Jennifer BOLEN JD
Proper documentation is both an ethical and legal duty of healthcare providers, particularly with respect to opioid therapy. Attorney Bolen discusses critical documentation skills, and outlines common mistakes that clinicians may make in maintaining the integrity of the medical record. Watch the video for tips on ensuring the adequacy of your record keeping.
Charles E. ARGOFF MD, CPE
There’s much that you can do to help your patients with postherpetic neuralgia—including how you manage referrals. In this segment, a professor of neurology offers insights for primary care clinicians on diagnosing and managing postherpetic neuralgia, including patient discussion to effectively set expectations for treatment outcomes.
Roger B. FiLLiNGiM PhD
Colleen M. FiTZGERALD MD, MS
- Meditation Training as Part of Chronic Neck Pain Multimodal Therapy
Research reported in Journal of Pain finds evidence that meditation may be effective in reducing chronic neck pain. Previous research has shown that meditation is effective in reducing stress levels, and that chronic pain is associated with heightened stress. The German research team hypothesized that an 8-week meditation program (jyoti meditation) would decrease pain more effectively than a standardized exercise program and that pain relief would coincide with stress reduction. Eighty-nine patients with chronic neck pain who showed increased perceived stress were randomized into meditation and exercise program groups. Results from the 89 patients studied showed that meditation training significantly reduced pain when compared to the exercise group and pain related “bothersomeness” decreased more in the meditation group as well. Consistent with the known benefits of exercise on pain related outcomes, the study found no significant differences between meditation and exercise for pain during movement, pain disability, psychological scores, and quality of life. The authors concluded that meditation has unique benefits for producing pain relief and for pain coping. Read a news story about the study findings here. The journal abstract and information to access the full article may be found here.
- Researchers Find Elevated Risk of Bleeding, Adverse Cardiovascular Events
A new study appearing this week in JAMA reports that myocardial infarction (MI) patients who are receiving antithrombotic therapy are at increased risk for bleeding, heart attack, stroke or cardiovascular death if they are also using NSAID medications. The elevated risk is apparent even after short-term use. Current guidelines recommend the administrations of dual antithrombotic therapy (aspirin and clopidogrel) for up to 12 months and one agent thereafter. Although bleeding risks associated with antithrombotic agents are increased by NSAIDs, certain NSAID agents such as ibuprofen may also impede the antithrombotic effects of aspirin and may increase risk of cardiovascular events. An editorial accompanying the study article comments that “The cumulative evidence available is an important reminder that the while NSAIDs can be helpful and at times necessary medications for satisfactory quality of life, use of these medications among patients with a history of a recent MI is likely to be associated with clinically meaningful bleeding and ischemic risks.” Read more about the study findings here.
- Findings Underscore Need for Comprehensive Opioid Risk Assessment by Prescribers
Researchers from the Cleveland Clinic examined the association of nonopioid substance abuse disorders, opioid dosage, and therapeutic opioid abuse (TOA). The authors hypothesized that a history of nonopioid substance abuse disorders and increasing opioid dosages would be associated with increased likelihood for TOA. Their findings, reported in Journal of Pain, conclude that a significant linkage does indeed exist between the variables. The study consisted of a retrospective analysis of 199 patients under treatment for chronic noncancer pain. The researchers found that 44% of the study cohort were diagnosed with TOA. For those patients with a known history of substance abuse the incidence of TOA was 83%. The corresponding percentage for those without such history was just 25%. The findings underscore the importance of gathering a comprehensive substance abuse history prior to administering opioid therapy for patients with chronic noncancer pain. Adequate risk assessment, including diligent monitoring and use of an enforced opioid contract, should also be taken when prescribing to a patient with a known substance abuse history. Read a news story about the findings here. You’ll also find much more from our PAINWeek faculty on risk assessment and opioid prescribing in the Expert Opinion and Brainfood sections of our website.
- Risk Scoring System May Inform Patient/Physician Decision Making
A study published in the Online First edition of Anesthesiology claims to offer physicians a new planning tool to help identify patients’ risks of chronic pain after surgery. Lead study author Antonio Montes Perez, MD, PhD, department of anesthesiology, Hospital del Mar in Barcelona, Spain, commented “We sought a tool that would reliably predict a patient’s risk preoperatively, at the time surgery is being planned. We developed a risk scoring system that can be used before surgery, when care planning and preventive measures are critically important.” The study examined 2,929 patients undergoing either hernia repair, hysterectomy, or thoracotomy to assess their pain at 4, 12, and 24 months postsurgery. A scoring system was developed based upon 6 predictors of pain likelihood. The authors assert that such risk scoring can promote more informed patient-clinician consideration of factors leading up to and following the surgical procedure, thereby leading to more favorable treatment outcomes. Read more about the assessment tool here.
Department of Public Health and Community Medicine
Tufts Medical Center