There are many moving parts when it comes to making changes to healthcare in America that can affect the entire system. In last month’s New England Journal of Medicine, Drs. Pizzo and Clark reiterated a lot of their conclusions from the original Institute of Medicine (IOM) report published in the summer of 2011. Pain, both acute and chronic is undertreated in this country. The total financial costs in the US alone are between $560 and $635 billion dollars. Sixteen specific recommendations...

Today I thought I’d talk about something dear to my heart, because it's something that I see and treat on a regular basis. Kidney stones. Kidney stones are painful, really painful. Most patients may present with classic symptoms with colic and hematuria. The colicky pain is severe, often described as 10 out of 10 and radiating from the flank towards the groin. There is often associated nausea as well. But sometimes there could just be vague abdominal pain with no radiation and no other...

Last week on Dr. Kevin Pho’s blog at http://www.kevinmd.com/blog/, there was a new posting about using a mobile app for chronic pain.  This is a great concept, and is something that is going to become a prominent tool for the management of chronic pain.  This specific app is not available yet, but will be in the near future.  Similar apps already exist and it is interesting to look at what is currently available.

Damon Lynn has a very well designed pain diary that is user...

The house staff called me just now from one of the hospitals I round at. They told me my patient, who was admitted less than 24 hours ago, was ready for discharge. Medically, he was stable. His pain was not controlled, but that could be handled as an outpatient. The interesting thing, though, is that the primary reason he came in was the pain, and although the disease process that we were worried about was excluded, and he was in no imminent danger, the pain was still there, was very real, and...

When we treat patients with chronic pain, it is a mainstay of therapy to make patients understand that we often cannot get rid of their pain completely, but we can help bring the pain down to a more manageable level.

Delta 9 tetrahydrocannabinol is a chemical that binds to CB-1 receptors on cells in part of the medulla affecting the pain pathway and decreases one’s perception of pain.  It works in a similar fashion to other pain medications, including the opioid class of medications. ...

The people in this world are getting larger, literally.

 As the rate of obesity rises, not just in America, but throughout much of the world, so too does the rate of diabetes. We can expect more and more patients suffering from the many complications of diabetes with every passing year. In the field of pain management, the treatment of diabetic peripheral neuropathy is always a challenge. But DPN is not the only painful condition brought on by diabetes. In fact, diabetes can produce painful...

Pain is undertreated in this country. The Institute of Medicine released its report on chronic pain on June 11^th of this year. In it, they stated that 116 million Americans suffer from chronic pain, a third of the population. This excluded children, chronic care facility patients and military personnel. The prevalence of chronic pain will increase as the population at large gets older. Millions of chronic pain sufferers are undertreated. Why then shouldn’t we have a medication on the market...

How many times do we have someone in the office asking for an MRI? For me personally, at least once a week and sometimes more, and I only see patients four days a week. A patient hurts their back. They were moving furniture and then had a severe pain in the lower back. The pain is obviously bad, but without neurologic signs such as noted weakness, foot drop, or bladder incontinence, it is difficult to justify getting an expensive test such as an MRI. This test will most likely show some form...

As health care practitioners, we treat patients in pain every day.  For many of us, our first go-to medications are often acetaminophen or an NSAID like ibuprofen.  Does anyone ever prescribe these two together?   I admit that I do sometimes, but not often.  When used together they do work well, but as expected, they do have an increased side effect profile this way. 

Typically, when prescribing NSAIDs, we need to consider their effect on the stomach, the increased...

For those people with chronic low back pain (pain for more than 3 months duration), acupuncture is one of the treatment modalities that is often prescribed by a health care professional.  But how well does acupuncture really work? One of the best trials looking at this is from a 2009 Archives of Internal Medicine article entitled “A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain.”  The data behind the success of acupuncture...