Mark's Musings - January 14

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

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Fear of Pain Triggers Crippling Anxiety for Some but Not All (132 views)

Thanks to Kathy Hubble for sharing. Converting self-reported subjective feelings to objective findings when it comes to #pain is difficult - kinesiophobia (fear of movement) makes it even more difficult. That's one reason why this study is interesting. "What makes this neuroscience-based approach and the brain scans below significant is that these images represent the first time researchers have correlated self-reported emotions relating to pain with specific neural signatures." In my discussions with behavioral psychologists over the past eight years, "fear avoidance" is a primary red flag for delayed recovery (along with perceived injustice and catastrophization). Being afraid to move because it might hurt - or that it might do additional damage - is a totally reasonable emotional response. But unless the treating physician believes movement will indeed cause more damage, not moving because of that fear can likewise do damage. And based on this study, the damage is just not physical (i.e. de-conditioning) but emotional and psychological.

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Why Exercise is My Best Sleeping Pill (1,425 views)

Becky Curtis had an attitude at one point that "moving made my pain worse" (kinesiophobia - see my other post above). But then she realized that just laying there and taking sleeping pills was actually worse than the pain from exercise. And so she moved. And has kept moving (I know because I've hiked with her). Not surprisingly, she found clinical evidence to back up her movement - "His conclusion is that inactivity is shriveling our brains and allowing stress to become toxic - both of which can be reversed with regular exercise." So if you're in #ChronicPain, do what Becky does: Move.

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Opioid fight shows glimmers of progress (362 views)

This is an op-ed documenting positive progress against the #opioid epidemic in three communities (Burlington VT, Rhode Island and Ohio). The article is primarily focused on the tactics of increased access to naloxone and MAT (Medication Assisted Treatment) in interesting venues (needle exchanges, prisons) with unique people (those in successful recovery). There’s also an interesting quote included … “What keeps people in recovery is hope that life can be better.” That's true for everybody but especially those caught in the #opioid epidemic. Yesterday somebody posted a comment on my article asking whether progress is being made. This article is one example of a "yes." Here are my actual responses to the initial question of "Well it's still a mess. Have you seen any progress?":

• I agree it's still a mess, and like I said in the blogpost ("#PreventTheMess") it will likely never be fully fixed. It's too complicated with too many divergent incentives involved. But I believe there is progress. Payers are increasingly open to (and willing to pay for) non Rx painkiller options. I've heard many patients reconsider and even push-back on "the status quo" (aka pills) with their physicians. I've heard/seen physicians that are changing their practice patterns - some begrudgingly but others because of an epiphany - and having a longer dialogue with patients. Everybody is talking about it so how to properly manage pain doesn't have the same stigma (especially when it comes to psychosocial considerations). Not all of that has been recorded in the mortality statistics yet - fentanyl overdose deaths continue to rise - but it's certainly better than it has been.
• Are there enough payers paying for the right care? No. Are there enough patients educated on the options to be engaged in their treatment choices? No. Are there enough physicians changing their prescribing patterns? No. Does our healthcare system and society still need a lot of change from that status quo? Yes.
• But positive progress? I believe there is.

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How Music Can Help Health Conditions (351 views)

"I bet you change what you listen to based on how you’re feeling (or how you would like to feel)." Yes, I do. And you probably do too. But can music improve your health - even be considered therapy? There is growing research that shows that's possible. And it connects with that opening statement - music can relax, distract, excite, motivate, set your mood. All of those could be a helpful add-on to your other techniques for managing your life. For example, #ChronicPain. Music could help "focus on your breathing, slowing it down if you are in discomfort. It can also reduce your heart rate and might even lower blood pressure." Sound like hype? Be in a stressful situation, put on some soothing music, and observe how the stress reduces. That will prove the point. And, consistent with my focus, music is self-managed and free - both of which make it much more plausible to use long-term. Try it. I've had a couple of people mention this article and their agreement with my comments since this post. Each said it was common sense. But none had given it much thought as a treatment or adaptation method for life's difficulties (including pain). But now they have! My agitator hat fits well...

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Surgeon General Believes It's High Time To Think About Science-Driven Policy For Cannabis Research (544 views)

Thanks for sharing, Carlos Giron. I've heard the rationale about #opioid alternative and revenue but not innovation ... "His (U.S. Surgeon General Jerome Adams) belief - and that of researchers around the world - is that the current U.S. classification of marijuana inhibits research for medical advancements that include #cannabis and cannabinoids, with the U.S. falling behind in both knowledge and financing." The primary argument of this article is that countries like China (600 cannabis-related patents), Israel (110 clinical studies) and Canada (recreational legalization) will solve the puzzle of how marijuana is medicine before the U.S. and therefore have the edge on innovation. When the "chief medical officer" of our country speaks there is a little more gravitas attached. FOMO (fear of missing out) is real, for an individual and a society, as evidenced by this article "How N.J. could lose out on millions of dollars if it doesn't legalize weed soon." Right now, it seems like the entire U.S. has FOMO about marijuana.

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How Did Our Medical Notes Become So Useless? (282 views)

Interesting perspective on medical notes. I can bloviate with the best of them, but it seems like the combination of clinicians and EMR (electronic medical records) is taking it to an extreme. "Clinical notes in the United States are nearly 4 times longer on average than those in other countries." Why? Is there a rationale for that? Does it help clinicians make better decisions and lead to better outcomes? Not always. How often does being overwhelmed with words cause you to zone out and miss important details? I can only speak for myself: it happens often. This op-ed gives three of the culprits: Money ("certain words or phrases or diagnoses yield higher reimbursement than others"); Copy/Paste (only "18% of the text was manually entered"); Text Expanders ("But do we clinicians really learn, or interpret, material that “autopopulates” a note?"). Is there a way to re-think this so what's put in electronically can actually be helpful to a human? I've read stories where an over-reliance on electronic notes has created an issue (and errors) for shift-change at hospitals. Rather than the personal interaction many clinicians just read what's been written. Well, what if what's written isn't accurate or complete? Or is so overwhelming and filled with "filler" that it's numbing to not just the facts but also that important nuance? Digital records are great until they're not.

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One Crucial Way Aviation Safety Could Help Advance Health Care Programming (196 views)

How is airline safety and healthcare best practices alike? Read for yourself how a pilot's checklist is very similar in concept to medical treatment guidelines. "What if treatment guidelines were not viewed as a medical-legal burden but as a conversation starter? As an organized method by which all stakeholders can assess options? As an opportunity to accelerate the delivery of care compliant with the guidelines and to slow things down when care is complicated or non-standard? As a way to help deliver better, more consistent care? In other words, as a checklist?" I hear opponents of treatment guidelines argue they are "cookie cutter" mandates for care that remove the expertise of the physician from the equation. That argument is answering the wrong question. The real question is why wouldn't a clinician want to have - at their fingertips - all of the current evidence around conditions and treatments so they could leverage their personal expertise to make the best possible decision?

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Artificial intelligence can detect Alzheimer’s in brain scans six years before a diagnosis (372 views)

AI (artificial intelligence) has promised many things for the future of healthcare and a lot is happening in the present towards that goal. For example, a 2017 study found that IBM's Watson identified malignant skin cancer at a rate of 76% - dermatologists found it at 70.5%. And this study is about identifying Alzheimer’s as much as six years before a clinical diagnosis can be made. What does all this mean? Hopefully quicker and better diagnoses that can lead to the right treatment and deliver positive outcomes. "AI’s diagnostic skills could give doctors a much-needed headstart on treating the degenerative disease." But it can probably do the same for other diseases and conditions, including pain.

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Safety Program Work, Long Island Comptroller Suggests (240 views)

One of the ways to #PreventTheMess is thru better workplace safety. The second of "5 Things to Know" by Nancy Grover is entitled "Safety Program Work, Long Island Comptroller Suggests" and outlines how that might work. "To reduce costs, the department:

• Hired a full-time health and safety assistant
• Instituted town-wide training on employee safety and injury reporting
• Implemented a centralized injury reporting system
• Mandated first-day contact with injured workers to coordinate medical care and workers' compensation filings."

All common sense. Especially the last item. Staying in touch with the injured worker, an EASY way for the employeR to let the employeE know they care. And if they feel that caring, chances are (really good) there will be less litigation and faster RTW. Simple stuff. Proactive. Up-front costs that deliver downstream results. This should be considered a best practice, By every employer. Is it? It not, it should be.

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In addition, I published two blogposts:

• "#PreventTheMess" on January 7
• "Mark's Musings - January 7" on January 8

And this article was published (actually updated from the original 2017 publishing) by my friends at LegalNet that describes who I am and what drives my day:

• "Thursday Thought Leader" on January 8

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#PreventTheMess + #CleanUpTheMess = The Answer.