Asynchrony EM: Opiate Rx in the ED (Keeping Current Conference)

This week in Asynchrony, we're teaming up with the Brown Keeping Current Conference team, and the assigned content is courtesy of Dr. Anu Ganapathy. 

Theme song, even this week. Opiates are on everyone's radar today, but pain, addiction, and despair aren't new problems. (Also a reminder that opiate addiction is not just a problem of the young.)

Tradução Machuquei Machuquei a mim mesmo hoje Pra ver se eu ainda sinto Eu focalizo a dor É a única coisa real A agulha abre um buraco A velha picada familiar Tento matá-la de todos os jeitos Mas eu me lembro de tudo (Refrão) O que eu me tornei?

OK, let's go.

1) First: from EM:RAP, March 2017:  Strayerisms -- Something for Pain  (Not #FOAMed, but residents, remember you can get EM:RAP through EMRA.)

I learned something new! -- and will likely change a particular prescribing habit of mine. Maybe you will, too. Read the comment section as well, because there are some interesting insights/questions there, too.

2) A TEDxTauranga talk on cultural and personal differences in pain perception, with some discussion on differences between US culture and NZ. Very interesting opinions -- what are your thoughts on this? Leave them in the comments.

"I have learned that acute physical pain is an almost universal part of the human experience. But our response to that pain is an individual choice." -Michael Jones

If pain is the 5th vital sign, how does one measure it? And treat it? Mike contemplates different culture's relationships with pain and presents a cautionary tale of the overuse of opioids. Dr Mike Jones is an American doctor who has spent the past 16 years practicing medicine in emergency departments across the globe.

3) CDC Report: March 2017 Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. "In a representative sample of opioid naïve, cancer-free adults who received a prescription for opioid pain relievers, the likelihood of chronic opioid use increased with each additional day of medication supplied, starting with the third day..."

4) Some people point the finger of 'why docs overprescribe' squarely at Press Ganey. It turns out, Press Ganey has a blog. (And yet survey responses are still paper, pencil and stamp based?) Here is their post that addresses pain control.  Let's Talk About Pain

5) Very worth the time, if you have a little extra: 

a) Pain-Free ED : a website by Sergey Motov, an ED Attending at Maimonides Medical Center who is one of the leading social media voices on this topic. 

b) Hot off the press, from JAMA Viewpoint: "Chronic Pain in the Aftermath of the Opioid Backlash"

c) EM Cases March 2017: Opioid Misuse in Emergency Medicine

d) A short animation on addiction called Nuggets. (I used this in a discussion with my kids about the nature of drug addiction -- it's simple, but powerful. Five minutes.)

Kiwi tastes a golden nugget. It's delicious. Script, direction, animation: Andreas Hykade Animation, artwork: Angela Steffen Music, sound design: Heiko Maile Postproduction: Ralf Bohde Production management: Bianca Just Funding: FFA Berlin Production:Thomas Meyer-Hermann Studio FILM BILDER 2014

That's it -- see you next time in Asynchrony EM!