Is it addiction or dependency?

Addiction vs dependency5Dr. Michael J. O’Connell, PainCare, New Hampshire commented that the distinction between addiction and dependency is constantly mangled by the press, lay people and even many professionals.  The difference between dependency and addiction is not withdrawal.  Withdrawal is a phenomenon common to both.

Addiction marks a transition into pathology; the chemical, activity or behavior to which one is dependent (oxycodone, heroin, alcohol, THC, sex, eating, extrovertism/introvertism) becomes harmful…physically, psychologically and/or functionally, to the individual.  Withdrawal or craving is not necessarily a pathology and therefore not necessarily an indication of addiction.

One would be hard pressed to declare a weekly snorter of heroin or cocaine an addict.  If a person dreams much about food, craves certain tastes or dishes, but lives a functional work and social life and is not obese, this can hardly be defined as an addict.  If another has elevated liver enzymes, presence of abdominal fat in an otherwise slender body, is thinking about drinking alcohol much of the day, has a couple DUIs, occasional blood in the stools, and yet persists in drinking alcohol, this is most likely an addict.

If a chronic back pain patient has had a laminectomy and then fusion, still requires pain meds but goes into intense withdrawal with sweating, shakes, diarrhea, and piloerection, when away on a trip forgetting meds at home, this is dependency, but unlikely addiction.

Dr. Michael J. O’Connell Donates $250,000 to CVHS Capital Campaign…

CVHS2Dr. Michael J. O’Connell, PainCare, New Hampshire has generously donated $250,000 to support Cocheco Valley Humane Society’s “Bring Us Home” capital campaign to build a new 11,000 square foot animal shelter that will be located on the grounds of the Strafford County complex in Dover. His leadership gift will name the surgical suite at the new facility.

Dr. O’Connell has been a steadfast supporter of CVHS for many years; regularly underwriting events and providing financial support to enhance the quality of care for thousands of abused, neglected and abandoned animals the shelter serves each year. In addition, he has served as a tireless advocate for CVHS and has worked to champion the shelter’s mission by authoring letters of support encouraging his peers to join him in making a difference in the lives of the animals at CVHS.

According to Dr. O’Connell, “As I reach the twilight of my career, and as CVHS approaches its momentous rebirth, I have decided that my plans to include CVHS in my will are far too conservative, not anywhere near as helpful to my favorite charity as I would like and as what CVHS deserves. The old saying “you can’t take it with you”, is particularly germane for me. I dearly wish to see with my own eyes, in my own lifetime, a vibrant, robust home for CVHS. As the caretakers for the truly innocent, I can’t imagine draining my retirement funds now for any more lofty or noble purpose. The employees and volunteers at CVHS are to be commended for an awesome, yet too often thankless job in face of recurring challenges. I hope with my assistance and that of many others, CVHS can realize a long held dream.”

With 12 locations throughout NH, Paincare is the leading medical practice in the northeast dedicated exclusively to pain management. Salmon Falls is a comprehensive family health care practice treating newborns, children, and adults of all ages. The practice has been serving the tri-city area of Dover, Somersworth, and Rochester for over 20 years. The mission of the R.O.A.D. To A Better Life program is to provide therapy and treatment for drug and alcohol addiction in a safe, respectful and friendly environment that is focused on recovery, relapse prevention, and a return to normalcy.


Medical tourism…

Thailand Medical Tourism 3Dr. Michael J. O’Connell, PainCare, New Hampshire commented that Morgan Spurlock, roving special reporter for CNN, recently spent a great deal of time and resources exploring “medical tourism” in Thailand.  Turns out it was less an investigation and more an anecdote reporting on his single personal experience.

Spurlock embedded himself as a patient at a large hospital there.  A wealthy US developer has created a slick niche system which as Morgan discovered provides high quality focused care, easy access (once you have flown to Thailand), but of course cash only.  The hospital targets upper middle class Americans who may have no insurance by design, or high deductible insurance (as with Obamacare and catastrophic policies).  Morgan sprinkles his piece with repeated price comparisons between this Thai facility and those same services if one paid cash in the US.  He undergoes a colonoscopy using a ‘swallowed’ camera, fairly extensive blood work, EKG and an MRI.  For every service, the Thai price is considerably lower, and Morgan’s workup is all benign.

This piece is grossly unfair for several reasons:

  1. Those insured by more typical low deduct policies in this country could access these services at a US hospital for far less than the ‘cash price’ he indicated in Thailand.
  2. He doesn’t compute the risk of flying to Thailand – not inconsequential.
  3. The swallowed camera ‘colonoscopy’ technique is available in the US, but is seldom done here (except on unhealthy patients) since many scientific studies indicate that it misses many polyps. And of course if a polyp is found, it cannot be biopsied or removed; a colonoscopy is therefore eventually needed.
  4. What would have happened if something had gone awry in the course of his care? What if Morgan had suffered a heart attack?  Does this hospital have cardiac services, stenting or bypass grafting?  Simply a CCU?

This unfortunately simplistic and naive piece on medical tourism should not serve to discourage such competition, but rather encourage a fair and detailed analysis of that competition.  Else Morgan Spurlock could be accused of mimicking that famously unscrupulous ‘documentarian,’ Michael Moore.

2015 Academy Award nominations…

Academy Awards 2015 2


Dr. Michael J. O’Connell, PainCare, New Hampshire, commented that many late night TV show hosts are apparently outraged at the ‘whiteness’ of this year’s academy award nominations; in a tizzy that the Oscars are not going to reflect ‘racial diversity’.  I entirely agree with the last part, blacks constitute 12% of the US population, but will definitely be vastly under represented, in every category, come Oscar night.  To which my response is…so what?

  • First, these are MOVIES folks! MOVIES!!!  Who cares about the Oscars except a few million folks who have nothing better to do than idolize celebrities?
  • Second, the Oscar selections are votes by individuals. A group did not get together and conspire to exclude an entire race of filmmakers.  CouAcademy Awards 2015 6ld it be that the individual academy members voted their conscience, how they really feel?
  • Third, will anyone squawk when next year (or the year after) two of the five nominations include leading black actors or directors?  But wouldn’t such a result just as readily reflect a lack of racial diversity?  An under representation of whites?
  • Fourth, politico-racial correctness has no role in Oscar nominations, just as it has no role in the color of our president or the race of our police officers. Winners should be chosen, freely based on merit.

Rather than being criticized, the Oscar nominations should be lauded for reflecting what they are supposed to…honest opinions of the best the industry could produce during the previous year.  To do otherwise is to delve into the nether world of racial absurdity.  How tiring that persistent drumbeat…



Cuba 6Dr. Michael J. O’Connell, PainCare, New Hampshire, commented that the recent diplomatic overtures to Cuba, with the probability of normalization of relations soon, makes me think back to Michael Moore’s very snarky documentary re healthcare, “Sicko”.  Moore’s point was that healthcare in the US is undependable, unequal and unaffordable.  But despite being a third world country, in Cuba healthcare was ‘free’, fair and accessible for all.  For these reasons opined Moore, healthcare there was far superior to the US.

Nearly all of network TV brought their evening news from Havana last week, highlighting the shift in policy, potential lifting of the embargo, and also to reveal the current economic status of the country.  Third world it barely is.  The buildings are decaying, infrastructure absent, internet servicing less than 5% of its population.Cuba 12

Whatever charms the Cuban healthcare industry held for Michael Moore, it’s hard to believe he actually gave it a whirl himself.  Medicines, needles, scalpels, sterile supplies, sterilizers, all cost a lot of money.  Would the Cuban government have somehow found the means to fund healthcare yet neglected everything else in their totalitarian economy?  And, why is it that Cubans with money procure their surgeries and cancer care outside of Cuba?

“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.