Pain medicine : the official journal of the American Academy of Pain Medicine
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Correlates of self-reported violent ideation against physicians in acute--and chronic-pain patients.
Physicians are at risk for patient-perpetrated violence. This study attempts to identify predictors for violent ideation against medical doctors (VI-MD), in acute-pain patients (APPs) and chronic-pain patients (CPPs). This is the first such study in the literature. ⋯ Being a rehabilitation patient increases the relative risk of affirming VI-MD. This risk is further increased by such variables as chronic pain, Worker's Compensation status, personal injury status, and, most important, litigation. We cannot as yet predict VI-MD affirmation significantly better than base rate prediction. Some variables implicated in this study for VI-MD affirmation relate to the physician-patient interaction and are clinically useful.
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Neuropathic pain is reported to be common based on studies from specialty centers and survey studies. However, few prevalence estimates have been completed in a community population using clinical evaluation. ⋯ The estimated rates and personal characteristics of community residents with "neuropathic pain" vary widely depending on the tools used to identify neuropathic pain. None of the screening tools compared well with clinical evaluation. The differences in the groups identified by alternative screening methods become of major importance when reporting neuropathic pain epidemiology, studying therapies for neuropathic pain, or attempting to translate neuropathic pain research into clinical practice.
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Prescription-drug diversion is a topic about which comparatively little is known, and systematic information garnered from prescription-drug abusers and dealers on the specific mechanisms of diversion is extremely limited. ⋯ The diversion of prescription opioids might be reduced through physician education focusing on 1) recognizing that a patient is misusing and/or diverting prescribed medications; 2) considering a patient's risk for opioid misuse before initiating opioid therapy; and 3) understanding the variation in the abuse potential of different opioid medications currently on the market. Patient education also appears appropriate in the areas of safeguarding medications, disposal of unused medications, and understanding the consequences of manipulating physicians and selling their medications.
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Review Case Reports
Pain management after Hurricane Katrina: outcomes of veterans enrolled in a New Orleans VA pain management program.
To evaluate Hurricane Katrina's impact on patients with pre-existing chronic pain. Design. Review of literature about Hurricane Katrina and chronic pain or pain management and a qualitative interview of all identified patients enrolled in a behavioral pain management program. ⋯ Health care planning for large-scale emergencies must take into the need for prompt continuation of pain management services in patients with chronic pre-existing pain. Coordination between emergency clinics and pain management specialists, as well as the availability of electronic medical records, is an important factor in continuing established pain management services after a regional disaster.