“Comprehensive” chronic pain management…

Chronic pain management 7Dr. Michael J. O’Connell, PainCare, New Hampshire, commented that many pain managers across the nation claim to provide “comprehensive” chronic pain management, yet this term has not been defined by any of the pain societies.  This is unfortunate since the pain patient should know before accessing services, or wasting a good deal of money on one type of ineffective treatment, and other potentially successful types not mentioned or offered.  Even the dictionary definition of “comprehensive” is uncertain, alluding to the inclusion of “many” or “all.”  Which is it?  Such vagueness is not helpful.

So it would seem that “comprehensive pain management” should include most, if not all services generally considered as useful treatment for pain.  Enter another problem…how is “useful” or “effective” measured or characterized?  Dr. O’Connell notes that historically this problem has been addressed by research, and scientific study.  Pain management as a discipline in itself, and is historically very “new” compared with other specialties such as general surgery, cardiology or neurology.  Hence, chronic pain management has not been subjected to rigorous study, and therefore its underpinnings are fragile if not precarious.

For example, the use of opioids in chronic conditions has been advocated by icons in pain management such as Lyn Webster, MD, former president of the American Academy of Pain Medicine, and Russ Portenoy, MD of New York’s Beth Israel Medical Center and former president of the American Pain Society.  Both of these renowned figures have been tarnished if not disgraced by accepting immense pharmaceutical funding to advocate for opioids, and with precious little clinical support for effective long term outcomes.  Webster has come under scrutiny by the DEA for over 20 ODs among his patients and has left clinical practice (despite having developed an assessment tool to root out abusers, both men named in a recent suit brought by the city of Chicago and several counties of California against the pharma that funded these men in promoting opioid use for chronic pain).

Another tool of the chronic pain manager, targeted steroid and anesthetic injections, has been subjected to a huge volume of studies by Lax Maschikanti, MD of Kentucky.  While he professes to be heavily involved with face to face treatment of patients in his private practice, he apparently had enough time to produce more than 100 studies over the past few years, looking at the effectiveness and safety of such injections, many printed in peer reviewed journals.  In addition, Dr. Maschikanti is reportedly heavily involved with the politics of pain and health care, the primary motivator behind a PAC advocating for the field of pain management.  All these activities makes one question whether he sleeps, and the quality and reliability of his innumerable research articles.

Other tools of the chronic pain manager include behavioral medicine, psychotherapy, non opioid medications, physiotherapy, neurostimulation, chiropractic and alternative care with massage therapy, herbs, etc.  Not one of these modalities has been subjected to rigorous scientific analysis of efficacy, not just short term, but long term.  Not one randomized controlled study with significant numbers of patients has been produced on any.

So you can see that to answer the question, what is comprehensive pain management?, is to question the answer.  Until questionable research can address the efficacy of each modality, the definition of comprehensive care cannot be entirely articulated.

 

Failure…

  1. 1.  Healthcare – AFailure 5ffordable healthcare act? Only a minuscule portion of the uninsured population has received coverage they didn’t have (and mostly didn’t want) before ACA, and many of those now covered have insurance that is equivalent to Medicaid.  Most independent physicians will not accept this paltry reimbursement, so will not enroll.  Sum total, failure.

2.  Foreign policy – Ukraine, loss of Crimea, impending loss of the eastern 1/3 of the country, and with puny economic sanctions as Obama’s response? Syrians still killing one another.  Genocide in the African desert.  Taliban biding their time through the Afghan “elections” and they will once again ravage the country, reinstall Sharia law, and foment terrorists abroad.  Egypt an economic and political mess, the Palestinian question no closer to resolution, Iran reactors centrifuging and purifying and lying and our weakness in this affair emboldening Iran to send a leader of the 1980 embassy hostage fiasco to represent them at the UN? Sum total, failure.

3.  Domestic – Given Obama’s sticky sweet relationship with Hollywood, he clearly still shines there, dancing and singing and ‘selfing’ with the stars.  Isn’t that so clever of this president?  So much talent to entertain.  While the economy continues its 6th year of slogging along, adding few              higher paying jobs, then he laments the wage gap between the top 2% and the rest of society.  About theFailure only good news is the lack of an illegal immigrant                policy – good because we no longer need one.  The desire to find a job in US has lost its appeal.  Mexico is looking a whole lot more  respectable.  Sum total,              failure, but  with a song.

4. Energy – Thanks to the aggressive natural gas exploration by private companies, we enjoy the distinction of now being an energy exporter, no thanks to                    Obama and his attempts to over regulate the industry and encourage higher prices.

5. Global warming – Words, words, words. Observation and no action.  …dismal Failure.

 

Taney Dragons…

Dr. MichThe Taney Dragons 8ael J. O’Connell, PainCare, New Hampshire, commented that recently he watched another segment about that amazing Philadelphia Little League baseball team, the Taney Dragons, who won yet another game.

The Dragons stars an equally amazing black female pitcher.  She can sling a 70+ mph fastball.  From 60 feet, that’s got to look like a blur to the batters.  She pitched an easy shut out recently. Accolades abound and are well deserved.  It is so refreshing to see such a reserved, intelligent, humble, yet hugely talented youth star.  On interview, she carefully, persistently diverts attention from herself to her team, like the true leader she is.  She attributes her team’s success not to her, but to the team, TEAM.

The Taney Dragons 2How refreshing is this youngster?  How exemplary?  How different from her ‘professional’ counterparts; those largely self-centered, pampered, arrogant sports figures we admire but swallow hard to endure.  Don’t know about you, but I am so sick of the fist pumping, chest beating, and end zone spiking.  Let’s hope she never loses this humility.  I wish her all the success.  She is indeed an inspiration and a breath of fresh air.

Big Brother activities…

Big brother 2Dr. Michael J. O’Connell, PainCare, New Hampshire agrees that it is somewhat unsettling that the NSA and CIA have access to so much, perhaps most, of our internet and telephonic activities.  All in the name of fighting terrorism, and perhaps crime, in general.  It is also unsettling that on practically every city street corner, there is camera surveillance.  Again, in the name of public protection.

Many ideologues, such as Slavoj Zizek believe that such Big Brother activities are not simply invasive, but nefarious.  Interesting that Zizek, a well-known castigator of ideologues, should himself delve into fanciful speculation of the use of information for fomenting evil.  A perfect definition of an ideologue HE is.  In his recent documentary, “The Pervert’s Guide to Ideology,” he presents a couple instances in which citizens in this country were arrested and detained for something they had written in an email or text.  This activity certainly gives one pause, but is that reason to believe there are widespread incarcerations of totally innocent people?  Where’s the evidence of that, aside from his several examples, all of whom were released after questioning?

Regardless of whether history will prove this huge information harvest to be an overall public benefit, an evil trap, or just a general but tolerable nuisance, it should send a wakeup call to all users of social media.  As an employer of over 200 people, I am amazed at the comments made available on Facebook by many of them.  Maybe it’s time to think before posting.

 

Medical research…

Dr. Medical research 5Michael J. O’Connell, PainCare, New Hampshire commented that the recent 350.000 subject study in the American Journal of Clinical Nutrition demonstrating consumption of saturated fats to be no more the cause of cardiovascular disease than consumption of polyunsaturated fats is another blockbuster example of the rise and fall of yet another conventional wisdom.  For decades we have been fed garbage (pun intended) by media and by medical literature that the hydrogenation (saturation) of fatty acids (converts liquid fat to solid, as in margarine) is tantamount to chemical ‘perversion,’ and ingestion of such products is certain to lead to a premature death.  The recycling of age old “rock solid” advice from physicians is in my opinion analogous to the frequent ‘turning’ of my backyard compost pile.  Depending on how deeply I drive my pitchfork, the more likely I am to find intact wine corks, jar labels, oak leaves and other paraphernalia from years ago.

Scientific literature, the term itself meant to be synonymous to ‘truth,’ is hardly that.  Facts are destroyed then reinvented in a truly bewildering and dangerous process.  When is the public going to raise its intelligence quotient to the level at which it realizes that scientific literature is often no better than my compost pile, and occasionally far worse?

Now this is not to criticize the mountains of ‘applied research’ that has led to astounding technological advances.  Information retrieval, data storage, communications, robotics…all have been made possible through science, and many if not most, make our lives much easier and productive.  However, when science is applied to the human body, not a machine, not a flask of chemicals in the lab, science does not exactly shine.  Medical science more often than not fails us.  It usually does not get it right the first time, or even the second, third or umpteenth.  This does not reflect an evil underpinning to medical research, but rather the infinite complexity of humans, both the researcher and the researched.  The list of barely effective medications, medications that years later cause catastrophic health problems; surgeries that do not cure but rather maim if not immediately after, but years down the road, is staggering.Medical research 3

Which brings me to my favorite subject—Obamacare.  One of the primary tap roots of ACA is EBM (evidence based medicine).  The presumption is that the medical literature will guide doctors and other worthy practitioners in their treatment of various human pathologies, for the noble purpose of applying the ‘right treatment at the right time’ (whatever that means). This purpose has the effect of reducing providers of healthcare to automatons, who merely plug in patient’s complaints, physical findings and results of lab and radiological procedures and voilá, up pops the right and timely treatment on the computer screen.

If only it all worked so smoothly.

Suboxone and addiction…

Methadone detox 3Dr. Michael J. O’Connell, CEO/Owner of PainCare, New Hampshire, developed the  Suboxone NH clinic in 2006, an addiction treatment medical practice using buprenorphine (Suboxone) combined with group therapy.  Dr. O’Connell is delighted to announce the addition of Dr. Charles Dreibelbis to the North Conway PainCare office where he will extend the outreach of NH Suboxone.

“Addiction to opioid painkillers is a major and increasing cause of morbidity and mortality among our youth,” according to Dr. O’Connell.  “The great majority of young addicts start down the path using alcohol and pot, the cheapest available high.  Then the attraction to experimenting with a friend or relative’s drug cabinet begins.  Heroin can rapidly follow due to its availability, low price and more intense high; first snorting then injecting, each step more risky, and perhaps more exciting to the addict.  Soon the addict’s life is totally enwrapped to one purpose, finding the next high.  Not finding an opioid in timely fashion is a very potent motivator since severe withdrawal and craving follows.

Dr. Dreibelbis comes with almost 10 years of dedicated experience with addiction treatment using Suboxone (buprenorphine).  He also sees patients in the Somersworth PainCare location.  He will greatly assist addicts who truly desire to be done with opioids by prescribing buprenorphine, a drug which tightly binds with opioid receptors in the brain.  Very small amounts effectively shut down cravings, yet do not stimulate the receptors to produce but only mild sensorial effect.  Dr Michael O’Connell recognizes the North Conway area as a particularly needy area where opioids including heroin abound.  No inpatient drug rehab exists nearby, and access to excellent outpatient therapy such as with buprenorphine is very limited.

PainCare is the largest pain management practice in New Hampshire, serving 12 locations.  Since some chronic pain patients are referred already taking large doses of opioids, Dr O’Connell sees not just a usefulness of addiction treatment under one roof, but a profound need. “Addiction treatment is part and parcel of comprehensive pain management, anyone who thinks otherwise is not facing reality.”