"Three Major Controversies in Neurology: A Debate"

[Asa]

Medscape: "Three Major Controversies in Neurology: A Debate"

1. Gene-Sequencing in Neurology? Yea/Nay

2. Stem Cell Clinical Trials? Yea/Nay


3. Opioids for Chronic Pain? Yea/Nay

"The session's feistiest debate explored the question of whether or not neurologists should prescribe opioids for chronic pain...

Dr Argoff started off with some epidemiology, stating that there are over 100 million Americans suffering from chronic pain, and most neurologists treat patients with the condition...

All of this is to say that Dr Argoff feels that pain is so commonly comorbid with neurologic disease that it's crucial that neurologists consider the best possible treatment regimens for their patients..."

"...Arguing the con position, Dr Franklin started by explaining that teachings in the early 1990s are what led to the "worst man-made epidemic in modern medical history." There have been over 140,000 deaths from the unintentional overdose of opioids, many more hundreds of thousands of overdose hospital admissions, and millions of people addicted or dependent on the compounds.

"What I'd like to hear from Dr Argoff is not that a few patients with multimodal therapy get along OK," commented Dr Franklin, "[but] how we're going to reverse this public health epidemic."

...Six states in all have in recent years implemented a dosing threshold for opioid analgesics, the first of which was Dr Franklin's home state of Washington. Since the change, opioid-related deaths in Washington have dropped 27%, and a large reduction in chronic opioid use has been seen in the workers compensation system.

"I believe we have to find ways to offer doctors and patients alternatives...like cognitive behavioral therapy and graded exercise," said Dr Franklin..."

http://www.medscape.com/viewarticle/844694_6


Just thinking of how societal trends affect individuals with ME:

For example--the classic, women-are-hysterical mindset (and of course the only thing worse than an hysterical woman is a man who "acts" like an hysterical woman).

Plus, an epidemic of western obesity means only bad, lazy, or mentally-ill people complain about an exercise regime.

And finally, an epidemic of opioid abuse means only bad, lazy, or mentally-ill people resist instruction by specially-trained, state-certified experts, who possess secret and superior knowledge that can only be ascertained through them.



Edit: See also--P2P The Role of Opioids in the Treatment of Chronic Pain (2014 - alongside ME/CFS P2P)

"Several workshop speakers stressed the need to use treatment options that include a range of progressive approaches that might initially include nonpharmacological options, such as physical therapy, behavioral therapy, and/or proven complementary and alternative medicine approaches..."

"Even if primary care providers had the requisite knowledge, skill, and intent, they often do not have access to the resources needed to manage pain according to current guidelines. This is often true because alternative first-line treatment strategies are not available. For example, most practices do not have access to experts in pain management, including specialty pain clinics, or access to the alternative approaches to pain management (e.g., physical therapy, cognitive and behavioral approaches, acupuncture, yoga, meditation, other complementary and alternative medicine)."

"Other payment structures, such as tiered coverage systems, keep non-opioid alternatives as second- or third-line options rather than placing them more appropriately as first-line therapy."

https://prevention.nih.gov/docs/programs/p2p/ODPPainPanelStatementFinal_10-02-14.pdf

 

[Snow Leopard]

My answer to all questions are: it depends, decide on case by case basis.

I believe those who have black/white thinking towards those questions are likely to be wrong.

 

[SilverbladeTE]

Funny thing is, one of the reasons there are so many opiod deaths is, the US largely banned morphine and totally banned diamorphine (heroin) for pain relief because of the sexually repressed, moronic, lunatic hypocrisy of the religious Prohibition/War on Drugs lobby!
so they turned to different treatments which are WAY more addictive and toxic.

Britain uses morphine for chronic pain relief (in form of Tramadol mostly), and heroin for trauma/end of life and particularly severe pain treatments with very little addiction/death problems
except for criminals/addicts who steal Tramadol for their drug abuse but that's a specific and limited problem. Round my way, they drink Buckfast (very potent fortified wine with more caffeine than 6 cans of coke!) mixed with tramadol and valium....few live very long doing that but it's form of severe addiction that does NOT come from medical use of opiods.
They are addicts first and foremost, nearly always through serious mental health problems, who look for whatever substance they can find to shut up the nightmares and fears in their heads.
there but for the grace of God go I....I get "oot ma heid" in book or games. Known those poor bastards and the majority are NOT bad folk just seriously messed up with little hope and they don't care if they die

 

[alex3619]

My answer to all questions are: it depends, decide on case by case basis.

I believe those who have black/white thinking towards those questions are likely to be wrong.

The problem is that simplistic interpretation of evidence based medicine, which is a favourite of insurance and large health care providers, tends toward black and white thinking.

 

[Seven7]

My answer to all questions are: it depends, decide on case by case basis.

I believe those who have black/white thinking towards those questions are likely to be wrong.

What is wrong with you proposing common sense?!!!!!


Isn't it amazing how people can be so damn stupid.???? (Doctors not using their common sense)

 

[alex3619]

What is wrong with you proposing common sense?!!!!!


Isn't it amazing how people can be so damn stupid.???? (Doctors not using their common sense)

Doctors are so bound up in regulations and restrictions, I wonder if they are allowed to have sense. As for common, well, I wonder if it should be renamed uncommon sense.

One thing that strikes me is the absence of the biggest controversy in neurology: the validity of "all in your mind" explanations.

 

[jimells]

My niece is an opiate addict. I'm sure by now everyone considers it to be her fault, since she won't (or can't) follow the "recovery" regimes that seldom seem to work, except to enrich the clinic owners.

Her original problem started in high school with endometrioses. This was compounded by a series of apparently incompetent surgeons. After a competent doctor finally fixed the original problem, she was left with the opiate addiction.

The pattern in the US seems to be that doctors just keep increasing dosage until they panic and then the patient is cut off from legal access and told to enter a "recovery program". At that point the doctor has transferred responsibility for the troublesome patient to somebody else.

Since these newly-created "druggies" are probably not familiar with the black market drug scene, it seems obvious to me that they will soon get into trouble or OD.

But who cares about a bunch a druggies anyway? That's what we have urban ghettos and prisons for...

 

[SilverbladeTE]

Jimells
saw that Claudia Christian, the actress, is an alcoholic, finally found a treatment that helped, alas can't recall name off hand but sure a Google will show it. A drug that breaks the link between a substance and the effects in the brain.

very interesting stuff, don't know if it will work on opiates, but certainly worth checking for your relative?

yeah, sorry, but US has become a police state, very opposite of it's original intent, sigh, and the swine make it so, so they can profit off prisoners, private jails
Oh FFS, there's damn good reason privately run prisons were got rid of a long time ago here, and it's turning to concentration camps, as prisoners can't bargain for wages, are desperate to do stuff not to be bored, so the corporations are investing heavily in prison work...

Tiananmen Square + Walmart.....profit from concentration camps selling cheap goods in the US, that sparked off a controversy years ago
there's no difference with US prisoners now, many of whom are innocent or their sentences vastly over done/cruel or deliberately evil to keep them as slaves.

Only people who should be getting life sentences are really serious dangers to the Public, or the most evil and debased scumbags.
Hey there's some gits who I'd weld into a cell personally, but far more are nothing like that. Just messed up, stupid or framed.
Now you have scandals of judges being bribed to falsely imprison children/youths, which has been proven in court, and the swine finally given hard sentences, originally the ex-judge gits were gonna get a few months in open jail!

Make drugs legal and you'd halve the murders in the US, save a great many people from being harmed or killed by adulterated street drugs etc. But oh noes!! the "Puritan Pitbull Plonkers" want to ban everything they think is "sinful"...them and the Taleban are same kind of lunatics we can all do without, sigh.