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Links for help and doctors, medications...

Sep 16, 2010 - 0 comments

Links for Help  
American Pain Foundation
The American Pain Foundation web site is an online resource for people with pain, their families, friends, caregivers and the general public. This site is devoted to patient information and advocacy, and provides many links to additional resources.

National Pain Foundation
Treatment Options, Personal Pain Inventory, Personal Pain Journal, Links, Education, Support, etc.

Arthritis Foundation

Pain Center

51 Ways to be Good to your joints: Relieve Stress and Pain

Back Pain
American Cancer Society

Pain Control: A Guide for People with Cancer and Their Families content/MIT_7_2x_Pain_Control_

Myths and Misconceptions About Pain Control

American Chronic Pain Association

American Council for Headache Education

Cancer Care

The National Hospice and Palliative Care Organization

The Mayday Pain Project

The Vulvar Pain Foundation

National Fibromyalgia Association

National Headache Foundation

The TMJ Association

Care Credit

False negatives...Pitfalls of Urine Drug Monitoring in Pain Care ...

Aug 09, 2010 - 9 comments

False negatives...Pitfalls of Urine Drug Monitoring in Pain Care ...

I am always looking for information on the effectiveness and accuracy of the drug test we have to endure. I have just come across this one from Early this year.
It has alot of information on how the UA works and why they are inconclusive most of the time.
I am including the link as I have not posted everything in the article.
The VA study I have posted in my journal and refer members to was done in 2004 I believe. I continue to look for updated material on this as we do get members who have to deal with the mysterious results of a false negatives alot.
I will also post this link in the health pages and journal for future reference.
I have several other studies I am looking at also that addresses false negatives.
With so many having to deal with this problem I try and keep the newest information up here in the community.
When someone has received a false positive it is good to have reference material to do to the doctor with and show that this is an all to common problem.
I do hope it will help someone:)

Drug monitoring in pain practice is often a two-stage process [Leavitt 2005]:

A.Preliminary Screening of patient-provided specimens, usually urine, at the point-of-care (POC) to detect the presence or absence of a limited number of prescribed and non-prescribed drugs of interest. The accuracy and reliability of relatively inexpensive POC screening assays are limited; although, more costly laboratory-performed assays can be of higher quality.

B.Confirmatory Testing techniques, using high-quality methods (eg, GC-MS, LC-MS), are more expensive but highly accurate and reliable. A problem is that these methods sometimes can be too good, detecting small amounts of irrelevant agents or metabolites that are diagnostically unhelpful or confusing.

While it would be presumptuous to caution against the use of urine drug monitoring, there are a number of potential pitfalls worth noting. Here are several common as well as less well-known considerations:

•Detection cutoff-levels do not always take into account passive (innocent) exposure to marijuana or cocaine consumed by others, consumption of poppy seeds (natural opiate), and the use of OTC products that may cross-react with the assay to produce false results [Evans et al. 2009; Reisfield 2009].

•A number of opioids are metabolized by liver (CYP450) enzymes: eg, codeine, hydrocodone, oxycodone, methadone, buprenorphine, tramadol, and fentanyl. Individual patients may have genetic variants of the enzymes, or may be taking inducer or inhibitor drugs, that strongly influence opioid metabolism and, hence, their detectable presence or absence in urine (or blood, or oral fluid if used) [see, Carlozzi et al. 2008; Smith 2009]. For example, the unexpected absence of one of the above opioid analgesics upon testing can be due to rapid metabolism in a patient rather than therapeutic noncompliance or drug diversion.

•Morphine preparations typically contain low levels of codeine as an impurity, which may be detected by high-quality assays in patients who have not been prescribed codeine [Evans et al. 2009].

•Patients prescribed high doses of oxycodone also may test positive for hydrocodone, which is believed to be present as an impurity; analytically this is a true positive, but diagnostically it is a false positive [Evans et al. 2009].

•It has been clinically observed that unanticipated conversions between opioids going beyond common metabolic pathways may occur, and these can be detected by high-quality assays [Haddox 2005]. For example, patients prescribed only codeine might test positive for codeine and morphine, and also hydrocodone and hydromorphone. Patients taking only morphine might also test positive for hydrocodone and/or hydromorphone. While mechanism behind this metabolic phenomenon are not understood, such findings could falsely suggest that patients are taking unauthorized opioids.

•Proprietary, computerized methods have been developed for quantifying the amount of opioid agents in testing samples; these have been based on controlled conditions examining carefully-selected patients [Couto et al. 2009] or pharmacologically adjusted values [Kell 1994, 1995]. Relying on quantitative tests to help determine whether a patient is properly taking the specifically prescribed dose of opioid can be questionable, especially in patients who do not fit typical patterns of metabolism or have other confounding factors. Due to their limitations, quantitative assessments have been eschewed by government agencies where the consequences of misinterpretation could be severe (eg, Drug Courts).

•Even the most high-quality laboratory testing may not deter persons seeking opioids for illicit purposes — they know how to cheat. An entire industry has sprung up offering advice and products to “beat the test” (just insert that phrase into any search engine to see the myriad of solutions being promoted).

•Case reports have noted false-negative results for opioids and cannabinoids in the presence of tolmetin, an NSAID, and for amphetamines due to interference by chlorpromazine (eg, Thorazine®) metabolites. The antifungal agent fluconazole may interfere with the detection of cocaine [Reisfield 2009]. Persons determined to “beat the test” may know about this.

•A popular and effective way to beat the test is by substituting “untainted” urine for one’s own by carrying a concealed specimen into the bathroom. The only way to thwart this is by supervised urine collection (ie, a staff member observing urine leave the patient’s body and fill the cup). While this is required for forensic urine testing, it could be the ruin of a typical medical practice; it is upsetting for patients and demoralizing for staff.

•To avoid the possibility of urine specimen substitution, oral fluid can be collected for use with screening devices employing technology similar to on-site, POC urine screens. Sensitivity and specificity of oral fluid screening and testing are acceptable, but subject to the same limitations of interpretation and confounding factors as urinalysis [Leavitt 2005].

•Urinalysis is unhelpful for detecting alcohol misuse or abuse [Moeller et al. 2008], and alcohol can be more hazardous in combination with opioids than many other drugs.

The above list is certainly not all-inclusive [eg, also see, Carlozzi et al. 2008; Reisfield et al. 2007b]; however, in view of the many caveats, healthcare providers may want to reconsider what they expect to accomplish by drug monitoring as a component of pain care and if it will adequately serve them and their patients

Medication conversion chart and much more...

Aug 09, 2010 - 0 comments

Please take a look... Medication conversion chart and much more...

We have so many members changing medications and I thought this would come in handy. I know when I changed medications I would like to have seen this chart.
There are other tools here as well. Many medical calculators,conversion data,live medical news feeds and so much more.
I came across this while doing further research on false positives to add to what I have found.
I try to keep anything important to us chronic pain sufferers here for us and new members.
We have so much to deal with I try and do what I can to help.

I will include this in the health pages as well as my journal just as I have with the other research I have done.
I hope this helps someone:)

Here is the link.....

Look up presciption prices in your area....

Feb 17, 2010 - 1 comments

I often have to call each pharmacy to check out the price differences. I recently found this place and they give you each price for each pharmacy in your area. Very nice. They also offer a look up for pharmacies in your area too.
I know with today's economy it is important to get the best prices and this helps us do that.
I hope it helps you as much as it has me:)