Opioid Guidelines California


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Opioid Guidelines for Chronic Pain

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80 mg Morphine Equivalent in California

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Maximum

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That’s about 50 mg Oxycodone

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Change is inevitable. It is about deaths from opioids, addiction and misuse, not about pain control. It is a done deal. Acceptance is required. CDC will set 90 mg morphine equivalence maximum nationwide soon. There is no legal alternative. A wake up call.

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Let’s now make the best of every best tool we have. This is going to be a very tough year. We can get through this together.

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With 18,000 plus deaths from opioid misuse, that is equivalent to a jumbojet crashing every 10 days and killing every passenger.

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I have advised my patients of the maximum 80 mg morphine equivalent that is required in California. The CDC will soon limit maximum dose to 90 mg morphine equivalent nationwide. This is a done deal. We must all accept it, and adjust ourselves to all the benefits of a rational approach to pain management that may have been overlooked many years since your started treatment for chronic pain and came to rely on the easy things like pills rather than changing our behavior – painful as it is for me and all of us.

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Housecleaning: Reassess opioid consent, opioid rules, cognitive behavioral therapy to teach coping skills, physical therapy for the mechanics, and other treatment as required. It does not count if you went through these steps 10 years ago or 5 years ago. This is now. Reassess thoroughly,  to see if we can correct or improve whatever we can.

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The good news is that everything will be reassessed and updated in order to maximize everything that can be done to help your pain. You may feel the brain feels clear on lower doses and you may even have less pain as long as you, together with your doctor, can work out a plan for your best needs.

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And no matter if you are thin, fat or just the right weight, the foods you eat will determine your body’s inflammatory response.

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This will be nationwide in weeks. There is no alternative. We can do this together.

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Don’t forget injured veterans are being completely taken off opioids to get them active and back to exercise. And research from 25 years ago showed 90 year old seniors can strengthen muscles with exercise. If the rest of the world gets by without opioids, so can we.

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Finally, it is very possible to get better pain control using compounded medications once you taper completely off opioids.

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Case:

One of my patients with neuropathy had complete loss of sensation and intense neuropathic pain below wrists and ankles despite high dose methadone – methadone helped better than all other opioids. There was no dose that brought his pain down to moderate. Since pain was severe on any dose of any opioid, I am not sure why they are prescribed at all – brain fog from severe pain, poor sleep, opioids. We may delude ourselves that we are helping.

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He had complete remission using oxytocin, a hormone the body makes. Oxytocin was affordable as long as his insurance paid for it. This allowed him to discontinue all opioid and he came alive again, depression and brain fog completely resolved when pain resolved 100%. He was able to rejoin life for the first time since 1991. Tragically his medicare disability does not cover compounded medications – no insurer does. He was not able to afford the oxytocin (hormone) and had to resume methadone though it gives poor pain control – it is better than other opioids for his pain.

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Not everyone responds to alternatives but they can be tried. I have spent the last 15 years applying new science to the understanding of mechanisms of old drugs, FDA approved decades ago for other purposes. We need to repurpose old safe drugs – invest in research to determine if they modulate pro-inflammatory cytokines. Drug discovery decades ago revealed basic mechanisms that still exist. Now, let’s find out if many safe existing medications work on the new science of the brain: the innate immune system.

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Opioids create pain. They create opioid induced hyperalgesia.

They stimulate pro-inflammatory cytokines in brain and spinal cord (CNS) that create pain.

My focus is on research and medications that modulate the cytokines and restore balance.

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Investment in research has not accompanied the radical cut in opioids. Work for change. Do not allow this to color your mood. Be strong. Get help. We can do this.

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Correction 2-23-16: California Guidelines (pdf) are not law. They are dead serious threats.

page 14: going over 80 mg morphine equivalent is yellow flag warning

 And here

page 3:

Clinicians should conduct semiannual attempts to wean patients whose dose has been 80 mg/day MED or higher for at least six months to lower than 80 mg/day MED.

 

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment

provided by a qualified health care provider.

Relevant comments are welcome.

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If any questions, please schedule an appointment with my office.

This site is not for email.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please be aware any advertising on this free educational website is

NOT advocated by me and NOT approved by me.

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Magnesium Deficient? – Add 3 or 4 Daily for Pain or Depression


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Here’s a keen publication from 1988:

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Magnesium and immune function:

an overview.

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*****Add Magnesium 3 or 4 per day for months.*****

*****Let me know if it helped your pain or depression.*****

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It’s got to be anti-inflammatory – possibly in CNS, and may influence pain, depression, other conditions. Since it is inside the cell, we cannot measure true deficiency. It may be subtle. Only in retrospect 5 months later, during some of the most intense work stress months of one patient’s life, did she realize not one single infection over fall/winter months when there would always be 3 or 4. You may not realize what it has done unless you think about it.

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If it does nothing but stop infections, that alone may prevent Alzheimer’s, years later. Or save your life from the flu that killed a healthy 20 year old. 

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Mg participates in immune responses in numerous ways: as a cofactor for immunoglobulin synthesis, C’3 convertase, immune cell adherence, antibody-dependent cytolysis, IgM lymphocyte binding, macrophage response to lymphokines, T helper-B cell adherence, binding of substance P to lymphoblasts and antigen binding to macrophage RNA. Mg deficiency in rodents impairs IgG synthesis and cell-mediated immunity; complications include thymus atrophy, elevated IgE, hypereosinophilia, histaminosis and lymphoma. Immunologic sequelae of Mg deficiency in humans are subtle and may be affected by genetic control of blood cell Mg concentration. Abnormal C’ activation, excess antibody production and susceptibility to allergy and to chronic fungal and viral infections have been reported. Mg appears to play a protective role in acute allergic reactions.

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From 2001, we learn how crucial magnesium is in many diseases:

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The multifaceted and widespread

pathology of magnesium deficiency

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Abstract

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…extremely important for the metabolism of Ca, K, P, Zn, Cu, Fe, Na, Pb, Cd, HCl, acetylcholine, and nitric oxide (NO), for many enzymes, for the intracellular homeostasis and for activation of thiamine and therefore, for a very wide gamut of crucial body functions. Unfortunately, Mg absorption and elimination depend on a very large number of variables, at least one of which often goes awry, leading to a Mg deficiency that can present with many signs and symptoms. Mg absorption requires plenty of Mg in the diet, Se, parathyroid hormone (PTH) and vitamins B6 and D. Furthermore, it is hindered by excess fat. On the other hand, Mg levels are decreased by excess ethanol, salt, phosphoric acid (sodas) and coffee intake, by profuse sweating, by intense, prolonged stress, by excessive menstruation and vaginal flux, by diuretics and other drugs and by certain parasites (pinworms). The very small probability that all the variables affecting Mg levels will behave favorably, results in a high probability of a gradually intensifying Mg deficiency. It is highly regrettable that the deficiency of such an inexpensive, low-toxicity nutrient result in diseases that cause incalculable suffering and expense throughout the world. The range of pathologies associated with Mg deficiency is staggering: hypertension (cardiovascular disease, kidney and liver damage, etc.), peroxynitrite damage (migraine, multiple sclerosis, glaucoma, Alzheimers disease, etc.), recurrent bacterial infection due to low levels of nitric oxide in the cavities (sinuses, vagina, middle ear, lungs, throat, etc.), fungal infections due to a depressed immune system, thiamine deactivation (low gastric acid, behavioral disorders, etc.), premenstrual syndrome, Ca deficiency (osteoporosis, hypertension, mood swings, etc.), tooth cavities, hearing loss, diabetes type II, cramps, muscle weakness, impotence (lack of NO), aggression (lack of NO), fibromas, K deficiency (arrhythmia, hypertension, some forms of cancer), Fe accumulation, etc. Finally, because there are so many variables involved in the Mg metabolism, evaluating the effect of Mg in many diseases has frustrated many researchers who have simply tried supplementation with Mg, without undertaking the task of ensuring its absorption and preventing excessive elimination, rendering the study of Mg deficiency much more difficult than for most other nutrients.

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment

provided by a qualified health care provider.

Relevant comments are welcome.

.

If any questions, please schedule an appointment with my office.

This site is not for email.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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.

.

.

.

Please be aware any advertising on this free educational website is

NOT advocated by me and NOT approved by me.

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