 but what is the best treatment(s) based on the needs of the individual seeking care. Its like the stock market- why invest in a good stock-when you can invest in a better stock? Shouldn’t we be trying to deliver the best for each person suffering from fibro and other painful conditions?
The vague but more important individual circumstance should not be relegated to stock treatments. When the NIH paid for an independent review of opioids- it found that treatments for pain lacked sophisticated algorithms and were not customized. Heroic simplification and violent abstraction in treating everyone with fibromyalgia as a class rather then an individual is regressive and not working. Its time to recognize people in pain aren’t the same as everyone else in pain- there is great biosocial heterogeneity. Its time that the health care industry and government recognize individuals as needing individualized treatment- and that means more then adjusting dosages.
I find it interesting that laboratory medicine doesn’t bother to test neurotransmitter levels- or levels of endogenous opioids before prescribing medications to alter the aforementioned. That to me is shotgun style. Even Dr Amen calls for looking at brain scans before prescribing psychotropics. Quick reductionistic medicine makes no sense from any point of view other then a penny wise pound foolish perspective.
My fibromyalgia is worse on my severe back pain days. Sometimes my arms hurt so bad it’s unrealistic. Since I was in a pain management clinic I could not get near any pot. Gabapentin made my pain worse and all the doctor offered was injections stating pain meds are a last resort. I have had back problems for 30 years and was over injected by doctors. My sciatic joint is practically decomposed from cortisone. If I turned down another injection the doctor thought I wasn’t trying to get better but just was addicted to opioids. I have no idea why he became a doctor but giving repeated cortisone injections into pain people is not the best option.
I have severe reactions to cortisone but I’m guessing that is no concern of his.
Before a doctor says pain meds don’t help fibromyalgia they better have several studies to back up those statements. What works for one patient doesn’t work for every patient and the ability to adapt your care for each is what a true caregiver should do.
I read the article and I want to scream. The “dark days” of opiate prescribing?!?
What about folks who don’t WANT to use medical marijuana? Are we going to be left with a choice?
Are doctors going to say, “Oh, go smoke some pot”? What if we persist that that’s not what we want? Will we be turned away… yet again?
I have plenty of reasons to feel the way I do. Legitimate reasons. I’ve already got fatigue. If you’re going to be home all day, then fine… but I cannot imagine being a productive employee in an office when I’m using marijuana. Daytime/work is when I MOST need my medication. Also, even if legalized, my employer is unlikely to feel favorably about me using pot for pain relief. And I’m morbidly obese so I really, really don’t need the munchies. Oh, and I have asthma, so I’d have to ingest it some other way than smoking.
So, don’t be so quick… for the sake of your patients… to write off pills. I am fortunate that tramadol helps me. I also have cervical spondylosis and widespread osteoarthritis.
I’m not against medical marijuana. If it helps and if you can maintain a better quality of life with it, then I would be happy for you. Just remember it’s not going to be for everyone!
There are many tools for pain and fibromyalgia- unfortunately people in the health care industry know and utilize few of the tools. In addition, the reductionistic tendency to oversimplify and to see everyone with fibromyalgia- as needing the same treatment- isn’t helping to improve care. It is unfortunate that doctors are wtoo willing to be bound by guidelines that focus more on oversimplifying and McDonaldizing care rather then helping people in pain.
Thanks for your contribution, Dr. Liptan. In a more equitable and grounded world, you might have been a very effective member of the CDC working groups on revised guidelines for use of opiates in chronic pain. As both a patient and physician, you are far better prepared to address a balance between valid needs of pain patients and the efforts of drug addicts or profiteers to game the medical system by diverting prescription drugs. Certainly you seem to know far more about the subject than psychiatrists or practitioners of psychosomatic medicine whose entire practice is based on little more than supposition or mythology.
Best wishes for your continued professional success.
I have had Fibromyalgia for over 19yrs now and have been on Cymbalta, Lyrica, Salvella and am now on Tridural (Tramadol Hydrochloride Extended Release tablets) 300mg (max dose) and find that it does help take the edge off. From my experience Oxycodone does nothing to help with the pain. I used to take Oxycodone for migraines, but can not now that I am on Tridural, it did nothing to relieve any of my fibro pain. I am an Ambassador for the Fibromyalgia program being run out of the South Lake Medical Centre in Newmarket, Ontario Canada and the many Fibromyalgia patients I have spoken to do not gain relief from Oxy or Vicodin. The best relief I have found is from Cannabis. Cannabis seems to put a barrier up, feels like an invisible shield between you and the pain. If someone asks me if the pain is still there and I think about it, the pain is still there but Cannabis disconnects you from it for a while to gain some relief and peace from the hell that is PAIN.
It amazes me how many view specific conditions as occurring alone when, in fact, most occur alongside or as a result of other conditions. For example, severe spinal pain from damaged facets following fusion surgery or discogenic pain and nerve root irritation leading to somatic referred pain or even sciatica, or the neuropathic pain originating in the neck that initiates cervicogenic headaches can also exacerbate fibromyalgia as it can myofascial pain and vice versa. Vicious cycles and downward spirals can occur.
pain that can become something hard to treat, like FMS.
Since most patients who see pain specialists have co-morbidities, it is reasonable to use opioids if and when they prove clinically helpful for the control of pain and improvement in function.
monitor hormonal balance amongst other things too but if these parameters are cared for then various side affects are less likely to occur or to prove problematic. It is the complexity and relationships between different conditions that justify whatever works to be used, especially within a multi-modality and interdisciplinary setting (including the integration of alternative treatments and psychology).Earlier this week, Philadelphia 76ers' center Joel Embiid traveled to Qatar to kick off the next phase of his rehabilitation process.
Joel Embiid is entering the next phase in his rehab process.
On Wednesday, Philadelphia 76ers' beat writer Tom Moore broke the news that Joel Embiid would continue rehabbing his broken right foot at Aspetar, an orthopaedic and sports medicine hospital located in Doha, Qatar.
At his annual post-trade deadline news conference on Friday, Sixers' general manager Sam Hinkie explained that Embiid's trip had been in the planning stages for six months, and that the 7-2 center would undergo a "fairly intense" program for a few days before returning to the States.
Translation: No Shirley Temples.
There's the obvious question, of course: With all of the world-class facilities available in the United States, why does Embiid need to travel nearly 7,000 miles as he works to recover from a surgically-repaired navicular bone?
For starters, Aspetar isn't your typical medical center. On Friday, Hinkie stated that the Qatar hospital is "world-renowned and known for having some of the best sports medicine docs, rehab specialists, orthopedic surgeons, sports psychologists, and dieticians; the whole gamut, sort of soup-to-nuts."
Aspetar is the official sports medicine partner for French soccer club Paris Saint-Germain, and the center's Web site is filled with testimonials from high-profile athletes such as Yaya Toure, Lennox Lewis, Novak Djokovic and Allyson Felix.
More importantly, the Sixers were able to work with Aspetar's staff to develop a custom-designed plan that "kicks off" the next phase of Embiid's rehab. And, for what it's worth, one of the experts the Sixers reached out to prior to Embiid's second surgery hails from Qatar, so it's likely that the physician in question had a hand in crafting Embiid's rehab program.
"He's done a great job," said Hinkie when asked about Embiid's commitment to his recovery protocol thus far. "He's been super professional. He's brought a whole new level of maturity to the game and to his rehab and his day-to-day approach."
Hinkie: "We're excited about (Embiid). He has a rare gift and has a real chance to have a fantastic NBA career."
Despite the positive progress reports, the Sixers still intend to keep Embiid under wraps until training camp.
"We haven't talked about it in great detail, but if I had to guess, I doubt