healthy people "independent of poor functional capacity or chronic medical illness.”

Untreated pain can lead to death by suicide "unnecessarily and prematurely.”…
2016 VA study didn't find evidence to support the claim that increases in med'l #opioid use lead to increases in intentional OD.…
Read 3 tweets
The medical use of #opioids did NOT cause the OD epidemic. But so many people believe it did, that in 2019 even @nytimes agreed with #Kolodny that #racism "protected" black Americans because doctors failed to treat their pain effectively. @afrakt /thread…
NYT 2019: "African-Americans received fewer #opioid prescriptions, some researchers think, because doctors believed, contrary to fact, that black people were more likely to become addicted to the drugs & would be more likely to sell the drugs."
Black Americans are less likely to receive adequate #pain relief, according to researchers, because there's a lingering (#racist) assumption that black people have a "higher pain threshold" than whites.

#BlackLivesMatter in medicine.
Read 16 tweets
Patient deaths & harm led #CDC to clarify in 2019 that people on long-term stable #opioid doses above 90 MME should be tapered "only if the risks [of continuing the medicine] seem to outweigh the benefits." Yet hard dosage caps continue as policy & law. /thread
In 2019, CDC, FDA, HHS, & medical experts also urged doctors to seek patient consent before tapering #opioids.

Forced tapers violate the cardinal rule "Do no harm," as forced & mandatory tapers put people at significantly higher risk of harm, distress, disability, & death.
🟠 #CDC recommends tapers of 10% per wk to 10% per month, noting the latter is better for people on long-term #opioids.

2019 JAMA study of +100k people found 1 in 5 were tapered faster than 40% per month & 5% faster than 60% per month.…
Read 9 tweets
The "perceived ambiguity of #pain" colors how clinicians see patients & how they see themselves, say anthropologists Megan Crowley-Matoka & Gala True in a thought-provoking 2012 paper based on ethnographic research in VA clinics. /thread Image
Behind the scenes, doctors characterize people w/ #pain as "demanding, desiring, disruptive" without acknowledging that patients show up w/ "maddening frequency," because fed policy limits scripts to 30 days.

Doctors often wonder if they're treating illness or playing dealer.
A senior PCP described a patient as a "pain player." Others physicians "nodded knowingly but without comment at the term."

For the anthropologists, the phrase "neatly captured the skeptical attitude & adversarial aura often surrounding pain in U.S. medicine."
Read 21 tweets
3% of US kids 3-7 have #migraine.

@IASPpain now internationally diagnoses all #pain from chronic disease as pain from chronic disease, EXCEPT pain from #migraine or severe #headache disorders, which it diagnoses as "emotional distress without a known cause."

That hurts kids. Image
.@winedarkme Did you hear the news? The Inter'l Association for the Study of #Pain (@IASPpain) decided that #migraine pain isn't from the Disease Known As Migraine, but a sign of "emotional distress & disability."

I was happy at 3 when diagnosed. How about you? Image
Mother (@janpurcell2) Remember when you picked me up at Elem School, and the nurse said if you stopped paying attention, my #migraine would go away & you said "That's the stupidest thing I've ever heard c'mon Jill let's get out of here"?

Say it to THESE GUYS: @IASPpain Image
Read 13 tweets
New OFFICIAL Classification of Diseases: #Migraine is not chronic 2ndary pain ("a symptom of an underlying condition") but chronic primary pain ("disability or emotional distress" not "accounted for" by a condition of “known etiology or established pathophysiology") >thread
#Migraine & #cluster are now officially classified as chronic primary pain (disability & emotional distress not accounted for by an underlying condition), not chronic secondary pain "where pain may at least initially be conceived as a symptom secondary to an underlying disease."
>>See @IASPpain: #migraine/#cluster as chronic primary pain (no underlying condition)…

>>chronic secondary head/face pain (underlying condition, but NOT migraine, cluster, or ICHD-3 primary headaches)…
Read 13 tweets
In 2019, #CDC Guideline authors quoted their 2016 stats:

"nearly 2 million" have #opioid use disorder,
"estimated 3% to 4%" rely on long-term opioid therapy
"approximately 11%" report daily #pain

"Nearly 2 million"=nearly 0.6%. Stick with me.…
Before governments recommend & legislators, providers, & insurers adopt policies that could harm up to 11% to possibly protect 0.6%, they need damned good evidence that what they're recommending is necessary.

But they didn't know if rx #opioid limits would help or kill.
#CDC set off a tidal wave of limits in 2016, even tho the studies then available on dose limits provided "very-low-quality evidence" that reducing or stopping med would improve pain, function, or quality of life. 76% got the *lowest* rating for evidence.…
Read 10 tweets
1/ A very compelling story about how #Women's #Pain & especially #Black women's pain is dismissed and disregarded by the healthcare system.…
2/ The story begins with a woman with sickle cell & her horrifying experience in the hospital. It also discusses pain from syndrome's unique to women, like endometriosis or fibroids.
3/ Pain is a feminist issue. #PainToo must be believed. First, there is the dismissal of women's accounts of their own bodies, tracing to a history of dismissal of symptoms due to absurd misconceived views of #Hysteria in women. Trans folks get the same treatment, or worse.
Read 9 tweets
2012 column by leading pain expert B Eliot Cole, MD, MPA, warned that "radical changes" proposed by a group calling itself #PROP would deny #opioids "to the majority of patients now receiving them for noncancer pain." / thread…
In the early 2000s, "buoyed by the success of treating cancer-related pain with #opioids, many physicians rose to the challenge of doing more for their patients suffering with #ChronicPain," Cole wrote.
"This led to an increase in the number of prescriptions for #opioids, which had the unintended consequence of more opioids ending up in medicine cabinets in more homes, ultimately giving more people (🚩not patients) access to these valuable medications for nonmedical purposes."
Read 21 tweets
2017 Review: “Expert guidelines recommend reducing or discontinuing long-term #opioid therapy when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed.” / #cpp thread.
🟠 How can guidelines be "expert" recommendations if researchers haven't carefully investigated how patients will react when their rx #opiod med is stopped or reduced?

Are we going to feel better or worse? Are we going to live or die?
In 2017, #VA-funded researchers identified 67 studies about #opioid dosage reduction or discontinuation.

Study quality was deemed “poor” in 76% of the 67, the lowest rating.
Read 21 tweets
Intern'l group of #pain experts called for urgent action on forced #opioid tapering in March 2019.

In early 2019, FDA warned that rapid & sudden tapers are harmful & can kill. They issued guidance to help doctors protect patients from harm. /thread…
Rapid/forced tapering can destabilize patients, "precipitating severe #opioid withdrawal accompanied by worsening #pain & profound loss of function. To escape the resultant suffering, some patients may seek relief from illicit (and inherently more dangerous) sources of opioids."
"New & grave risks now exist because of forced #opioid tapering," including an "alarming rise" in suffering & #suicides in civilians & #vets. Even patients at doses below 90 MME are being forced to taper.
Read 6 tweets
“Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that #opioids reduce pain" & 57% "report better quality of life": 2017 Guideline from American Society of Interventional #Pain Physicians.
Amer'n Society of Interventional Pain Physicians' 90-pg guide focuses on ways to "reduce the abuse & diversion of #opioids w/o jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use.”…
Latin American Pain Federation's 2019 position paper on #opioid & #pain management: "Although scientific evidence supports the safe use of opioids, there is still significant reluctance around the use of these analgesics." #cpp…
Read 5 tweets
At @RepJudyChu & @RepWalorski could you please provide additional information on the congressional caucus held on July 24 on #chronicpain? The invite for this indicated that individuals that have #chronicpain are responsible for current #opioidepedemic. Even with 1/
#patients with #chronicpain being ripped of opioid pain meds, with the number of prescriptions at all time low, SUD & overdoses continue to rise. This is NOT caused by those w #chronicpain. Respectfully, we have been harmed by such rhetoric used in your invitation 2/
The language in your invitation perpetuates the stigma those with #chronicpain face which impacts access to care. Meet my family (older pictures) My husband & children had/have #hereditarypancreatitis #PRSS1. A rare condition in whic one of symptoms is horrific pain 3
Read 11 tweets
What have false assumptions about rx #opioids cost people in #pain? Damn near everything.

@Brian_Goldstone's report ought to be required reading for every #PCP & every legislator who wants to play doctor. #MedicalTwitter…
For 4 yrs, an rx #opioid let Austin Sell escape the cage of pain, care for his kids, study to become a physician asst to help others w/ #ChronicPain. Then lawmakers in DC imposed a limit on what his clinic could prescribe. "And that was it. The app'ment lasted about 10 minutes."
Dr @StefanKertesz told @Harpers: “In a time of incredible tragedy, there’s a desire for something simple to latch onto as a way of explaining it. A story that has a clear-cut villain, with doctors as dupes and patients as innocent victims, is about as easy to sell as any story.”
Read 25 tweets
@NitaGhei @amylorrainelong @BrianMannADK @NPR @headsUPmigraine @vicwj @carriefeibel @MPBN @SusanSharon1 Exactly. I used to say rx #opioid limits didn't help people w/ addiction & harmed people w/ #pain until I started reading research & saw they're harming EVERYONE. Dose variability itself triples the risk of OD.…
@NitaGhei @amylorrainelong @BrianMannADK @NPR @headsUPmigraine @vicwj @carriefeibel @MPBN @SusanSharon1 “Attempts to discontinue #opioid therapy to reduce the risk of overdose & adhere to prescribing guidelines may lead patients to be exposed to variability in opioid dosing. Such dose variability may increase the risk of opioid overdose” by greater than 3-fold. Glanz, JAMA 2019
@NitaGhei @amylorrainelong @BrianMannADK @NPR @headsUPmigraine @vicwj @carriefeibel @MPBN @SusanSharon1 If people are being pushed off rx #opioids to save their lives, it needs to stop NOW because the practice is KILLING PEOPLE. OD/suicide rates go up A LOT: 3 times (Glanz JAMA 2019), 4-6.8 times (Oliva/Kertesz BMJ 2020). ...
Read 8 tweets
Such a powerful piece of music. If.. each person harming the chronically ill,RIGHT NOW (knowingly or unknowingly) could take a moment a breath-reflect, even a little. People want to LIVE & experience life. Do not take that away.
Every individual has a right to engage & experience a full life. Artist, scientists, philosophers, mothers, fathers. Some have bodies that are like war zones. So, we have good doctors and medications that should help these amazing people thrive as best they can - and
Realize their potential, regardless of disability. So many hearts and minds want to live, engage and give to this world.
But- a simple medication that can bring many function- has been weaponized politically. It NEEDS to END NOW.
Read 4 tweets

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