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The IV opioId analgesic shortage is not likely to abate until 2019 (fda.gov/NewsEvents/New…). We are also experiencing a shortage of ketamine. Good time to consider the value of regional anesthesia/analgesia for multimodal postoperative pain management.

The CDC may have overestimated the prescription opioid overdose deaths in 2016. The original number was 32,445 but they have revised the number to 17,087 deaths. Apparently, they included illegally manufactured fentanyl in the numbers. This is the reference, AJPH 2018;108:500

A meta-analysis of RCT comparing conventional and DMARDs v. placebo for OA (doi.org/10.1093/rheuma…) concluded that they did not provide better analgesia than placebo. Does this mean that inflammation may not be the primary source of pain in OA?

The AHRQ reports that every year 770K are injured or die in hospitals due to ADEs. 40% of patients >65 take 5-9 medications and 18% >10 increasing the risk of ADEs. By 2029, over 20% of the US population will be >65. This tool may help creating awarenes: bcbpsd.ca/docs/part-1/Pr….

I had hopes that Oliceredine, a new class of opioid analgesics may produce analgesia similar to other opioids with less SE due to less beta-Arrestine2 recruitment. On 10/11/18, the FDA’s panel advise stated that they believe that this is not the case. (bit.ly/2NvO7P9).

At a Palliative Care Congress in Lima, Peru I asked about avoiding Burnout. Their response, spiritual commitment! That was the Medieval concept of profession and Medicine was one of them, as it was not a trade or an industry. Should we try to strike a balance? It may save us!

The FDA Advisory Committee voted to approve the 30 ug Dsuvia tablet. This will be a great addition to our armamentarium because the increase in the number of patients with a history of opioid use/abuse having surgery and the high sufentanil’s intrinsic efficacy in these patients.

RE Tonight’s discussion between Don Lemon and Christopher C. Cuomo on marijuana: the argument that because alcohol is sold freely, marijuana should be too, is a fallacy. Two wrongs do not make one right! Please review Francesca Mapua Filbey work on mesocorticolimbic activation by THC in humans

New app will allow hip and knee surgeons to use Apple Watch to monitor patients' health data - heart rate, steps taken, standing hours. ow.ly/t43l30mjbCU

Please ask your cancer patients about complementary and alternative medicine (CAM) use. Two studies presented at the ESMO 2018 Congress in Munich showed that 60% of patients were not aware of their side effects and 20% reported major DDI requiring intervention in 30% of the cases

As a follow-up to my previous post, when dealing with herbals in pain management, one should be concerned with ginkgo biloba and St John’s Wort (risk of serotonin syndrome when co-administered with SNRI or TCAs), and the former and garlic also increasing the risk of bleeding.

Those using marijuana have FIVE TIME greater risk of developing psychosis-Lancet doi.org/10.1016/S2215-…. Current “medical” marijuana TCH concentrations are 18-30% while in the 80’s, 10%. High potency marijuana has >10% THC. Time for warning labels and government responsibility.

Productive meeting with the FDA to discuss the problems that stemmed from their physician letter on compounding for Intrathecal Therapy. They suggested we meet again to discuss the next steps to preserve access for our patients. ASRA will continue to be “at the table”.

Consider opioid-induced adrenal insufficiency in patients experiencing fatigue, asthenia, muscle/abdominal pain, and headaches. Low morning cortisol, ACTH, DHEAS, and peak cortisol levels after cosyntropin stimulation test can be helpful, but there is no “gold standard”.

The CDC clarified that their management of chronic pain guidelines do not include patients with active cancer treatment, palliative care, and end-of-life care. Thus, the recommendations still apply to survivors who are treated for pain as a result of their cancer treatment.

I was disturbed reading that Alex Trebek suffered severe pain due to his pancreatic cancer. This is unacceptable in the 21st century because all the successful options that we have to treat cancer pain. Take home message: ask the oncologist for a referral to a pain specialist.

Considering the consequences of a late diagnosis, this is very useful information.

Muscle and bone pain after the use of “zumabs” is on the rise in cancer survivors. Long-term NSAIDs is not an option. One more reason why opioid therapy has increased in cancer survivors (J Am Geriatr Soc 2019;67:945). Monitoring for opioid use/abuse is needed in these patients.

I am not a golf fan, but I was impressed by Kevin Na’s gesture. After his 3rd career tour win at the Colonial Country Club, he gave his caddie a ‘73 Dodge Challenger that was to be awarded to the winner!! GENEROSITY, PASS IT ON!!!

More importantly, Dr. Vallejos’ work suggests that electrical stimulation patterns DO make a difference in the therapeutic target of those impulses and in this case, the glial cells functioning in neuropathic pain.