Chronic pain following surgical procedures for breast cancer was once thought to be rare. The res... more Chronic pain following surgical procedures for breast cancer was once thought to be rare. The results of recent studies, however, suggest that the incidence of chronic pain following breast cancer surgery may be over 50 % (Tasmuth
Chronic pain following surgical procedures for breast cancer was once thought to be rare. The res... more Chronic pain following surgical procedures for breast cancer was once thought to be rare. The results of recent studies, however, suggest that the incidence of chronic pain following breast cancer surgery may be over 50% (Tasmuth et ...
Objective. Fear of government actions against physicians for prescribing opioids for their chroni... more Objective. Fear of government actions against physicians for prescribing opioids for their chronic pain patients is a cause for undertreatment of pain. This study was conducted to assess the risk of action by the federal Drug Enforcement Administration (DEA). Methods. The DEA responded to a written request with a list of all DEA arrests in fiscal 2003. The Federal Register was reviewed for all revocations of DEA registrations for 2003 and 2004. Results. There were 47 arrests in 2003 from among 963,385 doctors registered with the DEA and 56 revocations of registration seen in the 2003 and 2004 period. The reasons for these actions included loss of medical license, fraud, substance abuse by prescriber, sex in exchange for prescriptions, and prescribing without seeing patient. For the majority of cases, there was information to believe that a documented doctor-patient relationship with a chronic pain patient did not exist. Conclusion. When adequate documentation exists in the medical record, the risk of civil, criminal, or administrative action being taken by the DEA against a physician for prescribing opioids for a chronic pain patient is small.
Objective. In several high profile prosecutions of physicians for prescribing opioids, prosecutor... more Objective. In several high profile prosecutions of physicians for prescribing opioids, prosecutors claimed that the doctors should have known the individuals were feigning pain solely to obtain the prescriptions. This study was to determine how readily physicians can tell that patients lie. Methods. A literature search was done for studies of standardized patients used to evaluate physicians' practices. Standardized patients are actors taught to mimic a patient with a specific illness. The papers were then reviewed for the frequency with which the physician correctly identified which office visits were by the standardized (lying) patients. Results. Six studies of practicing physicians using standardized patients reported the frequency with which these actors were identified as the standardized patients. This occurred around 10% of the time. Some real patients were erroneously identified as the actors. Conclusion. Deception is difficult to detect. In the current legal climate surrounding prescribing opioids, accepting patients' reports of pain at face value can have significant legal consequences for the doctor. While doctors must make every reasonable effort to confirm the diagnosis and need for opioid therapy, allowance must be made for the fact that conscientious doctors can be deceived.
Although more severe acute postoperative pain increases the risk of chronic pain following breast... more Although more severe acute postoperative pain increases the risk of chronic pain following breast cancer surgery, few studies have examined the characteristics of patients who develop greater acute pain. To identify risk factors for acute pain and its persistence one month following breast cancer surgery, a sample of 114 women scheduled for breast cancer surgery was assessed preoperatively for demographic, clinical, and emotional functioning variables that were hypothesized to be associated with acute pain severity. Clinically meaningful postoperative pain was assessed at follow-up interviews 2, 10, and 30 days after surgery. In univariate analyses, the risk of clinically meaningful acute pain was increased among women who were younger, unmarried, had more invasive surgeries, and had greater preoperative emotional distress. In multiple logistic regression analyses, greater preoperative anxiety was the only variable that made an independent contribution to predicting clinically meaningful acute pain at 2 days after surgery whereas younger age, being unmarried, and preoperative anxiety each made an independent contribution to predicting clinically meaningful acute pain that persisted from 2 to 30 days after surgery. These results increase understanding of neurobiologic mechanisms and psychosocial processes that contribute to the development of acute pain following breast cancer surgery and have implications for the development of interventions to prevent it.
Chronic pain following surgical procedures for breast cancer was once thought to be rare. The res... more Chronic pain following surgical procedures for breast cancer was once thought to be rare. The results of recent studies, however, suggest that the incidence of chronic pain following breast cancer surgery may be over 50% (Tasmuth et ...
To identify risk factors for postherpetic neuralgia (PHN) using a validated definition of this ch... more To identify risk factors for postherpetic neuralgia (PHN) using a validated definition of this chronic neuropathic pain syndrome, to determine combinations of risk factors that identify patients with a high risk of developing PHN, and to examine the characteristics of patients with subacute herpetic neuralgia, that is, pain that persists beyond the acute phase of herpes zoster but that resolves before PHN can be diagnosed. The authors examined baseline and follow-up data from 965 herpes zoster patients enrolled within 72 hours of rash onset in two clinical trials of famciclovir. Univariate and multivariate analyses indicated that older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity made independent contributions to identifying which patients developed PHN. Patients with subacute herpetic neuralgia who did not develop PHN were significantly younger and had less severe acute pain than PHN patients but were significantly more likely to h...
PAIN®, Volume 118, Issue 1, Pages 10-14, November 2005, Authors:Beth F. Jung; David Herrmann; Jen... more PAIN®, Volume 118, Issue 1, Pages 10-14, November 2005, Authors:Beth F. Jung; David Herrmann; Jennifer Griggs; Anne Louise Oaklander; Robert H. Dworkin. ...
Chronic pain following breast cancer surgery is associated with decreased health-related quality ... more Chronic pain following breast cancer surgery is associated with decreased health-related quality of life and is a source of additional psychosocial distress in women who are already confronting the multiple stresses of cancer. Few prospective studies have identified risk factors for chronic pain following breast cancer surgery. Putative demographic, clinical, and psychosocial risk factors for chronic pain were evaluated prospectively in 95 women scheduled for breast cancer surgery. In a multivariate analysis of the presence of chronic pain, only younger age was associated with a significantly increased risk of developing chronic pain 3 months after surgery. In an analysis of the intensity of chronic pain, however, more invasive surgery, radiation therapy after surgery, and clinically meaningful acute postoperative pain each independently predicted more intense chronic pain 3 months after surgery. Preoperative emotional functioning variables did not independently contribute to the prediction of either the presence or the intensity of chronic pain after breast cancer surgery. These findings not only increase understanding of risk factors for chronic pain following breast cancer surgery and the processes that may contribute to its development but also provide a basis for the development of preventive interventions.
Chronic pain following surgical procedures for breast cancer was once thought to be rare. The res... more Chronic pain following surgical procedures for breast cancer was once thought to be rare. The results of recent studies, however, suggest that the incidence of chronic pain following breast cancer surgery may be over 50 % (Tasmuth
Chronic pain following surgical procedures for breast cancer was once thought to be rare. The res... more Chronic pain following surgical procedures for breast cancer was once thought to be rare. The results of recent studies, however, suggest that the incidence of chronic pain following breast cancer surgery may be over 50% (Tasmuth et ...
Objective. Fear of government actions against physicians for prescribing opioids for their chroni... more Objective. Fear of government actions against physicians for prescribing opioids for their chronic pain patients is a cause for undertreatment of pain. This study was conducted to assess the risk of action by the federal Drug Enforcement Administration (DEA). Methods. The DEA responded to a written request with a list of all DEA arrests in fiscal 2003. The Federal Register was reviewed for all revocations of DEA registrations for 2003 and 2004. Results. There were 47 arrests in 2003 from among 963,385 doctors registered with the DEA and 56 revocations of registration seen in the 2003 and 2004 period. The reasons for these actions included loss of medical license, fraud, substance abuse by prescriber, sex in exchange for prescriptions, and prescribing without seeing patient. For the majority of cases, there was information to believe that a documented doctor-patient relationship with a chronic pain patient did not exist. Conclusion. When adequate documentation exists in the medical record, the risk of civil, criminal, or administrative action being taken by the DEA against a physician for prescribing opioids for a chronic pain patient is small.
Objective. In several high profile prosecutions of physicians for prescribing opioids, prosecutor... more Objective. In several high profile prosecutions of physicians for prescribing opioids, prosecutors claimed that the doctors should have known the individuals were feigning pain solely to obtain the prescriptions. This study was to determine how readily physicians can tell that patients lie. Methods. A literature search was done for studies of standardized patients used to evaluate physicians' practices. Standardized patients are actors taught to mimic a patient with a specific illness. The papers were then reviewed for the frequency with which the physician correctly identified which office visits were by the standardized (lying) patients. Results. Six studies of practicing physicians using standardized patients reported the frequency with which these actors were identified as the standardized patients. This occurred around 10% of the time. Some real patients were erroneously identified as the actors. Conclusion. Deception is difficult to detect. In the current legal climate surrounding prescribing opioids, accepting patients' reports of pain at face value can have significant legal consequences for the doctor. While doctors must make every reasonable effort to confirm the diagnosis and need for opioid therapy, allowance must be made for the fact that conscientious doctors can be deceived.
Although more severe acute postoperative pain increases the risk of chronic pain following breast... more Although more severe acute postoperative pain increases the risk of chronic pain following breast cancer surgery, few studies have examined the characteristics of patients who develop greater acute pain. To identify risk factors for acute pain and its persistence one month following breast cancer surgery, a sample of 114 women scheduled for breast cancer surgery was assessed preoperatively for demographic, clinical, and emotional functioning variables that were hypothesized to be associated with acute pain severity. Clinically meaningful postoperative pain was assessed at follow-up interviews 2, 10, and 30 days after surgery. In univariate analyses, the risk of clinically meaningful acute pain was increased among women who were younger, unmarried, had more invasive surgeries, and had greater preoperative emotional distress. In multiple logistic regression analyses, greater preoperative anxiety was the only variable that made an independent contribution to predicting clinically meaningful acute pain at 2 days after surgery whereas younger age, being unmarried, and preoperative anxiety each made an independent contribution to predicting clinically meaningful acute pain that persisted from 2 to 30 days after surgery. These results increase understanding of neurobiologic mechanisms and psychosocial processes that contribute to the development of acute pain following breast cancer surgery and have implications for the development of interventions to prevent it.
Chronic pain following surgical procedures for breast cancer was once thought to be rare. The res... more Chronic pain following surgical procedures for breast cancer was once thought to be rare. The results of recent studies, however, suggest that the incidence of chronic pain following breast cancer surgery may be over 50% (Tasmuth et ...
To identify risk factors for postherpetic neuralgia (PHN) using a validated definition of this ch... more To identify risk factors for postherpetic neuralgia (PHN) using a validated definition of this chronic neuropathic pain syndrome, to determine combinations of risk factors that identify patients with a high risk of developing PHN, and to examine the characteristics of patients with subacute herpetic neuralgia, that is, pain that persists beyond the acute phase of herpes zoster but that resolves before PHN can be diagnosed. The authors examined baseline and follow-up data from 965 herpes zoster patients enrolled within 72 hours of rash onset in two clinical trials of famciclovir. Univariate and multivariate analyses indicated that older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity made independent contributions to identifying which patients developed PHN. Patients with subacute herpetic neuralgia who did not develop PHN were significantly younger and had less severe acute pain than PHN patients but were significantly more likely to h...
PAIN®, Volume 118, Issue 1, Pages 10-14, November 2005, Authors:Beth F. Jung; David Herrmann; Jen... more PAIN®, Volume 118, Issue 1, Pages 10-14, November 2005, Authors:Beth F. Jung; David Herrmann; Jennifer Griggs; Anne Louise Oaklander; Robert H. Dworkin. ...
Chronic pain following breast cancer surgery is associated with decreased health-related quality ... more Chronic pain following breast cancer surgery is associated with decreased health-related quality of life and is a source of additional psychosocial distress in women who are already confronting the multiple stresses of cancer. Few prospective studies have identified risk factors for chronic pain following breast cancer surgery. Putative demographic, clinical, and psychosocial risk factors for chronic pain were evaluated prospectively in 95 women scheduled for breast cancer surgery. In a multivariate analysis of the presence of chronic pain, only younger age was associated with a significantly increased risk of developing chronic pain 3 months after surgery. In an analysis of the intensity of chronic pain, however, more invasive surgery, radiation therapy after surgery, and clinically meaningful acute postoperative pain each independently predicted more intense chronic pain 3 months after surgery. Preoperative emotional functioning variables did not independently contribute to the prediction of either the presence or the intensity of chronic pain after breast cancer surgery. These findings not only increase understanding of risk factors for chronic pain following breast cancer surgery and the processes that may contribute to its development but also provide a basis for the development of preventive interventions.
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