Operationalizing Pain Treatment in the Biopsychosocial Model: Take a Daily "SWEM"--Socialize, Work, Exercise, Meditate.

In the United States, chronic pain is often poorly treated at an exceedingly high cost. The use of the biomedical model to manage pain is frequently ineffective, and evidence suggests that the biopsychosocial (BPS) model is a better choice. A problem with the BPS model is that it has not been operationalized in terms of patient behavior.

A 40-Minute Phone Intervention.

This article recounts the experience of an 88-year-old woman with sciatic pain and her attempts to get it treated. Common interventions were utilized and failed, and back surgery was recommended. A patient advocate was consulted who suggested the need to begin to exercise and to reconsider other medical interventions.

Pain and treatment from a human primate perspective.

Human animals have evolved with the primary missions of survival and reproduction and these natural drives may impact behavior whether humans are aware of them or not. The author offers evidence in support of the idea that injury and resulting acute or chronic pain may trigger the unconscious human primate brain to believe there is a threat to survival. This perceived threat may be exacerbated or mitigated by the pain manager, both of which may impact health outcomes in a negative or positive way, respectively.

Simple maintenance for dramatic effect.

In an article which first appeared in print in the March 2012 issue of The Australian Hospital Engineer, based on a presentation given at the Institute of Hospital Engineering Australia's 2009 National Conference, Scott Wells, energy manager, Engineering & Building Services, at Royal Brisbane Women's Hospital, and Mark Collen, a district account manager, Engineering and Process Development Division, at water treatment specialist, Nalco, discuss how sound, regular, and thorough, maintenance and cleaning of hospital air-handing units will not only enhance their operating efficiency, but will also help reduce airborne infection risk in the healthcare facilities they serve. They also detail practical measures taken at hospitals in Queensland to reduce the energy consumption of air-handling equipment.

Profit-driven drug testing.

Random drug testing of people being treated for chronic pain has become more common. Physicians may drug test patients on opioid therapy as a result of concerns over prosecution, drug misuse, addiction, and overdose. However, profit motive has remained unexplored.

Prescribing cannabis for harm reduction.

Neuropathic pain affects between 5% and 10% of the US population and can be refractory to treatment. Opioids may be recommended as a second-line pharmacotherapy but have risks including overdose and death. Cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning.

The Fourth Amendment and random drug testing of people with chronic pain.

It is common for physicians who prescribe opioids for chronic pain to drug test their patients. This practice may soon be mandated by the State of Washington as a result of passage of their new law ESHB 2876. Random drug testing of people simply because they seek treatment for chronic pain arguably constitutes a suspicionless and warrantless search that violates both the Fourth and Fourteenth Amendments.

Opioid contracts and random drug testing for people with chronic pain - think twice.

The use of opioid contracts, which often require patients to submit to random drug screens, have become widespread amongst physicians using opioids to treat chronic pain. The main purpose of the contract is to improve care through better adherence to opioid therapy but there is little evidence as to its efficacy. The author suggests the use of opioid contracts and random drug testing destroys patients' trust which impacts health outcomes, and that physicians' motivation for their use are concerns about prosecution, medication abuse and misuse, and addiction.

Analysis of controlled substance agreements from private practice physicians.

Controlled substance management agreements (contracts) are widely used by pain specialists in the United States, but what do they contain? This survey analysis answers that question by taking a thorough look at 41 controlled substance medication management agreements from physicians in private practice.

The case for Pain Insomnia Depression Syndrome (PIDS): a symptom cluster in chronic nonmalignant pain.

This commentary suggests that pain, insomnia, and depression might be considered as a symptom cluster in chronic nonmalignant pain and that it might be called Pain Insomnia Depression Syndrome, or PIDS. Evidence is provided in support of the designation. The author suggests acceptance of PIDS would increase awareness of the pain comorbidities insomnia and depression, and this might lead to improved symptom management and better clinical outcomes.

In my opinion... opioid tolerance.

A commentary on the problem of tolerance to opioids is presented from the perspective of a person with chronic nonmalignant pain. The writer challenges the position of many clinicians and professional societies that tolerance to opioid analgesia usually is not a barrier to effective pain management. Implications for clinicians are presented.

Life of pain, life of pleasure: pain from the patients' perspective--the evolution of the PAIN exhibit.

This commentary describes a person's experience with chronic pain, how his beliefs and understanding of pain resolved, and how he developed coping mechanisms and a focus for his life after developing chronic pain. His realization of how art was the most effective way to describe his pain experience to others and the resulting development of the pain visual arts exhibit PAIN Exhibit.com are described.