#PewPerspectives - Week of Jan 29

Following are the stories that I posted on LinkedIn during this week in case you missed them, along with my additional editorial comments in bold. View counts are as of 10:00am ET on February 6.

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Regular high-intensity exercise may stall Parkinson's symptoms (479 view)

Regular (three times per week at a minimum) of high-intensity (heart rate at 80-85% of maximum) exercise helped patients with early onset Parkinsons in this study to delay progress of the disease. While moderate (60-65%) exercise helped, getting the heart pumping harder helped more. Their point? "Exercise is medicine". Exactly. As I've relayed on multiple occasions, many doctors have used the term "motion is lotion" to reinforce with me how important activity is to managing pain. Well, here's some more proof (so many other studies that validate that assertion) for how that's true. Since pain is processed in your brain, and exercise helped slow progress of a neurodegenerative disease (i.e. in the brain), obviously exercise is a good thing for your brain (and your pain). For your heart's, and brain's, sake ... ADOPT AN ACTIVE LIFESTYLE.

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#WordsMatter (1,168 views)

WorkCompCentral has posted the replay of the "#WordsMatter" webinar that Bryan Conner and I presented on January 17. In case you didn't get to attend real-time, you can watch/listen now. Note that you'll need to setup a login for WorkCompCentral to access it but you do not have to pay anything if you don't already have an account. It was, and still is, free to listen. An "advocacy model" has just recently been gaining traction in Work Comp - to some degree, in parallel with the slow paradigm shift to the #BioPsychoSocial treatment model and value based (outcomes oriented) measurements. All three are very important to understand and implement. The days of treating a person in 2D (what's physically wrong with them) has passed. We all need to be thinking in 4D (psycho social spiritual). And part of that is our attitudes and actions that lead to the words we use in person, on phone calls, and in writing. "Us" vs. "Them" is counterproductive. Indeed, #WordsMatter.

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Opioid epidemic top priority for surgeon general (448 views)

If you've been following me for awhile you know I was a fan of now-former U.S. Surgeon General Vivek Murthy's involvement in battling the #opioid epidemic, especially his #TurnTheTide effort. It looks like the new Surgeon General, Dr. Jerome Adams, will have a similar focus on helping to #CleanUpTheMess. Especially given the personal story (as the opioid epidemic has become) of his brother that battles substance use disorder (SUD). According to this recap article, his focus will be on broadening access to naloxone and MAT along with encouraging broader training for clinicians on how to "detect and intervene" in SUD (an excellent idea). I'm sure there will be additional tactics he'll announce into the future, but it seems as though he will use his influential role of the Medical Director for the entire U.S. to talk about it. Of course, we need actions and not talk, and I'm hopeful he will do both ... Loudly. Many people in many areas of influence are working towards solutions, whether it be the parents of a child that died from an overdose to those in active recovery paying it forward to community leaders to state legislators to governors to the Federal government. They all have a significant part to play in such a complex issue. The Surgeon General certainly is part of that, from Dr. Murthy to now Dr. Adams. In this case, he has personal experience that will help not only motivate him but to exude empathy.

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Normal people in difficult health situations benefit from psychological services (282 views)

"Many people who are suddenly faced with UNUSUAL EVENTS have NORMAL HUMAN REACTIONS to them that lead them to make unwise decisions that lead to worse-than-necessary outcomes." Well said, Jennifer Christian! And I appreciate the analogy to hospice care. While we were not new to the concept of death, being confronted directly as immediate caregivers was new to my Mom and I as my Dad passed away from Parkinsons in 2014. We were grateful for the education that the hospice clinicians and pastor provided to help prepare us for what was happening and to come. As stated in this article, many people confronted with life challenges - including acute post-surgical pain and potentially the introduction of lifelong chronic pain - are not fully prepared for what that means. And that sometimes means they may not be fully prepared to deal with it successfully and could make uninformed choices that have negative repercussions. Psychological treatment, including CBT, is not just for "screwed up people" but for anyone that needs help in dealing with change. As many smart physicians and psychologists have consistently told me, it's not a sign of weakness to ask for help. For anyone that's overwhelmed (by whatever), asking for help is actually a sign of strength and self-awareness.

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ExecuSummit (488 views)

Changing demographics in the physical capacity of workers in just a decade. Imagine the impacts. This insight was provided by Thomas B. Gilliam, Ph.D of IPCS. These statistics bear the bad news that we are generally less physically fit and more sedentary than we should be. The implications are huge if we don't reverse the trend. ADOPT AN ACTIVE LIFESTYLE.

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More empathy for suffering improves patient experience (356 views)

Thanks to Robb D Wright, who I got to meet at today's (Jan 30) ExecuSummit event (and who provided very helpful comments as part of my interactive session) for sharing this article with me from Dr. Jennifer Christian. Yes, it's the second article of hers I've posted today. But her content this time, more empathy for suffering, is a perfect followup to my "Injured Workers Are People Too" session where I discussed with the audience the need for more empathy (and the difference between sympathy). Empathy (which is more than just words but action) doesn't rely on your job title or paycheck or education as evidenced by Jennifer's examples. Empathy just requires an attitude of servanthood and humility that helps others. You're probably sensing a theme for this week's articles ...

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Electronic Prescribing of Controlled Substances Growing (439 views)

Electronic prescribing of controlled substances (EPCS) definitely has a role in helping #CleanUpTheMess. States understand that. I have been a fan of it since NY mandated EPCS on 1/1/16. From what I can tell, there are currently 11 states with mandatory e-prescribing (GA, KY, LA, ME, MN, MO, NC, NJ, NY, TN, VA). There are another 10 states that have requirements but are voluntary (CA, FL, KS, MI, MT, NE, ND, OH, OR, WI). There may be some I'm missing, but the trend is to at least suggest if not require EPCS. According to this article, the top 10 states for EPCS in 2016 were NY, ND, SD, NE, RI, DE, MN, TX, MI, NC. There was a 256% rise in the use of EPCS from 2015 to 2016. However, only 14.1% of prescribers were enabled for EPCS. And obviously a majority of states don't mandate this best practice. Given how it can reduce errors (no concerns with legibility), reduce fraud (paper script pads can be stolen or reproduced), and increase security (no doubt who wrote it, where it's going, and who it's for) - Why is this not more widely used / mandated? This seems like a HUGE no-brainer. States working on their "opioid task forces" should include this in their strategy.

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Pain Psychology: Is it really all in your head? (683 views)

Is pain in your brain? Yes. Not that it's made up. Just that your brain is what processes your pain, and there's a lot of other things rattling around in your brain that effects how it does that processing. "Living with chronic pain for months and years leads to negative conditioning in the brain and the body --toward pain and distress—that’s the bad news. The GOOD NEWS is that you can recondition mind and body away from that negative conditioning and toward a healthier state – one that leads to greater comfort, less distress, and less need for pain medication." Everybody - from patients to providers to payers - often forget how important the brain (not the tissue but the thought processes) is to the proper management of pain. Not that everyone can "think" their way out of pain, but anyone who dismisses the value of addressing those thoughts when managing pain is missing the big picture.

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Walmart offers free opioid disposal product that turns dangerous painkillers fueling a nationwide epidemic into a useless gel (753 views)

Given that 67-92% of 810 patients in 6 studies did not use all of the #opioid pills they were given, and > 90% don't dispose of them properly, this offer by Walmart to provide ... FREE ... a way to properly dispose of unused painkillers is important. In fact, THIS . IS . HUGE for taking these pills out of circulation from those that might abuse, misuse or divert them. Not just because it's FREE but because of the mainstream highlight this will place on proper disposal. However you secure them or get rid of them, don't delay. Lives could be at stake.

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DEA launches new crackdown on pharmacies and opioid over-prescribers (458 views)

"The industry <Big Opioid Pharma> has countered that corrupt doctors and pain-pill mills are mostly to blame for the epidemic and that the DEA has not done enough to combat the epidemic." A gross over-simplification and not entirely accurate. But for the sake of that argument, consider this new "surge" initiative by the DEA as a response to the "prescription drug diversion" issue. As I've mentioned before (as has many others), we can't "arrest" ourselves out of the epidemic. But anyone who dismisses law enforcement as part of #CleanUpTheMess is missing the big picture.

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Doctors work to balance pain control, potential for addiction (1,045 views)

Finding the right balance in public policy (in this case, a Florida law) and the individual needs of patients is difficult and complicated. The good news is there is discussion around that balance. The bad news is there doesn't appear to be any consensus just yet and it's something our society will wrestle with for awhile. "There has to be a conversation with patients. This is a partnership among the physicians, pharmacists and patients. As physicians, we are working to heal and avoid harming the patient." Education on choices and what "pain management" is (maybe not the absence of pain but the ability to function regardless). Medicare's 1/1/18 requirement of hospitals to not just ask "how well the hospital did at controlling their pain" but also "how well the hospital did in talking with them about their pain" is a start in the CONVERSATION that needs to happen. As is the 1/1/18 requirement by the Joint Commission to focus broader (than opioids) treatment options for pain (read my article). The dialogue we're having as a society, and the medical community is having among themselves, is vastly overdue. We shall see how Florida decides to address it in the 2018 legislative session. Solving this issue is not easy, and it will not be fast. But it's extremely important that it's balanced.

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Working through workplace stigma: Coming back after an addiction (667 views)

From a doctor ... "bring your body, and your mind will follow" ... RTW (return to work) is a goal for #WorkComp but it may not be as straightforward for someone in recovery. I believe the majority of injured workers (and, more broadly, patients) using inappropriate polypharmacy regimens for weeks/months/years are dependent, not addicted, to the painkillers. But if it's the latter, we need to be aware there are many success stories of recovery and making an assumption based on #stigma leads nowhere good.

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In addition, I published one blogpost:

• "#PewPerspectives - Week of Jan 22" on January 29

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

#CleanUpTheMess