The role of illness perceptions and medicine beliefs in adherence to chronic pain medication
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Presentation given by Dr Leanne Ramsay & Dr Martin Dunbar to the West of Scotland Pain Group on 7th October 2008 at the Royal College of Physicians and Surgeons of Glasgow.
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Do ♛ The Conversation Project a collaboration with the Institute for Healthcare Improvement. http://theconversationproject.org/starter-kit/intro/
Do your conversation kit now and make your loved ones aware of your wishes.
Wishing you the very best, Michelle
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1) This randomized clinical trial compared opioid vs nonopioid medication therapy over 12 months for patients with chronic back, hip, or knee pain.
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This study examined whether a psychological opioid-risk evaluation influenced physicians' opioid prescribing decisions for 151 chronic pain patients being considered for chronic opioid therapy. Patients underwent an evaluation that assigned them an opioid-risk level of low, moderate, or high. The evaluation report was made available to physicians before their follow-up appointment where prescribing decisions were made. Results found that risk level significantly predicted opioid prescribing, with lower risk patients more likely to be prescribed opioids. A history of substance abuse also predicted less likely opioid prescribing. Demographic factors did not significantly influence prescribing contrary to some previous research. This suggests providing additional information about patients' abuse risk aids prescribing decisions and may reduce bias.
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Bernacki & Block (2014) found that there is a large body of evidence demonstrating that early discussions of serious illness care goals are associated with:
♛ beneficial outcomes for patients,
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Apply & Do
To prevent dying badly start early conversations, enhance your knowledge and establish goals. Dreams are only dreams until you write them down. When you write dreams down then they become goals.
Do ♛ The Conversation Project a collaboration with the Institute for Healthcare Improvement. http://theconversationproject.org/starter-kit/intro/
Do your conversation kit now and make your loved ones aware of your wishes.
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2) It discusses the physical, psychological, social, and spiritual components of palliative care, highlighting how an interdisciplinary team assesses and manages symptoms using evidence-based guidelines while contextualizing treatment plans to patient's disease status and goals.
3) It emphasizes the importance of addressing psychological, social, and spiritual well-being through open communication, social support, spiritual assessments, and consideration of patients' and families' beliefs, relationships
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Similar to The role of illness perceptions and medicine beliefs in adherence to chronic pain medication
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Drug seeking behavior in patients with little or no real pain, has led to the opioid crisis. Until now, there was no reliable method for detecting drug seeking behavior. The Pain Validity Test from www.MarylandClinicalDiagnostics.com can predict with 95% accuracy who will have medical test abnormalities, i.e. who has a valid complaint of pain, and predicts with 85%-100% accuracy who will not have any medical test abnormalities, i.e. who is faking and drug seeking. The Pain Validity Test has been admitted as evidence in over 30 legal cases in 8 states.
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The Pain Validity Test predicts which patient will have medical test abnormalities with 95% accuracy, thereby validating their complaint of pain. The Pain Validity Test also predicts with 85%-100% accuracy who will not have medical test abnormalities, thereby detecting drug seeking behavior, faking and malingering.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims Data
This study examined the relationship between medication adherence and future healthcare costs using pharmacy claims data. It found that increased medication adherence, as measured by compliance and persistence, was associated with lower total future healthcare costs. The study also found that using a boosted regression model that incorporated medication adherence measures provided similar or better predictive accuracy for future healthcare costs compared to other econometric models. However, overfitting was an issue with the boosted regression model that would need to be addressed through parameter respecification.
Opioids for LBP Meta-Analysis JAMA
This systematic review and meta-analysis evaluated the efficacy and tolerability of opioid analgesics for low back pain. The analysis included 20 randomized clinical trials involving nearly 8,000 participants. The review found that within recommended doses, opioids provided only modest short-term pain relief for chronic low back pain, with the effect unlikely to be clinically meaningful. Approximately half of trial participants withdrew from studies due to adverse effects or lack of efficacy. The review concluded that opioids provide limited benefit for chronic low back pain within guideline doses and that evidence for long-term efficacy is lacking.
FIRST DRAFT1FIRST DRAFT9First DraftErica K.docx
FIRST DRAFT 1
FIRST DRAFT 9
First Draft
Erica K. Fernandez
Argosy University
Pain Management for Patients with Addiction Problems
Thesis Statement
The ability of clinicians to keep patients in check has proven to be a challenge, especially with concerns regarding the legitimacy and physical functions affecting overall pain management in patients with an addiction problem.
Background
The treatment modalities for chronic pain using COT in active drug users or those who are in remission present a significant challenge for clinicians who oversee the effectiveness of the intervention. Moreover, such notions are correlated to the concerns of patients experiencing a relapse to substance abuse during the duration of therapy since analgesics may obscure drug-seeking behaviours that are characteristic of addictive diseases. This results in poor treatment outcomes where patients are likely to be discharged prematurely from pain care treatment (Ballantyne & Mao, 2003). Additionally, there is the widespread misconception that chronic pain patients with an addiction problem often encounter health professionals who possess inadequate training in clinical guidelines that are related to comorbidities of chronic pain and related addiction issues. Moreover, there exists a dilemma for the treatment of abstinent and former heroin addicts as they are at a high risk of relapsing to addiction if they are exposed to opioid drugs. They also face the risk of relapsing if they are not accorded sufficient care. For people who are already on opioid medication such as methadone often experience challenges responding to pain relievers when they are hospitalized. In such as case, the fundamental principle of management denotes the prevention of withdrawals by initiating methadone for heroin users while providing additional analgesia as recommended while confirming whether the pain relief is satisfactory (Chou et al., 2009). Additionally, most physicians have developed a phobia of over prescribing narcotics as pain relievers. Perhaps this may be attributed to the fear of the legal repercussions that may ensue including the divergences in federal guidelines on matters about the use of narcotics as a pain reliever. Thus, it is the responsibility of the individual practitioner to offer pain management using opioids for legitimate standard and by the regulation of medical practice.
Objective
The purpose of this research is to evaluate the challenges that are faced by clinicians in pain treatment for patients with addiction problems. On the other hand, the study focuses on offering a counter-argument to the thesis by providing ideal solutions for pain management for patients with SUDs. Additionally, the research intends to highlight the complex interconnection that exists between pain management and addiction to opioids.
Supporting Points
For clinicians, the hardest challenge is perhaps knowing the right way to handle patients who require pain medication, ...
2016 EULAR FMS Guidelines
The document provides revised recommendations for the management of fibromyalgia based on a review of evidence from systematic reviews and meta-analyses published since the original 2005 guidelines. Key findings include:
- Exercise was the only intervention with a "strong for" recommendation based on meta-analyses showing benefits for pain, fatigue, sleep and functioning.
- A graduated four-stage approach is proposed, beginning with patient education and non-pharmacological therapies. Pharmacological therapies (amitriptyline, pregabalin, cyclobenzaprine, duloxetine, milnacipran) received "weak for" recommendations for severe pain or sleep issues.
- Growth hormone, sodium oxybate, NSAIDs, S
2016 EULAR FMS Guidelines
The document provides revised recommendations for the management of fibromyalgia based on a review of evidence from systematic reviews and meta-analyses published since the original 2005 guidelines. Key findings include:
- Exercise is the only therapy strongly recommended based on meta-analyses showing benefit for pain, sleep, and functioning.
- A graduated four-stage approach is proposed, beginning with patient education and non-pharmacological therapies.
- If non-response, further therapies such as psychological therapies, pharmacotherapy, or rehabilitation may be tailored to the individual. However, meta-analyses only found weak evidence for all potential pharmacological therapies.
- Most treatments show relatively modest effects. Future research priorities are identifying who benefits from specific interventions,
Predicting Medical Test Results and Intra-Operative Findings in Chronic Pain ...
The Pain Validity Test can predict which patient will have abnormal medical test results with 95% accuracy, and surgical abnormalities with 94% accuracy. This on-line questionnaire takes only 5 minutes of staff time to administer, and takes only 15 minutes of patient time.Results are available immediately. This test can be used to document "medical necessity" for insurance pre-authorization for testing and surgery.
MDR
This document discusses adopting a "universal precautions" approach to assessing and managing chronic pain patients to improve care and reduce risks. It notes that while some chronic pain patients have substance use disorders, there is no reliable way to identify those individuals in advance. It recommends thoroughly assessing all patients for present and past substance use, including illicit drugs and alcohol, to better understand risks. A universal precautions approach allows for formulating individualized treatment plans based on mutual trust and honesty while improving care, reducing stigma, and containing overall risks.
Suicidality Poster References.docx
This document contains summaries of several research papers on topics related to chronic pain, suicide risk, and bipolar disorder:
1) One study found that tapering opioid doses for chronic pain patients was associated with increased risks of overdose and mental health crisis compared to patients who did not taper. Higher tapering speeds were linked to even greater risks.
2) Another study observed chronic pain patients undergoing opioid tapering or transition to buprenorphine treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine use predicted dropout. Pain levels varied after treatment.
3) Research on combat veterans found that those exposed to combat had higher rates of PTSD, suicide attempts, strokes and chronic pain
Physicians being deceived
Physicians have difficulty detecting when patients are lying or deceiving them. A literature review found that standardized patients, or actors trained to mimic real patients, were correctly identified as fake by physicians only about 10% of the time during office visits. Some real patients were even mistakenly identified as standardized patients. Deception is challenging for physicians given their tendency to assume patients are being truthful. The legal risks of prescribing opioids when deceived mean doctors must take precautions to minimize risks of abuse or diversion, but allowance must be made for the fact that honest physicians can still be misled by deceptive patients.
Measurement of outcomes in pharacoepidemiology
The document discusses various methods for measuring outcomes in pharmacoepidemiology studies. It describes:
1) Common outcome measures including functional status, symptom status, patient satisfaction, economic measures, and quality of life studies.
2) How therapeutic outcomes can be classified as cure, improvement, no change, or deterioration and as success or failure.
3) How drug use is also measured using monetary units, number of prescriptions, units dispensed, defined daily doses, and medication adherence.
4) How risk is expressed using attributable risk, relative risk, time-risk relationships, and odds ratios to quantify the probability of outcomes in exposed versus unexposed groups.
Catastrophizing & Iatrogenesis
This study compared chronic pain patients whose symptoms were considered medically unexplained (cases) to those whose symptoms had clear medical explanations (controls). The key findings were:
1. Medically unexplained symptoms were associated with higher rates of psychiatric morbidity, including a 3.4 times higher odds of any psychiatric diagnosis.
2. Cases reported more potential iatrogenic factors like over-investigation and over-treatment from healthcare providers compared to controls.
3. There were no significant differences between cases and controls in rates of medication abuse or dependence.
Spousal solicitous responses & opioid dose.
1) The study examined the association between spousal or significant other solicitous responses and opioid dose in 466 patients with chronic pain. 2) It found that higher scores on a scale measuring solicitous responses, such as asking about pain symptoms, were associated with higher daily morphine equivalent doses. 3) This association remained even after adjusting for other factors like age, sex, depression and pain severity. The findings suggest solicitous responses may influence opioid dose among chronic pain patients.
Lecture 16: Patient Compliance-Dr.Naif
The document discusses factors that affect patient compliance with medical treatment. It examines compliance vs adherence and discusses factors like individual characteristics, disease factors, environmental factors, and the practitioner-patient relationship. Educational interventions have been found to have limited effectiveness on compliance, while behavioral strategies that focus on changing behaviors have been more effective. Reasons patients give for non-compliance include issues like side effects, cost, forgetting, and lack of belief in treatment effectiveness.
Similar to The role of illness perceptions and medicine beliefs in adherence to chronic pain medication (20)
An Internet questionnaire to identify Drug seeking behavior in a patient in t...
An Internet questionnaire to identify Drug seeking behavior in a patient in t...
Pain Validity Test to detect drug seeking behavior
Pain Validity Test to detect drug seeking behavior
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims Data
More Predictive Modeling of Total Healthcare Costs Using Pharmacy Claims Data
Predicting Medical Test Results and Intra-Operative Findings in Chronic Pain ...
Predicting Medical Test Results and Intra-Operative Findings in Chronic Pain ...
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Further reading:
DAHL, J., & LUNDGREN, T. (2006). Living beyond your pain using acceptance and commitment therapy to ease chronic pain. Oakland, CA, New Harbinger Publications.
http://www.worldcat.org/oclc/63472470
HAYES, S. C., STROSAHL, K., & WILSON, K. G. (1999). Acceptance and commitment therapy an experiential approach to behavior change. New York, Guilford Press.
http://www.worldcat.org/oclc/41712470
MCCRACKEN, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Progress in pain research and management, v. 33. Seattle, IASP Press.
http://www.worldcat.org/oclc/57564664
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Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
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Influence on behavior
Selection of food based on metabolic needs
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Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
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2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
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4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Dehradun #ℂall #gIRLS Oyo Hotel 8107221448 #ℂall #gIRL in Dehradun
Dehradun #ℂall #gIRLS Oyo Hotel 8107221448 #ℂall #gIRL in Dehradun
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