Persistent Pain Linked With Greater Memory Decline & Dementia Probability

Posted on June 30, 2017 by Pharmaciststeve

Older adults with chronic pain have been found to have poorer memory and executive function than their younger counterparts.Persistent Pain Linked With Greater Memory Decline & Dementia Probability

http://www.clinicalpainadvisor.com/pain-comorbidities/executive-functioning-is-affected-in-elderly-individuals-with-persistent-pain/article/669954/

In a population-based cohort study described in JAMA Internal Medicine, older adults with persistent pain showed more rapid memory decline and greater dementia probability compared with adults without persistent pain.1 

The prevalence of chronic pain in older adults is 25% to 33%, and recovery is less likely in this group compared with younger individuals.2,3 Recent findings demonstrated a link between pain and outcomes that commonly affect the elderly, including functional impairment, cognitive decline, and dementia.4-6 Older adults with chronic pain have been found to have poorer memory and executive function than their younger counterparts, both of which are closely associated with functional independence.6

In the current study, data from 10,065 participants (median baseline age, 73; 60% women; 1120 [10.9%] with persistent pain) in the Health and Retirement Study was analyzed to assess the longitudinal effects of persistent pain on memory and the probability of developing dementia. In addition, the impact of pain-related memory decline on daily functional tasks (ie, medication and financial management) was examined.

Participants initially reported outcomes in 1998 and 2000 and were followed until 2012 or until death or dropout from the study. Composite memory score and dementia probability were “estimated by combining neuropsychological test results and informant and proxy interviews.” Patients with moderate to severe persistent pain were compared with age-adjusted peers without persistent pain.

Study participants with persistent pain at baseline had worse depressive symptoms and more functional limitations pertaining to daily tasks vs participants without persistent pain. After adjustment for covariates such as marital status, alcohol use, and financial assets, more rapid memory decline was observed in patients with persistent pain (mean, 9.2%; 95% CI, 2.8%-15.0%; P <.001). 

These patients also had an increased relative risk of inability to manage medications (11.8%) or finances (15.9%) after 10 years, compared with patients without persistent pain. In addition, the increase in adjusted dementia probability was 7.7% (95% CI, 0.55%-14.2%) higher in the pain group.

These findings suggest that, along with the direct treatment implications of asking patients about pain, such discussions could provide clinicians the opportunity “introduce mitigation strategies—such as assistive devices or other physical or occupational therapy interventions to address pain-related functional limitations, or self-efficacy and mindfulness strategies to reduce the affective impact of chronic pain,” the researchers concluded.

Summary and Clinical Applicability

Moderate to severe persistent pain in older adults is linked with accelerated memory decline and increased dementia probability. 

Limitations

Because more patients with chronic pain had higher rates of death and dropout in the study, these patients had fewer evaluations than the comparison group. Also, the Health and Retirement Study provided scant information about the origin, nature, or treatment of the pain, which precluded the stratification of participants based on common criteria. 

 

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3 strikes and you are out … takes on a new meaning ?

Posted on June 29, 2017 by Pharmaciststeve

3 Strikes, You’re Out! City to Let Overdose “Victims” Die After 3rd Time

www.eaglerising.com/45079/3-strikes-youre-out-city-to-let-overdose-victims-die-after-3rd-time/

Do we continue to save people who are willingly putting drugs into their bodies and overdosing? That is the question one city has been struggling with for a while, and they are making a decision as to whether they should let the overdosing “victim” die after the third time being saved.

I use the word victim lightly because they aren’t really victims. Cancer patients are victims. They have a disease that they cannot help. Drug addicts are just that. It may not be an easy choice because their bodies are addicted, however, it is a choice they make nonetheless.

Butler Dispatch reports:

Middletown, Ohio officials are tired of overdoses in their town, and they have a way to stop this from continuing. But city officials are concerned this “proposal” may hurt them in the end. The proposal is a 3-strike policy. On the 3rd 911 call of a known “overdoser”, the 911 dispatcher will simply hang-up.

WLWT-TV and WKYC-TV stations in Ohio has released new information as to the 3-strike policy. Middletown, OH has spent $11,000 on Narcan in 2016. In 2017, they have spent over $30,000 and are projected to spend another $45,000 unless they do something to resolve their addiction problem.

Last year Middletown has 74 overdose-deaths. In 2017, they have had 51 overdose deaths and it is still rising weekly. The proposal begins with giving the person 3-chances.

The first revival is “free”, per say. The 2nd revival results in the person doing community service to pay off their “debt” for the Narcan used to revive them. The 3rd-strike results in the dispatcher hanging up on you.

The way a dispatcher would know whether to hang-up on you is a database will be created. This database will result in the names, addresses, and phone numbers of known users. If a dispatcher receives a call, and they see you have not completed your community service or you are constantly a “frequent flyer”, the dispatcher will disconnect the line and not dispatch an ambulance.

The city claims this is not a way to solve the overdose issue, but to save the city money.

 

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How Congress moves one small step at a time to control opiates

Posted on June 29, 2017 by Pharmaciststeve

OxyContin and Beyond: Examining the Role of the Food and Drug Administration and the Drug Enforcement Agency in Regulating Prescription Painkillers.

https://www.gpo.gov/fdsys/pkg/CHRG-109hhrg24947/pdf/CHRG-109hhrg24947.pdf

This is a 131 page report on a Congressional hearing TWELVE YEARS ago on how they were going to deal with the perception of increased abuse of opiates by certain segments of our population.

IMO.. this also clearly demonstrates how Congress moves like a tortoise.. one small step at a time… until they get accomplished their goals.. while everyone else is busy living their life and don’t see it coming ? 

 

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Trump Administration’s idea of HEALTH CARE ?

Posted on June 29, 2017 by Pharmaciststeve

Trump Administration Looks to Give Federal Employees Fewer Opioids

http://www.govexec.com/pay-benefits/2017/06/trump-administration-looks-give-federal-employees-fewer-opioids/139059/

The Trump administration is promising to give federal employees injured on the job fewer prescription opioids, noting the risk of substance abuse for that line of treatment.

The Labor Department’s Division of Federal Employees’ Compensation instituted new rules that took effect this week, which will limit the duration of opioid prescriptions for incapacitated feds to 60 days. The office encouraged doctors to prescribe “the shortest duration of opioid medication that will provide appropriate pain relief,” and capped fills to 30 days at a time. No more than two opioids may be prescribed at once, including in compounded medications. Those meds will now require a Letter of Medical Necessity before being prescribed.

The rules will apply to employees enrolled in coverage through the Federal Employees Compensation Act, which pays medical expenses and compensation benefits to feds who sustain work-related injuries, or their survivors. In fiscal 2016, the program, which is administered by Labor, provided $3.2 billion in benefits to 219,000 employees and survivors.

Starting in August, the FECA division will not authorize newly prescribed opioid drugs after the initial 60-day period without a special letter from a provider. Labor employees must personally review those letters before more opioids are dispensed. The department will soon issue further rules for existing prescriptions issued within the last six months. It also advised physicians to limit the daily dosage of the drugs.

Ideally, the Labor division said, FECA recipients will avoid opioids altogether.

“We strongly urge our claimants and their treating physicians to be mindful of safety concerns relating to opioid medications and to consider alternative drugs that do not pose the same risks for addiction, dependency and overdose,” the agency said. It conceded that opioid drugs “can provide necessary and safe pain relief to injured workers” when used appropriately, but noted the number of deaths from painkiller overdoses has skyrocketed in recent years.

The Trump administration has focused on the opioid abuse issue, with the president in March signing an executive order creating a commission tasked with fighting the crisis. 

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INDIANA… new OPIATE DOSING GUIDELINES — EFFECTIVE JULY 1, 2017

Posted on June 29, 2017 by Pharmaciststeve

 

INDIANA… new OPIATE DOSING GUIDELINES — EFFECTIVE JULY 1, 2017

http://iga.in.gov/legislative/2017/bills/senate/226#document-b9523207

 

 

 

Important Notice regarding Changes to Indiana Law concerning the Prescribing and Dispensing of Opioids:

 

Effective July 1, 2017, pursuant to Senate Enrolled Act 226, new laws concerning the prescribing and dispensing of opioids will go into effect. Please be advised, these changes affect any practitioner who maintains an Indiana controlled substance registration and a federal Drug Enforcement Administration registration as well as any pharmacy or pharmacist dispensing opioid prescriptions. The Indiana Medical Licensing Board is currently reviewing the statute should additional considerations for the prescribing of opioids be necessary.  For more information and a copy of the enrolled act, please visit the Indiana General Assembly website here.

 

Please note, that neither the Professional Licensing Agency nor its boards, can provide legal guidance regarding these laws.  If you require legal assistance, please contact a private attorney.

 

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States’ push to pass “right to die” – “physician assisted suicide” laws

Posted on June 29, 2017 by Pharmaciststeve

Until a few years ago, it was a CRIME for anyone to commit suicide regardless of the reason… there are also many groups that opposed capital punishment to eliminate the worse of the worse in our society.  Has anyone notice any of these same groups opposing right to die laws ?

When Obamacare was first passed there was “talk” about “death panels”

http://www.thirteen.org/bid/sb-howmuch.html    Slightly more than half of Medicare dollars are spent on patients who die within two months.   Total Medicare annual budget is 600 + billion and covers some 56 million people..

From the bureaucrats’ perspective… how many believe that we are spending TOO MUCH MONEY just “keeping a small percent alive”… just “financial leeches on the healthcare system” ?

OFFICIAL “DEATH PANELS” have seemingly not developed… at least not visibly.. but.. all of these various Federal and State agencies that have imposed adequate treatment for chronic painers is not – in the true sense – a death panel , but… denial of care and causing chronic painers – in desperation – commit suicide rather than spend another day enduring torturous level of pain.

And now we have various states endorsing suicide/physician assisted suicide to “end a pt’s suffering”

Bureaucrats seldom enact anything in a LARGE CHANGE… they make barely perceivable incremental changes until they end up accomplishing their ultimate goal… this may take several years or a decade or two… they will not rush things so that the “common day folks” won’t catch on to what is coming down around them.

Just like the frogs put in a pan of cold water and you turn on the heat.. and before they know it their ASSES ARE COOKED !

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call MORGAN & MORGAN ..UPDATE

Posted on June 29, 2017 by Pharmaciststeve

Below is the response to the pt that had originally contacted Morgan and Morgan abt two weeks ago..  Apparently that there are MORE PROFITABLE and DEEPER POCKETS …. lawsuits that they can devote their resources to…. Morgan & Morgan - ForThePeople.com

Thank you for allowing Morgan & Morgan to review your potential class action claim. After review, we have decided to decline representation on your behalf in this particular matter.

Our decision does not mean you do not have a viable claim. Rather, it simply means that we have made a decision not to represent you. We strongly suggest that you contact another attorney immediately for assistance, as law firms evaluate cases differently and another attorney may believe a claim can and should be pursued.

If you choose to contact another attorney, you should do so immediately as all legal claims are subject to a statute of limitations. In other words, if your claim is not filed against the responsible parties before the statute of limitations expires, then you will be forever barred from bringing a claim. Because we have not investigated your case, we are not making any determination as to the statute of limitations applicable to your claim. The statute of limitations in your case may have expired before you ever contacted our law firm, or the statute of limitations may expire in the very near future. As such, you should act quickly to avoid jeopardizing your potential claim.

Although we are declining to represent you at this time and will not be filing any lawsuit on your behalf, we wish you the best and again thank you for allowing us to review your potential case. Please consider calling us in the future if the firm may be of service to you.

Finally, please be advised that if you have a separate claim being investigated or handled by another Morgan & Morgan attorney or department (such as a medical malpractice or personal injury claim), this letter does not impact that other matter. This only relates to the potential class action you brought to our attention.

OKay folks, I just hung up with the law firm Morgan & Morgan and they are forwarding my case to the appropriate attorneys for a class action within their firm. They ask that the rest of you call as well to give your story and please refer to a chronic pain patient class action. The number is 1-888-670-2630 PLEASE call immediately as it will take 3 weeks to review our case and respond to us. Hope your all having as pain free day as possible!

need to ask for the medical malpractice dept when they call. It would be a medical malpractice class action based on the harm caused to us by the cdc guidelines and the doctors

A possible way to get results is to tell a representative, “hey, look up this case #7751565. 

Tell them. “hey, I want to do that. A class action law suit based on the harm caused to me by the CDC Guideline  and the doctors.”   

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Obamacare is imploding and Repeal and Replace – no one will be happy..

Posted on June 28, 2017 by Pharmaciststeve

We have some 320 million people in the USA… when you look at all “the numbers” how our country is going to fund a health insurance program … the numbers don’t really add up..
As a country we have 55.5 million on Medicare
We have 72 million on Medicaid – up abt 50% since 2009
There is some people eligible for both Medicare/Medicaid .. so you can’t add the two together to get a realistic total number..
We have some 8.4 % unemployed (actual unemployed and non participation rate)
We have 47% of family households that PAY NO FEDERAL INCOME TAXES.
Our “national healthcare bill” is almost $1000.00/person/month…3.8 TRILLION DOLLARS..
3.8 trillion is the SAME amount as the Annual Federal Budget.
The question has to be asked … how much of that 3.8 trillion goes to the cost infrastructure and profits of various middlemen that may or may not be really necessary parts of our healthcare system ?
It is quite obvious that we are quickly moving toward a point of “no return” when we have more “takers” than “makers”
This issue may be a good example of how the impact of lobbyists and all the money that they spread around in Congress to help big companies to protect their profits.. and healthcare is just another FOR PROFIT BUSINESS..

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Judge rules that HIPAA doesn’t apply to DEA PMP searches ?

Posted on June 26, 2017 by Pharmaciststeve

US Does Not Need Warrant to Subpoena Oregon Drug Data

https://www.usnews.com/news/best-states/oregon/articles/2017-06-26/feds-dont-need-warrant-to-subpoena-oregon-drug-data

PORTLAND, Ore. (AP) — The 9th U.S. Circuit Court of Appeals ruled Monday that the U.S. Drug Enforcement Agency does not need a court order to subpoena a prescription drug database kept by the state of Oregon, but the ruling did not specify whether those subpoenas would violate constitutional protections.

The ruling reverses a 2014 judge’s ruling finding that the agency must obtain warrants to access the database, which Oregon uses to help healthcare providers identify abuse. The appeals panel, however, said nothing prevents Oregon from challenging individual warrantless subpoenas in court “in light of the particularly important privacy interest implicated here.”

The ruling did not resolve the question of whether the DEA’s administrative subpoenas violate constitutional protections against unreasonable search and seizure outlined in the Fourth Amendment of the U.S. Constitution protecting people against unreasonable searches and seizures.

The Oregon Prescription Drug Monitoring Program sued the DEA in 2012 over the administrative subpoenas for patient prescription records because under state law police must get court orders to check the same database. The DEA argued that the federal Controlled Substances Act allowed it to access the information without a warrant.

The American Civil Liberties Union joined in the case to litigate the broader issue of whether the requests violated Fourth Amendment protections.

The appeals court said that the ACLU does not have standing in the case and did not address that issue.

A similar Utah case may help to resolve that question, said Nathan Wessler, the ACLU attorney who argued the Oregon appeal.

The case began in 2012 when the DEA sought the records of one patient and two prescribing physicians as a part of an investigation. The state argued it could not be compelled to disclose health information about a patient without a federal court order.

 Oregon lawmakers approved the prescription database in 2009 and it became fully operational two years later. A pharmacy must electronically report information about the quantity and type of drugs dispensed, identifying information about patients and the names of doctors prescribed medication.

About 7 million prescription records are uploaded to Oregon’s system annually, according to the 2014 opinion on the case written by U.S. District Judge Ancer L. Haggerty.

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Often to get the justice you are entitled to… requires a law firm

Posted on June 26, 2017 by Pharmaciststeve

There are dozens of laws on the books that is suppose to protect segments of our population against discrimination regarding several different issues.

We have both the Civil Rights Act 1964 and The Americans with Disability Act 1990 and yet various Fed/State Agencies pass rules, laws, regulations, guidelines that discriminate against portion of our populations that are suppose to be protected.

Right now Congress is discussing repeal/replacement of Obamacare and they are talking about insurance guarantee of coverage for PRE-EXISTING ILLNESSES.. but they are not talking about GUARANTEED TREATMENT for pre-existing illnesses..

AG Jeff Session’s ONE PERSON’S OPINION wants Congress to OVER-RIDE the will of the people in some 30 states that has made Marijuana or Medical Marijuana legal in some form or another.

Who believes that the CDC did not know or should have known that any “guidelines” that they published would soon be adopted as standard of care and best practices in a wide area of the medical community.  Even choosing some of the poorest quality studies to use as justification for their guidelines…and refusing to acknowledge anecdotal evidence that opiates work long term for chronic pain pts.

Various state legislatures are passing opiate dosing guidelines in some form or another… and even though there are exemption to those daily limits for certain health issues… all too many prescribers are refusing to recognize or acknowledge that those exemptions exist.

You can put up dozens of petitions on various websites.. has anyone seen the first petition concerning chronic pain treatment effected any change?

Has the hundreds or thousands of FACE BOOK pages … made any difference ?

Has any of the calls, emails, faxes, letters sent to elected officials … made a difference ?

There is no guarantee that anything a politician/bureaucrat does.. is legal/constitutional ?

Cities, Counties, States are “piling on” and suing various entities that produce or sell the LEGAL PRODUCT of opiates…  because of the perceived “damages” that have happened because a number of people have ignored any personal responsibility and use/abuse some substances.

Those in the chronic pain community are technically protected from numerous discrimination by numerous laws … both at the Federal and State level… but those who are in charge of enforcing and protecting those in the chronic pain community seems to have little interest in doing their jobs.

That is what law firms are for… the chronic pain community has VOTES .. in unity, enough to decide just about any election in this country and they have the numbers that a few dollars from each would add up to a HUGE LEGAL WAR CHEST… 

The system can be REFORMED with UNITY.. .or each chronic painers can chose to suffer individually as they walk down a singular path.

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