The use of prescription opioids for the treatment of acute and chronic pain syndromes has increased significantly over the last 10 years. Abuse of these medications has always been an issue, and there has been increased scrutiny of, and publicity about, the escalation of misuse, abuse, and diversion attending the higher rates of prescription. Recently, the front page of the Wall Street Journal carried an article describing the measures being taken by the federal government in trying to crack...

Back in December of 2011 on the Veterans Affairs Web site, there was a posting about chronic pain. The entry is titled “Chronic Pain and PTSD: a Guide for Patients". It is brief, approximately 8 paragraphs long. It helps to define what chronic pain is, and demonstrates how common it is, stating that approximately one in three Americans suffer chronic pain in their lifetime. The link between PTSD and chronic pain is made with a few interesting statistics:

- 15%-35% of patients with chronic...

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...

Just a few days ago a man went into a pharmacy, not too far from where I live and killed 4 people at gunpoint.  His objective there was to obtain opioids for himself and his wife.  This crime was horrific, and helps to explain the recent laws enacted by the state of Washington which will go into effect in 2012.  They have created a set of rules regarding the prescribing of opioids by any healthcare practitioner which are fairly specific in nature.  I would like to take a minute...

Southern Ohio.  It’s full of state parks, historical sites, and nature preserves.  It also unfortunately has a serious problem with opioid use and abuse.  The leading cause of accidental death is unintentional drug overdose.  In Scioto County alone last year there were 22 overdose deaths.   As reported on NPR, “If you count up every pain pill that was legally prescribed within Scioto County last year, you get 9.7 million tablets and capsules.  That's...

For patients who are taking opioid medications, constipation occurs at least 41% of the time and some studies report rates as high as 95%.  This is a major issue and needs to be addressed whenever someone is prescribed an opioid.  The saying goes: the hand that writes the opioid prescription also writes the medication for constipation.  But too often this is not done, or if it is, the wrong medicine is prescribed!

Opioids work at the Mu receptor.  These receptors are located...

The adolescent mind does not finish developing until one reaches their mid 20’s. Different parts of the brain develop faster than others and unfortunately the pre-frontal cortex, the area responsible for a lot of our reasoning abilities and impulse control, is one of the last areas to fully develop. This leaves adolescents with a real challenge; making important decisions when it comes to risk taking behavior. According to an article published in the Journal of the American Medical Association...

I’d like to start by reviewing a recent encounter between two patients. The encounter is real, just a slight variation to maintain anonymity.

Patient 1: I fell and hurt my wrist 4 months ago and I originally had an xray that made it seem like everything was ok, but now after 4 months and an orthopedic evaluation I just found out that I may have a slight fracture after all and I may even require surgery. Meanwhile my wrist is killing me. I started with over the counter medications and they...