Posted on Mar 06, 2019

Opioids: Under Fire with chronic pain are suffering from ham-handed efforts to curb opioid overdoses, a series of witnesses told the Senate Health, Education, Labor and Pensions (HELP) Committee.  In particular, the CDC's 2016 guidelines for opioid prescribing came under heavy fire, as even a self-described supporter of its recommendations admitted the evidence base was weak.

Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation, argued that well-intentioned efforts to address the epidemic -- particularly strategies to tamp down overprescribing -- have stoked a "climate of fear" among doctors.

Thousands of patients with chronic pain have been forcibly tapered off their medications or dropped from care by their physicians, said Steinberg. Physicians in California, under threat of medical-board sanction if patients die from overdoses, have reported similar reactions.  Such decisions are “inhumane and morally reprehensible,” she said.

She was especially critical of the CDC’s opioid guidelines, which included recommendations regarding the number of days and dosage limits for certain pain patients.  "When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed,” notes a CDC fact sheet.  These recommendations have been “taken as law," she said. 

Because of the CDC's reputation, "people think that those [guidelines] are based on strong science and they're not," Steinberg said. Pain consultants were not involved in the development of the guidelines, she said.  Steinberg said, "I think we need public education about pain and the fact that pain is a disease itself. ... Pharmacists are not getting proper training in that, I don't think anyone is getting proper training in pain." She asserted that veterinarians get nearly 10 times as many hours of pain management training as do medical students.

Insurance coverage can be a barrier to non-opioid alternatives. For example, the Mayo Clinic has a Pain Rehabilitation Center staffed by specialists in pain medicine, physical therapy, occupational therapy, biofeedback, and nursing that aims to treat pain without opioids. But Medicaid won't pay for it, she testified.





Effect of Chiropractic on Reaction Time of Special Operations Forces Military Personnel



Chiropractic manipulative therapy (CMT) has been shown to improve reaction time in some clinical studies. Slight changes in reaction time can be critical for military personnel, such as special operation forces (SOF). This trial was conducted to test whether CMT could lead to improved reaction and response time in combat-ready SOF-qualified personnel reporting little or no pain.

This prospective, randomized controlled trial was conducted at Blanchfield Army Community Hospital, Fort Campbell, KY, USA. Active-duty US military participants over the age of 19 years carrying an SOF designation were eligible. Participants were randomly allocated to CMT or wait-list control. One group received four CMT treatments while the other received no treatment within the 2-week trial period. One hundred and seventy-five SOF-qualified personnel were screened for eligibility; 120 participants were enrolled, with 60 randomly allocated to each group. 

A single session of CMT was shown to have an immediate effect of reducing the time required for asymptomatic special operation forces (SOF) qualified personnel to complete a complex whole-body motor response task. However, sustained reduction in reaction or response time from five tests compared with a wait-list control group was not observed following three sessions of CMT.



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