Medication overuse headache (MOH) is very frequently diagnosed; however, the MOH diagnosis is often overused. Patients are labeled as having MOH when what they actually suffer from are refractory headaches, without medication overuse (MO). Current diagnostic criteria for MOH only require abortive medication use on 10 or 15 days of each month (depending upon the medication). No evidence is needed showing that the abortive actually causes an increase in headache.
Migraine is a very common and disabling illness. Picking an agent that is best for each individual patient requires considering the patient’s history, lifestyle, comorbid conditions, and individual preferences. A recurring headache that is of moderate or severe intensity, and is triggered by migraine-precipitating factors, usually is considered to be migraine. Precipitating factors can include stress, certain foods, weather changes, smoke, hunger, fatigue, hormones, and so on.
One of the biggest challenges with using a solitary approach such as pharmacotherapy, including opioid therapy, for the patients with pain, is that chronic pain is best treated through a multimodal approach. Pain affects the whole person. Patients and practitioners need to learn techniques to adapt to and manage the pain, not just take it away temporarily. There is a push to teach active self management strategies, such as sleep restoration, pacing, conquering worry and anxiety, and how to minimize depression in the face of pain.
We had a spectacular meeting in September at the Crowne Plaza Hotel in New Orleans. We collaborated with the Southern Headache Society and included breakout sessions for both chronic pain and headache providers. The opening session on Friday afternoon included talks and panel discussions around the relationship between payors and providers, patient disability issues and managing chronic pain in the cognitively impaired patient.
One of the ways I like to unwind is to watch HBO on my cellphone or tablet. Whether it’s Real Time, Last Week Tonight, Westworld, or Game of Thrones, I am captivated by HBO’s shows! One show, VICE – and its online companion, VICE News – has recently featured several stories that have to do with opioids and pain management. The stories do a great job of capturing the multi-faceted aspects of this issue. They also show how strict and unyielding policy solutions to current controversies in opioid-based pain management can make misery out of the lives of countless people.
The Opioid Epidemic has forced providers and insurers to re-evaluate the way chronic pain is treated both short and long term. As a result, there has been a renewed interest in non-medical based treatments that restore pain patients, particularly injured workers, to health and optimal function. Chronic pain is a common presentation in work injury. Functional restoration is a non-medication based option that can restore patients with pain to higher function and return to work. True functional restoration includes Cognitive Based Therapy (CBT) and intensive physical therapy.
News reports are replete with stories about the problems of opioid use disorder (OUD) and overdose deaths. The Healing Arts Network of New Hanover Regional Medical Center has a successful 20-year track record of managing pain with a multi-modal approach, including a variety of medications, {appropriate use of opioids, non-opioid analgesics, co-analgesic agents) and non-pharmacologic interventions. Many people may be interested in non-pharmacologic interventions but don’t know much about them, where to find practitioners or how to afford them.
“I would not recommend that you go into pain medicine… find something else rewarding to do.” The honesty of that statement just exploded from my mouth – like it has been welling up to be spoken (or shouted) for many months. I am at my clinic at Tulane University Medical Center, where for many years […]
We see the great arc of change that our field has been through … From one practice standard and swinging to another – pain management as a field and as a professional practice has experienced marked changes and intense scrutiny that few fields of medicine have undergone over the last thirty years.
During 2014, patients were admitted more frequently with diagnoses of soft tissue abscesses, epidural abscesses, and endocarditis. Two common denominators…were a history of self-administering opioids intravenously and now needing IV antibiotics for prolonged periods of time. This combination posed a challenge for health care providers.