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Why opioids are overrated for pleasure and pain

About the event

Opium, morphine and other opioids are famous for their ability to relieve pain and cause pleasure. These mythical effects may however be just that: mythical.

In recent years, systematic, well-controlled studies of opioid analgesics suggest little benefit from opioid treatment of chronic pain or even of acute musculoskeletal pain. In addition to reducing pain, opioid drugs change a cascade of other feelings, such as increased nausea, constipation and sedation that limit their clinical utility. The numerous unpleasant opioid effects are also thought to substantially dampen any opioid-induced pleasure.

In healthy people who do not regularly use opioids, the sum total is frequently a disliking of opioid drug effects. Healthy people will sometimes even pay money to *avoid* getting another opioid! I will discuss the evidence on how opioids change how people feel, and discuss how some of these opioid-related myths have become so persistent in science and society.

World Event Times

London – Tuesday 11 May 2021, 19:00 GMT

Oslo – Tuesday 11 May 2021, 20:00 CET

Amsterdam – Tuesday 11 May 2021, 20:00 CET

New York – Tuesday, 11 May 2021, 14:00 EDT

Adelaide – Wednesday, 12 May 2021, 03:30 ACST

Prof. Siri Leknes

Siri Leknes is a Professor of Social and Affective Neuroscience at the University of Oslo, Norway and Senior Researcher at Oslo University Hospital. She completed her D.Phil. at Oxford and postdoctoral research at Gothenburg University. Her lab in Oslo, the Leknes Affective Brain lab (LAB lab), studies how the brain and body give rise to pleasurable and painful feelings. One interdisciplinary project centred on benefits of acute pain and was awarded The Daniel M. Wegner Theoretical Innovation Prize in social/personality psychology. Currently, LAB lab specialises in drug studies. Through psychopharmacology in healthy humans, Leknes’ team charts how the brain’s neurochemical systems shape hedonic feelings, decisions and behaviour. LAB lab also conducts studies in drug-treated clinical populations. Leknes is currently funded by an ERC grant to study state-dependent effects of opioids and their relation to social support, stress and dopamine, as well as by the Regional Health Authority to study mood, stress and pain in clinical groups treated with opioid agonists and antagonists.

Get your tickets here!

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Call for an Urgent Action on Forced Opioid Tapering

Call for an Urgent Action on Forced Opioid Tapering

Synopsis

Opioid tapering guidelines were created, in part, to decrease harm to patients resulting from high-dose opioid therapy for chronic pain. However, countless “legacy patients” with chronic pain who were progressively escalated to high opioid doses, often over many years, now face additional and very serious risks resulting from rapid tapering or related policies that mandate extreme dose reductions that are aggressive and unrealistic.

Key Points

There are major concerns:

  • rapid, forced opioid tapering among outpatients;

  • mandated opioid tapers that require aggressive opioid dose reductions over a defined period, even when that period is an extended one.

Research papers

You can read a full text here

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Implementing models of care for musculoskeletal conditions in health systems to support value-based care

Implementing models of care for musculoskeletal conditions in health systems to support value-based care

Synopsis

Recognition is growing that to create patient‐centred care, health‐care organizations need to more directly engage patients across the spectrum of health‐care design and quality improvement. We highlight two papers that emphasize the necessity of implementing models and frameworks for research and  the clinical setting. From: Abstract

Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems..

From: Abstract

Key Points

This study demonstrated the feasibility and benefits of including a roughly equal number of patients and clinical providers/staff in design events and ensuring that the patients represent diverse perspectives.

The evidence is clear that the development, implementation and evaluation of MoCs must rely more on the involvement of those with the lived experience. Their involvement must be in collaboration with those who provide care, their managers and funders.

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What can patients contribute and why it is needed?

What can patients contribute and why it is needed?

Synopsis

If patient-oriented research is intended to focus on priorities that are important to patients and produce information that is truly taken up and used to improve health care practice, therapies and policies, a strong foundation for ensuring successful collaboration must be laid.

The Canadian vision:

“Patients are active partners in health research that will lead to improved health outcomes and an enhanced health care system.”

Key Points

Patients bring the perspective as “experts” from their unique experience and knowledge gained through living with a condition or illness, as well as their experiences with treatments and the health care system. Involvement of patients in research increases its quality and, as health care providers utilize research evidence in their practice, increases the quality of care. “Engaging patients in health care research makes (investments in) research more accountable and transparent, provides new insights that could lead to innovative discoveries, and ensures that research is relevant to patients concerns. The international experience with engaging citizens and patients in research has shown that involving them early in the design of studies, ideally as early as at the planning stage, leads to better results.”Footnote 1 By encouraging a diversity of patients to tell their stories, new themes may emerge to guide research. Patients gain many benefits through their involvement including increased confidence and master new skills, access to information they can understand and use, and a feeling of accomplishment from contributing to research relevant to their needs.

Read more about this here

Research papers

Two other papers that may be of your interest that talk more about co-design/co-production of care/services:
 
 
 
And research oriented resources, may be useful for any researchers interested in taking on this work:
The AP2 website – International Association for Public Participation is a great resource . Here is the resource page for their 3 pillars: https://www.iap2.org/page/pillars
 
And the Canadian Institute of Health Research’s Ethics guidance for developing partnerships with patients and researchers and their webpage for their overall Strategy for Patient Oriented Research
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Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain

Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain

Investigating Trust, Expertise, and Epistemic Injustice in Chronic Pain

Synopsis

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of epistemic injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management.

Key Points

The first challenge relates to the conflicting obligations HCPs face in providing care for patients living with pain, especially when the pain sufferer is also living with addiction and mental illness.

The second challenge is that epistemic humility re- quires the HCP to be empathic and compassionate in inviting the pain sufferer to tell their story.

A third challenge in motivating epistemic humility is that caring for patients with pain can be demand- ing. Many providers are overworked and overburdened

Further reading

We would strongly recommend you to read this paper. You can find a full text here

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Pain doesn’t stigmatize people. We do that to each other

Pain doesn’t stigmatize people. We do that to each other

Synopsis

This is a bit heavier reading yet really important, Pain doesn’t stigmatize people. We do that to each other. By DANIEL S. GOLDBERG JANUARY 23, 2020 – published on StatNews.com. Well worth a read. For the full article you can the the link. 

 A bioethicist who did his PhD on stigma in chronic pain: 

‘I view stigma as the combination of difference plus deviance: An in-group marks an out-group as different on the basis of a shared demographic characteristic, then judges the out-group as deviant. This is precisely what happens too many people in pain. They are marked as different because of their pain, and then have that pain denied, invalidated, and delegitimized. This is more likely to happen to women and racial or ethnic minorities than to white men.’

To alleviate pain stigma, we also have to decouple it from the stigma directed toward opioid use. While these two types of stigma often occur in the same spaces, they are not identical. We stigmatize people in pain, like my friend Andrea, who neither take nor desire opioids. And we stigmatize individuals who take opioids even if they do not live with chronic pain. A focus on opioid stigma is welcome and important, but it is not equivalent to intervening specifically to address pain stigma. Both of these terrible burdens deserve our attention and efforts.

We have tools to effectively and fairly treat people who live with chronic pain. We have the power to help them live better. We should do so, and without stigma.

The author

Daniel S. Goldberg is a faculty member in the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus, associate professor of family medicine at the University of Colorado School of Medicine, and associate professor of epidemiology at the Colorado School of Public Health. He is the principal investigator of an epidemiologic study related to addiction stigma funded by The Well Being Trust, a 501(c)(3).

Professor Goldberg also wrote ‘Pain, objectivity and history: understanding pain stigma‘ in BMJ and they did an interview with him about it: https://blogs.bmj.com/medical-humanities/2017/12/21/daniel-goldberg-shame-stigma-medicine/

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Why Do We Fear Co-Producing Health with Patients?

Why Do We Fear Co-Producing Health with Patients?e

Synopsis

This blog is posted on the website of the Institute for Healthcare Improvement on November 12th, 2020:

Helen was a nurse who believed her role was to help make things better. Wherever there was a problem, she was determined to help “fix it.” When Helen started working as a nurse in the community, she realized she was no longer “protected” by the status conferred by the uniform she had worn in the hospital setting. She was now in her regular clothes, a guest in someone’s home. This shift in the power dynamics initially made her feel vulnerable. Helen wondered if people felt this way when they were in the hospital.

In health care, outcomes are not created by health care professionals on their own. Health outcomes are co-produced with patients. As leaders and clinicians, we bring a wealth of “learned experience” to the table when working on quality improvement (QI), but it isn’t enough if people with relevant “lived experience” aren’t included as equal partners. Only by partnering with patients can we understand the whole story and see what matters. Only then can we co-design and co-produce improvements together.

During her physiotherapist/physical therapist training, Aimee was taught that her role was to be the “expert” when working with patients. Meeting Bob challenged this view. Aimee was responsible for talking with Bob about whether he was ready for a knee replacement. Practicing shared decision making, Bob and Aimee co-produced a plan that included not only talking about his knee and the surgery, but also how to address his needs as a whole person to optimize his experience and outcomes.

Clinicians are not often taught to co-produce care. Instead, we often struggle with feeling out of our comfort zones. Instead of asking people what matters and improving with them, with the best of intentions we presume to know what is best and improve for them. In her book Dare to Lead, researcher and thought leader on vulnerability, Brené Brown, describes the situation this way:

When something goes wrong, individuals and teams are rushing into ineffective or unsustainable solutions rather than staying with problem identification and solving. When we fix the wrong thing for the wrong reason, the same problems continue to surface. It’s costly and demoralizing.

  •  

Key Points

The literature (see the list below) highlights many benefits of co-producing quality improvement:

  • Creates a sense of urgency among staff and connects them to their core purpose
  • Results in often simple and low-cost change ideas
  • Co-produced improvement projects are set up for success, ensuring ideas are robust and based on quality and practical experience

Read more

You can read the full post here

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Community initiative co-led with patients could improve care for people with complex health and social needs

Community initiative co-led with patients could improve care for people with complex health and social needs

Synopsis

Feb 28, 2020 – BMJOpinion. Canadian family physician Antoine Boivin and patient partner Ghislaine Rouly describe how they work together with community partners to provide holistic care for patients with challenging social and medical problems

The physician’s perspective

As a physician working in a primary care group practice of 12 000 patients, in a disadvantaged neighborhood of Montreal (Canada), I have often had the feeling of being the “right answer to the wrong problem.” Many of my patients present with medical symptoms (depression, chronic pain, fatigue and anxiety) that are exacerbated by underlying social problems (isolation, poverty, divorce, bereavement, stress, violence or work difficulties). I can sometimes refer those patients to a social worker or psychotherapist, but for many, this is met with suspicion (“You mean it’s in my head?”), resistance (“I’ve seen a shrink before and it didn’t help”) or practical barriers (“I don’t have the money”). Most of all, I feel that health professionals are a poor substitute for a caring friend, family member, or neighbour. It was keen awareness of these issues that prompted me to approach Ghislaine, a much trusted and valued patient partner at our University of Montreal partnership programme, to adopt a new way of caring for patients together. [1] Her extensive knowledge as a patient and caregiver, her ability to listen without judgement, her humility and her diplomatic skills gave me confidence that working together we could deliver what I could not do alone. 

The patients perspective

Ghislaine Rouly—the patients perspective

I have been a patient all my life as I was born with two genetic diseases, and have subsequently had three major cancers, for which I have experienced months in an induced coma. As a result I live with chronic pain. I have also lost a daughter following the early diagnosis of an incurable disease. Despite all this, I have found that you can lead a good life if you are determined to do so. For me, helping other patients has always been a natural thing to do. For over 45 years, I have provided peer-support to other patients, accompanying them on their healthcare journey until their end of life. My experience has taught me a lot about the importance of being treated with humanity; and how this is especially important for those who are isolated, alone, depressed, and sick. In the past decade, I have trained health professionals in medical ethics, health communication, and collaboration, based on my lived experience as a patient. 

Four years ago I joined Antoine’s practice as a patient partner, working three days a week with him on a salaried position to care for patients together. We co-designed and co-lead the Caring Community project where patients, professionals and citizens work as partners to bridge medical and social care for people with complex conditions in the community. I was touched by Antoine’s humanity, humility, and concern for his patients. It was clear from the outset that we shared common values and a dream of caring for patients differently, drawing on our complementary skills.

Key learning and next steps

Ghislaine: At the beginning of the project, professionals were telling me that as long as I was here, everything would be fine: but how can we clone you? There is no need for that. There are many patients with great experiential knowledge and engaged citizens with deep knowledge of their community.  It is natural and instinctive that people help each other. We have identified such patients and citizen partners in the past year to join our project: we bring them together, support them, and build a team. 

Antoine: This project has reminded me that healthcare, in its essence, is about building caring relationships and seeing patients as people with knowledge, skills and life projects. I have learned that it is feasible to integrate patients and citizens as members of the team. However, this requires time, patience, and sensitivity to professional resistance and fears. It is possible to build a two-way bridge between the health system and communities. However, keeping a project like this alive is a tough balancing act. Currently, the most pressing questions in front of us are:

  1. How to build Caring Communities with patients and citizens in a way that is equitable and inclusive, ensuring that we mobilize a diversity of patients, clinicians and citizens who recognize the specific knowledge of everyone involved, and work toward a common goal?
  2. How to fund, lead and implement Caring Communities with health and community organisations in a way that is adaptable, sustainable and scalable to other contexts?
  3. How to rigorously assess the impacts of caring with patients and communities on health and social outcomes? What are the main risks, costs and pitfalls? At this stage, individual cases can help us build an intervention theory and hypothesis. Our next research focus will be to strengthen impact evaluation with more robust designs. 

For me, the most important take home message from this initiative so far is that caring with patients and citizens is feasible, enjoyable, natural, and helps refocus care on what matters most to people.

 

The full article is here

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Empowered Relief: Improving access to interventions for pain relief and opioid reduction

About the event

Interested in opioid usage reduction? Then it doesn’t get much better than this!

We are SO excited to welcome, Stanford pain scientist, evidence-based psychologist, author and chronic pain suffer, Dr Beth Darnall to talk about the importance of patient-centered opioid prescribing and deprescribing. She will be looking at

  • The recent statistics around chronic pain and opioids.
  • A low or no-risk alternative to opioids.
  • The role of psychology in chronic pain.
  • The role of emotions in pain.
  • Why opioids are not a long-term strategy for pain.
  • Integrated strategies for pain-relief.

Beth will share insights into her published work as well as her ‘in-progress’ science on brief, digital, and home-based treatments for pain and opioid reduction.

This is going to be an incredible Le Pub Homebrew!

World Event Times

London – Wednesday 20 January 2021, 20:00:00 GMT

Amsterdam – Wednesday 20 January 2021, 21:00:00 CET

New York – Wednesday 20 January 2021, 15:00:00 EST

Adelaide – Thursday 21 January 2021, 06:30:00 ACDT

Beth Darnall, PhD

Beth Darnall, PhD, is a Stanford pain scientist, international speaker, evidence-based psychologist, and author.

Dr. Beth Darnall, PhD

Beth Darnall is Clinical Associate Professor in the Division of Pain Medicine at Stanford University. A pain psychologist, she has treated patients with chronic pain for 15 years. She serves on the boards of directors for several national pain organizations, editorial boards, is a section editor for Pain Medicine, and served as the 2012 President of the Pain Society of Oregon.

Her research — conducted mainly on women with chronic pain — includes investigations of pain catastrophizing and its impact on neural functioning, the immune system, and sensory perception. She is focused on broadening access to low-cost, high-quality pain psychology treatments. She is currently studying how optimizing psychology prior to breast cancer surgery may improve pain and recovery in women.

She serves as the primary investigator on more than $5 million in NIH funding. She is currently investigating mechanisms of catastrophizing and the single-session catastrophizing treatment she developed.

She is Co-Chair of the American Academy of Pain Medicine’s Task Force on Pain Psychology, and in 2015 received a Presidential Commendation from the American Academy of Pain Medicine.

Her main passion is empowering people with chronic pain to harness the power of their mind-body connection to reduce symptoms and optimize health. She is author of Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control Over Chronic Pain © 2014 and The Opioid-Free Pain Relief Kit © 2016.

Cancellation Terms

Places can be cancelled and refunded up to 48 hours before the start of the event. Within 48 hours of start time no refund.

Recordings

Please note that Le Pub Home Brew is a LIVE EVENT. We are looking at options for giving access to recordings in the future, but right now, we are doing what we are best at – bringing you awesome live and interactive learning events!

Get your ticket HERE

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A way Forward and No Going Back

Synopsis

This conversation video with Pete Moore and well known Le Pubbers Kat Gloor, Joletta Belton and Sandy Hilton share thoughts on how the healthcare system is a barrier for access high value care. Very well summarized from multiple perspectives.