Monday, December 16, 2013

Time of Year Matters


When injuries occur near very memorable times of year, it can be much harder on you and your family.

Having a bad car accident at Christmas time can mean that every Christmas after that will be tainted by memories of your accident. If your injuries heal up, and your losses are restored, the intensity of  these memories will lessen over time.

If you continue to suffer from serious pain symptoms, injuries and losses, you may relive the accident when the anniversary time approaches each year. Your emotions and vivid memories may be even more intense if the accident was a frightening or life-threatening one. The combination of emotional trauma at the time of the accident and long-lasting pain, injuries and disabilities is a powerful one.

This pattern doesn't just relate to religious holidays. It can occur near wedding anniversaries, birthdays and even Valentine's Day. Some of my patient's have been injured soon after they bought their new home. Now, having to pay their mortgage with money they don't have brings strong and vivid memories of their accident back to them.

The time of year, or connection between the onset of your injuries and important dates in your life, does matter. Vivid memories and powerful emotional reactions make it all the harder to cope with injuries and pain.

Yours with care - Mike

Monday, December 9, 2013

Aggressive Insurers (and WSIB) Will Lose Everytime



Over 90% of my patients, over the past 25 years, have suffered from various types of long-term (or chronic) pain. Often, high levels of relentless pain plus heavy losses trigger depression. This then becomes an added source of limitation, creating even higher levels of disability and loss.

When insurers (or WSIB, Worker's Compensation) place undue pressures on such people and terminate their income or treatment benefits, what is the most likely outcome? This is not rocket science. Of course, most people under these conditions experience much higher stress levels. Most people get worse. Their pain levels, often from multiple sources of pain, escalate. They become more depressed. They lose hope. Many feel defeated and give up. Now, they are even more limited and more disabled, because their injuries have worsened.

Unfortunately, some people, under such harsh conditions, need to go to the emergency room for help with their soaring pain levels and severe depression. Suicidal risks are significantly elevated.

Does this turn of events really help anyone? Injured people and their families suffer more and lose more. Insurers and WSIB are at much higher risk for losing any appeals, tribunals, arbitrations or court cases.

In the last few years, I have seen fewer of these unfair and self-defeating actions from car and disability insurers. Unfortunately, WSIB is behind the times (as usual). WSIB has decided to become more aggressive. As more and more appeals are won, I can't see that their actions are really helping, even themselves. Sadly, they leave  many injured worker's suffering in their wake.

Yours with care - Mike

Monday, December 2, 2013

Abuse and Misuse of Pain Medications - added References


These are the references that I should have included in my last post.

Commentary by Dr. Mark Sullivan

Clarifying opioid misuse and abuse. Pain, 2013, 154, 2239-2240

Here is the original article that Dr. Sullivan referred to in his commentary. It is by Dr. Shannon Smith and a long list of colleagues.

Classification and definition of misuse, abuse and related events in clinical trials: ACTTION systematic review and recommendations. Pain, 2013, 154, 2287-2296.

Both articles, and any other research, can be found through Google Scholar or Pubmed.

Yours with care - Mike

Abuse and Misuse of Pain Medications



Dr. Mark Sullivan, from the University of Washington, outlined new definitions of abuse and misuse of pain medications, in a recent article in the prestigious journal, PAIN. I have provided the reference below.

Misuse is defined as   "Any intentional therapeutic use of a drug product in an inappropriate way".

Therapeutic uses could include taking extra medication to treat higher that normal pain levels, using pain medications to help with insomnia, depression or fatigue.

Abuse is defined as   "Any intentional, non-therapeutic use of a drug product or substance, even once".

Non-therapeutic uses could include taking pain medication for euphoria or to get high, or for self-harm.

I have been working with people in pain for over 25 years. Over 90% of my patients suffer from diagnosable and legitimate sources of pain. Most of my patients follow their doctors orders for taking their pain medication. When they do get off-track, it is usually a case of misuse not abuse.

These definitions are important. They can help all treatment providers, insurers, lawyers, and the justice system be more clear about how medications are used and not lump all problem situations into the drug abuse category.

Yours with care - Mike