Pain Management

Why this anesthesiologist says “no” to fentanyl

Meds
October 26, 2017

No, I’m not talking about putting fentanyl into my own veins — a remarkably bad idea. I’m questioning the habitual, reflex use of fentanyl, a synthetic opioid, in clinical anesthesiology practice.

I’ve been teaching clinical anesthesiology, supervising residents and medical students, in the operating rooms of academic hospitals for the past 18 years. Anesthesiology residents often ask if I “like” fentanyl, wanting to know if we’ll plan to use it in …

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This is who’s to blame for the opioid crisis

Physician
October 11, 2017

“Do not get caught” seems to be the real rule of the law in South Florida, where I live.

I was trained to limit the use of controlled substances, narcotics, hypnotics and sedatives. Their use can affect consciousness, ability to drive a car and work.  More severe consequences include respiratory depression and overdose from too high of a dosage or mixing too many medications and over the counter items.

The Joint Commission, …

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9 reasons the “golden age of medicine” was golden

Physician
August 29, 2017

To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don’t care about quality or cost. We are killing off 250,000 patients every year with our ignored “errors.” We purposely keep our patients in pain, or we addict them to …

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This doctor sings to her patients. And the results are beautiful.

Physician
August 22, 2017

I am an interventional pain physician. I spend most of my days doing spine injections with a fair amount of kyphoplasties and spinal cord stimulators thrown in as well. It seems to me that these are minor procedures that shouldn’t evoke anxiety in patients, but they do. Patients get nervous. They get anxious.

I am also a singer. I had the privilege of being classically trained through my college years. Like …

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What does it mean to be well? Ask an opiate addict.

Physician
March 16, 2017

Wellness. It’s all the rage these days as we try to manage our crazy work schedules while still maintaining balance in life. We have wellness committees, wellness workshops, wellness coaches, and wellness apps for our smartphones.

So, then, what does it mean to be well?

To the average person, and to the dictionary, to be well is to be “in good health” or “in a good or satisfactory way.”

However, to those suffering …

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Are doctors the new drug dealers?

Meds
November 18, 2016

I have written about pain medicine, previously on this blog, and it generated some spirited responses. Let me be clear that I am completely against all forms of pain, whether foreign or domestic, physical, spiritual, psychic or even phantom. The medical profession has superb tools to combat and relieve pain, and physicians should utilize them, within the boundaries of appropriate use. We now have an actual specialty — …

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Pain patients are being cut off from their drugs. Here’s why.

Meds
September 18, 2016

In March, 2016, the CDC released guidelines for prescribing opioids.  The guidelines were a response to a serious and growing problem: millions of pain patients became addicted to prescribed opioids, and hundreds of thousands died as a result.

Since the guidelines were released, reports of pain patients being abruptly cut off of their medication or having their medication abruptly reduced have become rampant. These patients report they were using opioids long …

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Pain tolerance: A story of two patients

Physician
September 21, 2015

One thing I learned early on as a doctor is different people have different tolerances for pain.  At one end of the spectrum, for example, I recall a woman who came to the emergency department with a small splinter in her foot.  She arrived wailing in pain, and we had to take her back to a treatment room ahead of other patients because her howling was scaring the people in …

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Ask for Dilaudid, get Dilaudid. No questions asked.

Meds
February 28, 2015

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gomerblog

A local hospital is trying a new, controversial but more efficient approach to medical care. “We have changed our guidelines, if you want Dilaudid you get Dilaudid, if you want Valium, you get Valium. No questions asked,” CEO Michael Shoemaker told reporters Wednesday.

In what experts are calling pure genius, emergency …

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Lying to receive pain medications hurts patients in true pain

Conditions
August 28, 2014

My patients lie to me every day. Some tell me that they have been taking their medications regularly when they haven’t. Some say that they have been eating a healthy diet and exercising for at least 30 minutes every day and don’t know where the extra pounds are coming from. Some lie that they are using condoms every time they have sex, that they have quit smoking, and if they …

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Understanding the uproar over Zohydro ER

Meds
March 30, 2014

In March 2014, Zohydro ER (hydrocodone extended-release) was introduced to the market. Never in my medical lifetime do I recall a medication stirring such angst. Worries of mass overdoses, backdoor FDA conspiracies, and blatant disregard for the public well-being abound. Is there method to this madness?

Zohydro ER is a pain pill that, when taken by mouth, is released slowly over twelve hours. The active ingredient, hydrocodone, is an opioid (i.e. narcotic) that’s been around for decades …

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