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Anchor lead: There is a role for opioid medications in managing some chronic pain, Elizabeth Tracey reports

Now that federal authorities are so focused on curtailing the opioid epidemic, does that mean that there’s no place for these medicines in the treatment of chronic pain? Not at all, says Michael Clark, a pain expert who spoke at a recent Johns Hopkins symposium on chronic pain management.

Clark: These are substances with abuse potential. Some set percentage of people will develop an addiction, we don’t really know how to predict that. All we can really say is that we have to be clear about our outcomes for the patient so that if I give you opioids and you become more functional, your symptoms improve, your approach to living your life is better, any of those things that we would put under a functional, satisfying life, then it would be hard to argue with giving you opioids.   :31

Clark is in favor of short courses of the drugs as part of a comprehensive pain management strategy with an eye toward eliminating opioids if possible. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Helping people in chronic pain requires a multipronged approach, Elizabeth Tracey reports

Chronic pain is complicated to manage, and now that opioids are being tightly controlled, new approaches are needed. Michael Clark, a pain expert who spoke at a recent Johns Hopkins symposium on pain, says an understanding of why someone is in pain to begin with is critical.

Clark: How do you distinguish the different causes of pain, the different comorbidities of pain, such as major depression, or substance abuse, or even other medical causes that would benefit from more specific treatments. You hear people talking about precision medicine. It comes from knowing your patient, and what it is that they have wrong with them. Then you can decide well this person might actually benefit from opioids but this person might actually benefit from any number of other interventions that would actually do a much better job than opioids. :33

Clark says strategies like cognitive behavioral therapy, acupuncture, and stress reduction as well as treating the other problems appropriately should render most cases of chronic pain manageable. At Johns Hopkins, I’m Elizabeth Tracey.

 

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Anchor lead: How can pain be managed in the wake of the opioid crisis? Elizabeth Tracey reports

Now that many clinicians are reluctant to prescribe opioid medications, what options are available for those in chronic pain? Michael Clark, a pain expert who spoke recently at a Johns Hopkins symposium on chronic pain, says we must first rethink the issue.

Clark: While you may hear that pain is a vital sign or pain is a symptom, it really isn’t. It’s much more than that.  :08

Clark advocates for a very thorough assessment of the patient.

Clark: With that kind of careful formulation, if you consider what diseases the patient has, what behaviors they’re engaging in, who they are as a person and what capabilities they have, and what stressors or life events they’re trying to make it through, you can then determine what’s the best approach for this person as opposed to the other person.  :25

Clark acknowledges that such an approach is time-consuming but will likely produce better pain management results over the long term. At Johns Hopkins, I’m Elizabeth Tracey.

 

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Anchor lead: Can a new device replace the traditional gastric bypass surgery? Elizabeth Tracey reports

A device to treat obesity known as an ‘Endobarrier’ is producing good results in helping people lose weight and manage their diabetes better, a study presented at the recent European Association for the Study of Diabetes meeting found. Kimberley Steele, a bariatric surgeon at Johns Hopkins, describes the intervention.

Steele: This procedure has created a long tube that is placed endoscopically into the first part of the small intestine. What that does is create a passage for the food however it decreases the absorption of that food. It’s in place for a year. It has had some really nice results with weight loss, maybe 30-40 lbs, but that weight loss is enough to reduce the need for insulin, to improve liver function tests, and to remit type 2 diabetes.  :33

Right now the device is only used in Europe but Steele says if further studies have similar results it may soon make its way stateside. At Johns Hopkins, I’m Elizabeth Tracey.

 

 

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Anchor lead: What can following people for 12 years tell us about bariatric surgery? Elizabeth Tracey reports

The most common type of weight loss, or bariatric surgery, known as gastric bypass, really does work, a study following about a thousand patients for 12 years has shown. Kimberley Steele, a bariatric surgeon at Johns Hopkins, describes the outcomes.

Steele:It’s big cohort. They looked at weight loss outcomes also type 2 diabetes, hypertension and hyperlipidemia. And what they showed is that even after 12 years there is reason to be doing a gastric bypass. It is resolving or at least making better these comorbidities and making people healthier.  :21

Patients also lost weight and kept it off.

Steele: Patients are able to sustain weight loss so what it proved was long term durable success of weight loss via the gastric bypass procedure.  :10

Steele says those who are very obese and considering the surgery should educate themselves about all the options before making an informed decision. At Johns Hopkins, I’m Elizabeth Tracey.

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Close-up Of Person Practicing Cpr Chest Compression On Dummy

This week’s topics include predicting mortality in those with congestive heart failure, bystander CPR impact, best management of stable COPD, and NOACs and bleeding risk.

Program notes:

0:50 NOACs and bleeding risk
1:51 Also taking other medicines increased risk
2:49 Physicians need to know
3:18 Managing people with COPD
4:21 So many more people with the condition
4:43 Bystander initiated CPR
5:43 2/3 at home, 1/3 in public setting
6:44 Increased survivorship
7:00 How can we predict mortality in patients with heart failure
8:01 Easily obtained variables
9:04 Admission afterward?
10:26 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/10/13/bystander-cpr/

 

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Anchor lead: What can we learn from data extracted from electronic medical records? Elizabeth Tracey reports

Sepsis, where someone develops an infection that spreads throughout their body and can be life-threatening, appears to be increasing. Yet a new study published in the Journal of the American Medical Association demonstrates two very different conclusions relative to sepsis incidence based on data from the electronic health record. Kevin Gerold, a critical care medicine expert at Johns Hopkins, explains.

Gerold: There’s two kinds of medical information being entered into the electronic record. One is the objective data, the ekgs, the x-rays, the laboratory studies, then there’s the clinician entered data that is highly subjective.   :15

The objective data found stable rates while the subjective data showed an increase.

Gerold: It sends a signal that we need to be careful about what data we extract from the electronic medical record for what purpose. For epidemiologic purposes we need to use the objective data. For direct patient care we can use that subjective impressionistic data, that’s very effective for patient care.  :18

At Johns Hopkins, I’m Elizabeth Tracey.

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