Stepped-care strategy improves function, decreases pain severity in veterans

A new study by researchers from the Richard L. Roudebush VA Medical Center in Indianapolis, the Regenstrief Institute and the Indiana University School of Medicine reports that a stepped-care strategy improved function and decreased pain severity, producing at least a 30 percent improvement in pain-related disability…

Thirty percent is nothing to sneeze at, about double the rate of a placebo effect.  Still…

The ESCAPE program was provided over the telephone by nurse care managers. They worked with the veterans to help counter maladaptive thought and to help them better understand that while they might not be able to continue rigorous activities that they had enjoyed before deployment, a substitute activity like swimming might be achievable and decrease their pain…

All veterans in the study had suffered from moderate to severe chronic pain for more than three months. Veterans with current substance or alcohol dependence were excluded from the study, as were those with active suicidal ideation, active psychosis or schizophrenia. Two-thirds of the trial participants had served in the army, 88 percent were male, and 77 percent were white. The mean age was slightly under 37 years.

Well, that’s a rather narrow patient group.  If that group had included more women, would the success rate for this program be a little bit higher?  I just think that women and men respond differently to certain treatment plans, and the ones that don’t necessarily work for men might work better for women.  Plus, the rate of PTSD is a lot higher in the veteran population, whether it’s part of the written diagnosis or not.  What I’d like to see is the overdose and suicide rate for this program, although the patient exclusions would skew that result.

I dunno… this doesn’t seem to be a very impressive program.

Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions


Harvard Review of Psychiatry:
March/April 2015 – Volume 23 – Issue 2 – p 63–75

Abstract: Medication-assisted treatment of opioid use disorder with physiological dependence at least doubles rates of opioid-abstinence outcomes in randomized, controlled trials comparing psychosocial treatment of opioid use disorder with medication versus with placebo or no medication. This article reviews the current evidence for medication-assisted treatment of opioid use disorder and also presents clinical practice imperatives for preventing opioid overdose and the transmission of infectious disease. The evidence strongly supports the use of agonist therapies to reduce opioid use and to retain patients in treatment, with methadone maintenance remaining the gold standard of care. Combined buprenorphine/naloxone, however, also demonstrates significant efficacy and favorable safety and tolerability in multiple populations, including youth and prescription opioid–dependent individuals, as does buprenorphine monotherapy in pregnant women.

The evidence for antagonist therapies is weak. Oral naltrexone demonstrates poor adherence and increased mortality rates, although the early evidence looks more favorable for extended-release naltrexone, which has the advantages that it is not subject to misuse or diversion and that it does not present a risk of overdose on its own. Two perspectives—individualized treatment and population management—are presented for selecting among the three available Food and Drug Administration–approved maintenance therapies for opioid use disorder. The currently unmet challenges in treating opioid use disorder are discussed, as are the directions for future research.

What are EMS providers learning in Pennsylvania?

Click to access 2015brochure.pdf

Pennsylvania’s Largest EMS Conference (March 26-28, 2015)

11:00am—noon Patients Populations

Chronic Pain and “Drug Seekers”



Frustrating Patients

Overdoses and Interactions
Heather Goetze, PharmD—Forbes Hospital
CEU: 1.5 Clinical patient care/core
When hearing the word “overdose,” the first thought is usually illegal substances or perhaps prescriptions opioids. However, overdoses of non-opioid prescription and overthe-counter
medications are on the rise. Interactions with multiple medications and herbal supplements can contribute to the severity of the overdose, whether intentional or unintentional. This presentation will help the attendee to identify and address patients suffering from drug overdoses and drug/substance interactions.

Risky Teen Behavior: Part Two
Josh Stuart, EMT-P—Medical Rescue Team South Authority
CEU: 1.5 Clinical patient care/core
Explanation of new risky behavior, such as vampirism, planking, car surfing, and condom snorting. Did you know kids are ingesting distilled hand sanitizer or vodka soaked gummy bears?These and other new scary trends are explored. Signs and symptoms of behavior, treatment of related injuries, and prevention are reviewed.

Condom snorting?  Holy cow, what is that?

Reported by the Huffington Post in 2013:  The “condom challenge” is the newest, most disturbing YouTube trend in which young kids snort condoms and then pull them out of their mouths. Yes, it’s as gross as it sounds.

Oh no, another product the DEA will want to add to the drug scheduling list.

Wikipedia:  The term planking refers to mimicking a wooden plank. Planking can include lying flat on a flat surface, or holding the body flat while it is supported in only some regions, with other parts of the body suspended. Many participants in planking have photographed the activity in unusual locations and have shared such pictures through social media…

Planking looks relatively harmless and is even described as exercise.  And vampirism?  In teens?  I just don’t know what to say about that.