Another MedPage Today gem:  In patients with knee osteoarthritis (OA), pain likely first appears during weight-bearing activities that involve bending of the knee, such as climbing stairs, a new study suggests.

F*ck, here we go again…


1/12/2015, Scant Evidence for Opioids in Chronic Pain

There’s no evidence for the long-term safety and efficacy of opioids in chronic pain — a fact long touted by advocates who have called for tighter controls on opioids, now supported by a large-scale evidence review commissioned by federal agencies.

Another government-sponsored report supporting the failed drug war…  I’m bored already…

Most randomized, controlled trials of opioids for chronic pain were shorter than 6 weeks, and nearly all ran for no longer than 16 weeks, according to Roger Chou, MD, of Oregon Health and Science University, and colleagues.

So, on the one hand, you’re saying that there is no evidence because the research hasn’t been done; and on the other hand, you’re saying this proves there is no evidence (of long-term safety and efficacy with opioid treatment).  You know, this kind of circular logic is the same kind used with medical cannabis…

And there is evidence of harm, including increased risks of overdose and abuse, Chou and colleagues wrote in their report — which was commissioned by the Department of Health and Human Services.

Of course there is evidence of harm — all drugs show harm with use, including many that aren’t even on the drug scheduling list.  And treating pain is what drugs are used for most, so of course you will see more harm in this patient population.

The real question is, do the benefits outweigh the harms?  My conclusion?  Yes, more patients achieve benefit than harm.  I’m talking about both chronic pain patients and those addicted to drugs.

Part of the problem is a lack of drug education — just like there’s a lack of sex education in this country.

The report was presented in September at an NIH Pathways to Prevention workshop evaluating the role of opioids in chronic pain. The workshop was co-sponsored by the NIH Office of Disease Prevention, the National Institute of Neurological Disorders and Stroke, the National Institute on Drug Abuse, and the NIH Pain Consortium — many of which are involved in drafting a National Pain Strategy.

This is so depressing…  All these government agencies working on making the lives of chronic pain patients even worse than they are now…

“The lack of scientific evidence on effectiveness and harms of long-term opioid therapy for chronic pain is clear and is in striking contrast to its widespread use for this condition and the large increase in prescription opioid-related overdoses,” Chou and colleagues wrote.

The lack of scientific evidence… because the research with the right controls hasn’t been done… it’s not there so it doesn’t exist.  Now I’m not only bored, but dizzy.

The panelists drew heavily from the report, concluding in their paper that opioids may work for some patients, but there are “probably more effective approaches for many others.”

Oh my god, I am so glad that someone has found “more effective approaches” for the treatment of pain…

So, weren’t you going to mention what these treatment options consist of? Maybe, because as a doctor, you feel funny recommending massage and accupuncture to treat chronic pain?  And what happens when all your customers switch from seeing a doctor to seeing a massage therapist?

Panelist David Steffens, MD, MHS, of the University of Connecticut, and colleagues wrote in their report that a rising tide of both chronic pain and opioid overuse has “created a situation in which large numbers of Americans are receiving suboptimal care.”

Please, someone define “suboptimal care”… Is that like being treated as a criminal and drug addict?  Or not being treated at all?

The root of the problem is a lack of knowledge about the best approaches to treating various types of pain and a dysfunctional healthcare delivery system that “promotes prescription of the easiest rather than the best approach to addressing pain,” they wrote.

Really?  Is that the root of the problem?  Well, okay, if you say so.  However, with the internet, you can’t really say there’s a lack of knowledge — more like the medical industry can’t figure out how to treat constant pain.

And we could give a shout out to the insurance industry, which refuses to cover all available treatment options.  In fact, you could put a lot of the blame for the overuse of drugs on the insurance industry — drugs are covered more than any other kind of treatment.  You know, because they’re cheap.  Or, at least, they used to be.

They issued several recommendations, including a call for studies to identify which types of pain patients are most likely to benefit — as well as incur harm from — opioids, the development and evaluation of multidisciplinary pain interventions and risk assessment tools, and that clinicians in the interim should follow the recommendations of their professional societies when it comes to prescribing pain treatments.

Blah, blah, blah…

MedPage Today and the Milwaukee Journal Sentinel have launched several investigations into the lack of evidence for the use of opioids in chronic, noncancer pain. The stories revealed that behind that surge in opioid prescribing was a network of pain organizations, doctors, and researchers who pushed for expanded use of the drugs while taking millions of dollars from the companies that produced them.

And who’s behind the surge in the drug war, and the criminalization of pain patients and those addicted to drugs?

Yes, pain patients can easily conclude that MedPage Today is obviously run by some government agency — does it matter which one?

Richard Deyo, MD, MPH, of Oregon Health and Science University, and a co-author of the HHS review, expressed doubt that the type of randomized trial evidence now needed regarding opioid therapy would ever be done.

So, there’s no evidence, and none will be forthcoming.  Huh.

Another controversy in the opioid space has been a Institute of Medicine report that estimated 100 million Americans live in chronic pain, particularly because experts who drafted the report had close ties to opioid drugmakers.

And MedPage has ties to (and is likely funded by) the Government.  And the Government is addicted to the drug war.  Now, which is worse?  The greedy corporations or the anti-science government?

But Steffens and colleagues noted in their workshop report that while 100 million patients may have chronic pain, it’s a much smaller number that has moderate-to-severe chronic pain that limits activity and diminishes quality of life: about 25 million.

I dunno, 25 million people suffering from constant pain sound like an awful lot of people to me…

Are government connections and funding not considered conflicts of interest?  Sure, to the government.

County, hospital sued over teen’s overdose death


Staff at Christus St. Vincent Regional Medical Center and the Santa Fe County youth detention facility failed to properly care for a 17-year-old who died of a heroin overdose while in county custody, claims a lawsuit filed on behalf of her estate.  The state District Court complaint includes details about the death of Desiree Gonzales not included in previous accounts of what happened the night she died and accuses county employees of attempted cover-ups.

“Her cries for help in the form of altered mental state, chest pain, anxiety, gasping for air, gurgling noises during breathing and completely stopping breathing were all ignored,” wrote attorneys Lee Hunt and Santiago Juarez…

The teen died in the early morning hours May 8 at the hospital, where she was taken after a guard found her unresponsive at the Santa Fe County youth detention center on Airport Road, the sheriff’s office has said. Hours earlier, Gonzales had been discharged from the hospital following a naloxone treatment for a heroin overdose, the sheriff’s spokesman reported. The drug, often known by the name Narcan, is used to reverse the effects of an opioid overdose…

The lawsuit states that emergency responders gave the girl a Narcan dose at 7:45 p.m. before taking her to the hospital, where she was admitted at 8:40 p.m. The suit says the doctor discharged her at 9:52 p.m., which, the lawyers argue, endangered the teen…

The lawyers also stated that the youth detention center didn’t have the resources to treat Gonzales, including any supply of Narcan…

Why do so may overdoses happen so soon after treatment with naloxone?  Is this antidote helping or hurting people who suffer from addiction?

1/9/2012, HZNP – Horizon Pharma’s unsustainable business model


Duexis is a combination of ibuprofen 800 mg and famotidine 26.6 mg, indicated for rheumatoid arthritis (RA) and osteoarthritis (OA). It is essentially a formulation of Aleve/Motrin and Pepcid. Unsurprisingly, when Horizon ran the trials for DUEXIS, they only compared DUEXIS vs Ibuprofen alone, instead of Ibuprofen plus Pepcid or any other preventative ulcer medicine. There really is no benefit to using DUEXIS over generic Ibuprofen and Pepcid. Additionally, 800mg of ibuprofen doesn’t allow for much flexibility in dosing patients…

Generic prescription famotidine 40 mg twice daily costs about $10/month and generic ibuprofen 800 mg costs about $8-10/month at a three times daily dosage. DUEXIS at three times daily costs about $150/month. This is for a convenience of 3 vs. 5 pills daily. Horizon reps provide coupons to reduce maximum copay to $25, but this still hurts their business when all is said and done…


Before Horizon, Walbert helped launch two of the world’s biggest-selling pain relievers—Celebrex from Pfizer and Humira from Abbott Laboratories and its pharmaceutical-maker spinoff, AbbVie… Horizon’s breakthrough in 2014 wasn’t in the lab or a pharmacy; it was in finance. The company shifted its corporate address to Dublin through a $660 million acquisition of Vidara Therapeutics International, enabling it to reduce income taxes.