The Pain Medication Conundrum

Danielle Ofri, an associate professor at N.Y.U. and a physician at Bellevue Hospital, is the author of “What Doctors Feel: How Emotions Affect the Practice of Medicine.”

MY patient Mr. W. wheeled himself into my office for a checkup. He’d lost a leg to diabetes and was also juggling hypertension, obesity, vascular disease and elevated cholesterol. He was an amiably cranky fellow in his mid-60s who’d used heroin in the past though had been clean for decades.

As we finished up and I handed him his stack of prescriptions, he said, “Oh, by the way, Dr. Ofri, I was wondering if you could prescribe me the oxycodone I use for my back.”

Oxycodone? In the six months I’d known him, I hadn’t been aware that he was taking narcotic pain medication.

“I’ve been getting it for years from my pain doctor in the Bronx, but that clinic closed,” he explained. “So now I’ve got to get it from my primary care doctor.” …

What are doctors to do? Pain is a subjective symptom. There is no instrument to indicate its severity. All that a doctor has is the patient’s word.

For patients with chronic pain, especially those with syndromes that don’t fit into neat clinical boxes, being judged by doctors to see if they “merit” medication is humiliating and dispiriting. It’s equally dispiriting for doctors. This type of judgment, with its moral overtones and suspicions, is at odds with the doctor-patient relationship we work to develop.

As Mr. W. and I sat there sizing each other up, I could feel our reserves of trust beginning to ebb. I was debating whether his pain was real or if he was trying to snooker me. He was most likely wondering whether I would believe him or if I would be biased because he was an African-American man with a history of drug use. Studies show that minorities are consistently undertreated for pain…

A solid doctor-patient alliance is a critical factor for good health. But when patients feel judged by their doctors, and doctors are exhorted to not undertreat pain and simultaneously pilloried for overprescribing pain meds, this relationship can be sabotaged. That isn’t good for anyone’s health.

PTSD and RA: Is There a Smoking Gun?

“I noticed years ago in working with veterans that people who have severe chronic PTSD also had inflammatory diseases,” said Joseph A. Boscarino, PhD, of the Geisinger Clinic in Danville, Penn. “They tended to have diseases like rheumatoid arthritis and psoriasis and it was thought to relate to an increase in the immune response,” he told MedPage Today.

Among a cohort of 2,500 Vietnam veterans, chronic PTSD was associated with rheumatoid arthritis, psoriasis, diabetes, and thyroid disease…

While these studies suggested an association between PTSD and rheumatoid arthritis, they were limited in that the study populations consisted primarily of male military veterans… Therefore, to further explore these concerns, Lee and colleagues analyzed data from the Nurses’ Health Study II, which began enrolling participants in 1989 and includes more than 116,000 women who regularly respond to questionnaires about health and lifestyle, including smoking…

In addition, in the subgroup analysis of women with four or more symptoms who began to smoke after PTSD onset, the risk remained similar… meaning that smoking also was not a mediator and the risk for rheumatoid arthritis was therefore independent of smoking, and that other factors must be involved.

Further complicating the relationship with smoking is a recently identified genetic association, according to Boscarino. “Something interesting we discovered recently is that the CHRNA5 gene that predicts smoking also affects anxiety, fear, and stress,” he said…

Limitations of Lee’s study included the possibility of selection bias and the fact that causality cannot be assumed in the analysis. Lee disclosed financial relationships with Forest, Merck, Cubist, Perrigo, and Express Scripts.

Mental Health Awareness Patch

Earlier today I came across an interesting article from the International Bipolar Foundation (IBPF) which you can find by clicking here. The new scheme put into place by IBPF allows young girls across America to earn a Mental Health Awareness Patch as apart of their Girl Guides, Girl Scouts and Heritage Girls training…

So wouldn’t it be great if we could now incorporate mental health into the training these young girls receieve? The IBPF lists the following aims for the new Mental Health Awareness Patch distributed across America:

-Learn how the brain impacts mental health

-Explore how discrimination against those with a mental health condition makes it difficult to seek help

-Learn about many great achievers who experienced mental illness

-Research how mental health is portrayed in the media

-Create anti-stigma campaign activities

This training wouldn’t just enable these young girls to grow up into understanding and well-rounded women, but would also encourage them in later life to get the help they may need, with less fear and stigma attached to the idea of mental illness…

This is a fabulous idea. I remember earning patches in Brownies and Girl Scouts, along with earning them in school for physical fitness:

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Isn’t it pretty? I don’t know why I still have this patch, except the blue color is so stunning. 🙂

Depression is a burden

“A [depression] diagnosis is burden enough without being burdened by secrecy and shame.” –Jane Pauley, at a luncheon for The Foundation for Mental Health

“I have never been remotely ashamed of having been depressed. Never. What’s to be ashamed of? I went through a really rough time and I am quite proud that I got out of that.” –J.K. Rowling, in an interview with a student journalist

“I did do therapy and antidepressants for a brief period, which helped me. Which is what therapy does: it gives you another perspective when you are so lost in your own spiral, your own bullshit. It helps. And honestly? Antidepressants help!” –Jon Hamm, to The Observer

“There is no need to suffer silently and there is no shame in seeking help [for mental illness],” –Catherine Zeta-Jones, to People

Robin Williams, One of a Kind

TrueAmurrican, 1 year ago
This sucks.
Robin Williams was an awesome guy.
17 years ago, my Dad’s dad killed my grandma and then himself in a drunken rage. We held a massive service at the church my dad’s mom attended in San Francisco. It was obviously a hard night for my dad. My parents stayed late in the city to clean things up and spend time with family. It was about 2:30 AM when we finally started making our way home, but before leaving the city, my dad wanted to stop and get a doughnut at some random doughnut shop we passed by. We all went inside, and lo and behold, Mr. Robin Williams was there, sitting in a booth eating a couple doughnuts and drinking some coffee. He noticed our well dressed, solemn looking crew walk in, and pretty quickly after we sat down to eat the delicious treats, he came walking over. Now, I admit fully that I do not remember what he said to us, but I do remember what he looked like and I remember him Introducing himself as Robin (Which is my aunts name, I think thats why it caught my attention). He ended up joining my family at our table and (as my Dad always said) he just started making pleasant conversation, which quickly turned in to him making my parents smile, and soon after he had us all laughing. I couldn’t tell you what they laughed about, but I remember seeing my parents laugh and smile for the first time in weeks. My dad remembered that so fondly. He always said it was exactly what he had needed in that time, and that he appreciated the way Robin Williams went about it. It wasn’t that he was a celebrity, he was just being a nice guy who saw a bunch of sad folks and realized he could probably make a difference. And he did. I loved hearing my dad tell that story because you could tell that moment meant a lot to him. I’m sad he felt the need to go.
Edit: Thank you all for reading this story and appreciating it with me. I always wanted to get the chance to thank Robin Williams for this moment, and I’m sad to not get that chance, but I’m happy so many others know it happened now as well. Thank you for the gold as well, everyone.

Bigirishjuggalo1, 1 year ago
My brother attended Job Corp on Treasure Island in San Francisco. Was there for culinary arts and one of the awesome things they got to do was cater movie sets. He got to cater Flubber’s set and had the pleasure of meeting Robin Williams as he came to get some lunch. He only spent a few minutes talking to him but all these years later it is one of my brothers favorite memories as Mr Williams treated him like a fellow human being and not just part of the caterers. He was a genuinely good, kind and generous man.

(Photo taken 8/2/2015 at dawn.)