Rethinking “Doing Well” on Opioid Therapy
Patients do well on long-term opioids a lot less often than their physicians imagine, according to a provocative essay by David Juurlink, MD, PhD, in CMAJ (Canadian Medical Association Journal). Patients derive early pain relief from opioids. But it often fades. “Opioid analgesia attenuates with time, while the harms persist or accrue as doses increase. For some patients, the primary benefit of opioids becomes the avoidance of withdrawal. This constitutes harm, but is easily misconstrued as ongoing effectiveness,” according to Juurlink. Unfortunately, many patients appear more likely to be harmed than helped by long-term opioid therapy. Juurlink suggests that the entire approach to the long-term treatment of chronic pain has to be revised, with greater emphasis on the use of evidence-based nondrug therapies.
Here is a link to the article: http://www.cmaj.ca/content/189/39/E1222
Pessimism Rampant Among US Physicians
Pessimism about the future of medicine, unfortunately, has become rampant among US physicians, according to a nationwide survey conducted by the Leavitt Partners consulting firm in 2017. The researchers found that 38% of physicians were “somewhat” or “very” pessimistic about the practice of medicine, 41% were “somewhat” or “very” optimistic, and the remaining physicians were neutral. Pessimism did not appear to be concentrated in any particular medical specialty. However, pessimism was more likely among doctors dissatisfied with the electronic medical record, more common in private practice than hospital or corporate settings, and more common among older physicians.
Here is a link to a commentary on the study at the Lown Institute: https://lowninstitute.org/news/blog/why-are-so-many-doctors-pessimistic-about-the-future-of-medicine/
Readers can apply to access the full paper from Leavitt Partners here: https://leavittpartners.com/press/leavitt-partners-releases-examining-pessimism-among-physicians-white-paper/
Where Does Back Pain Rank as a Complaint in Primary Care?
Patients and physicians disagree as to the most common health complaints in primary care, according to a recent systematic review by Caitlin R. Finley, MSc and colleagues. Physicians reported the most common conditions to be (1) upper respiratory tract infection; (2) hypertension; (3) routine health maintenance; (4) nonback-related arthritis; (5) diabetes; (6) depression or anxiety; (7) pneumonia; (8) acute otitis media; (9) back pain or spinal pain; and (10) dermatitis. Patients, interestingly, classified back pain as the second most common condition, trailing only cough as a symptom complaint. Back pain was the 4th most commonly cited complaint in “developed” countries, trailing hypertension, upper respiratory infections, and depression or anxiety. But it was not listed in the top 10 in “developing” countries. Of course, it remains to be seen whether the papers in the systematic review give an accurate view of conditions in real-world settings.
Here is a link to a free version of the survey: http://www.cfp.ca/content/cfp/64/11/832.full.pdf