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...

At this year’s PAINWeek, I had the pleasure of sitting with Dr. Harry Leider, Chief Medical Officer and Senior Vice President at Ameritox to talk about a study he was presenting at the conference, and to get his perspective on the PAINWeek experience.

The use of opioids has grown significantly over the past 20 years, and patients on long term opioid therapy need to be monitored closely. Part of this monitoring includes urine drug testing to ensure compliance with the medication and to rule...

For a variety of reasons over the past few years, the Tylenol brand of medication has been disappearing from the shelves of pharmacies all over the nation. In June of this year over 60,000 bottles of Tylenol were recalled due to a musty odor linked to a trace amount of a chemical found in the pill. What is interesting is that acetaminophen, the active ingredient in Tylenol, is found in over 600 over the counter and prescription medications. The generic formulations of acetaminophen have the same...

Gout. After all these years, it's still an issue. 

I have a patient right now in the hospital whose knee is swollen like a balloon, red, hot to the touch, and in severe pain.  He has not gotten out of bed for two days.  It is unfortunate, but for this patient this attack may have been preventable.  He has kidney disease, but not severe.  A few months back he was hospitalized for another issue and upon discharge was supposedly told not to take his medications (allopurinol...