The opioid pain drug misuse problem solved?

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Today using opioids to treat chronic pain seems quite obvious for a lot of clinicians. This trivialization, beyond the responsibility of both the clinician and the patient, is responsible for the dramatic increase of opioid misuses and overdoses.

An excellent article written by Dr. Daniel Alford in the last issue of NEJM proposed smart solutions. Prescriber education is one of them. It would allow a more specific approach to addressing the opioid-misuse epidemic: benefit-risk assessment of patient’s needs and care individualization. It should be completed with patient close follow-up and monitoring as well as the careful evaluation at each encounter of whether to start, continue, decrease, increase or stop the treatment.

Training should start early in the medical education and students have to be aware of the best practices for that type of prescription. All the options for chronic pain management have to be taught and not only to doctors but to all healthcare providers in order to tackle the lack of awareness and education in the field.

Beyond drugs, other alternatives should be tested and proposed, especially when an opioid-based treatment is stopped. Explanations have to be provided in order to reassure the patient that his/her pain is manageable without this type of drugs.

The whole discussion, and a whole lot of other healthcare themes, are closely linked to the doctor-patient relationship. Trust, collaboration and open discussion are all key in order to have the best outcomes for the patient.

As a conclusion, I would like to invite you to watch the fantastic talk given by Elliot Krane, an expert in chronic pain about how this disease invades the body, what are the treatment options and what’s next.

 

Additional information:

Overdose Death Rates – US National Institute on Drug Abuse

Understanding the Epidemic – US Centers for Disease Control and Prevention

How drug use changes the brain — and makes relapse all too common – STAT – April 2017

The Painkillers That Could End the Opioid Crisis – MIT Technology Review – August 2016

Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education – NEJM – February 2016

Mortality Trends Among Working-Age Whites: The Untold Story – The Commonwealth Fund – January 2016

Trends in Opioid Analgesic Abuse and Mortality in the United States – NEJM – January 2015

When Pain Kills – AARP – September 2015

Opioid Addiction Facts and Figures – ASAM

Assessment & Management of Chronic Pain – Healthcare Guideline – ICSI – November 2013

 

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Gender-specific medicine is necessary

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What’s gender-specific medicine?

As stated in a well-known article, “Gender-specific medicine is the study of how diseases differ between men and women in terms of prevention, clinical signs, therapeutic approach, prognosis, psychological and social impact. It is a neglected dimension of medicine.” Medical research conducted over the past 40 years has focused almost exclusively on male patients.

How men and women are different?

Differences could lead to wrong diagnosis, symptoms underestimation, and even premature death. Differences appear in a variety of domains such as:

  • PKPD (pharmacokinetics & pharmacodynamics): efficacy and side effects profiles as well as drug-drug interactions.
  • cardiovascular diseases: risk factors for these diseases; clinical manifestations; influence of drugs (see below for more).
  • cancer: incidence; aggressiveness and prognosis.
  • liver diseases: epidemiology and progression.

The main goal

The main goal of gender medicine is focused on understanding the differences of patho-physiology, clinical signs, prevention and treatment of diseases equally represented in men and women.

Advocacy

Advocacy in this field is emerging with amazing women like Marianne Legato, Alyson McGregor and Noel Bairey Merz, whose conference and TED Talks below really show the decisive importance of this discipline.

Conclusion

Traditionally, research has been done almost entirely on men and those conclusions were then applied to both men and women. Even though the law requires that women be included in studies, the gender-different results are almost never analyzed. Instead, they are blended. This is detrimental to both men and women. Perhaps now is the time for everything in research and medicine to be reviewed in the light of potentially significant gender differences.

Additional resources:

The Foundation for Gender-specific Medicine

Why Sex Matters

Women’s Heart Attacks Look Nothing Like Men’s – TIME – 2016

Gender-Specific Medicine in the Genomic Era – Clinical Science – 2015

Sexism In The Doctor’s Office Starts Here – Even actual lab rats are subjected to science’s male bias – HuffPost – 2015

Why Gender-Specific Medicine Matters in the Emergency Department – Emergency Physicians Monthly – 2015

Gender medicine: a task for the third millennium – Clinical Chemistry and Laboratory Medicine – 2013

Men and women get sick in different ways: Developing gender-specific medicine is a major challenge of the future – Science Daily – 2013

Incorporating and evaluating an integrated gender-specific medicine curriculum: a survey study in Dutch GP training – BMC Medical Education – 2009

 

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