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9/11

Sep 11, 2008 - 0 comments

"They were our neighbors, our husbands, our children, our sisters, our brothers, and our wives. They were our countrymen, and our friends."

Godbless all the innocent that lost their lives, the rescuers who fell, and the survivors who go on without their loved ones from that day.

Plowed - Sponge

Jun 24, 2008 - 1 comments

Will I wake up some dream I made up
No I guess it's reality
What will change us or will we mess up
Our only chance to connect with a dream

Say a prayer for me

Say a prayer for me
I'm buried by the sound
Of a world of human wreckage
In a world of human wreckage
Where I'm lost and I'm found and I can't touch the ground
I'm plowed into the sound

To see wide open with a head that's broken
Hang a life on some tragedy
Plow me under the ground
That covers the message
That is the seed

Say a prayer for me

Say a prayer for me
I'm buried by the sound
Of a world of human wreckage
In a world of human wreckage
Where I'm lost and I'm found and I can't touch the ground
I'm plowed into the sound

Will I wake up some dream I made up
No I guess it's reality

Missed the Boat

May 29, 2008 - 0 comments

While we're on the subject
Could we change the subject now?
I was knocking on your ears
Don't worry, you were always out
Looking towards the future
We were begging for the past
Well, we know we had the good things
But those never seemed to last
Oh, please just last

Everyone's unhappy
Everyone's ashamed
Well we all just got caught looking
At somebody else's page
Well, nothing ever went
Quite exactly as we planned
Our ideas held no water
But we used them like a dam

Oh, and we carried it all so well
As if we got a new position
Oh, and I laugh all the way to hell
Saying, "Yes, this is a fine promotion"
Oh, and I laugh all the way to hell

Of course everyone goes crazy
Over such and such and such
We made ourselves a pillar
But we just used it as a crutch
We were certainly uncertain
At least I'm pretty sure I am
Well, we didn't need the water
But we just built that good goddamn

Oh, and I know this of myself
I'd assume as much for other people
Oh, and I know this of myself
We've listened more to life's end gong
Than the sound of life's sweet bells

Was it ever worth it?
Was there all that much to gain?
Well, we knew we'd missed the boat
And we'd already missed the plane
We didn't read the invite
We just danced at our own wake
All our favorites were playing
So we could shake

Tiny curtains open and we heard the tiny clap of little hands
A tiny man would tell a little joke and get a tiny laugh from all the folks
Sitting, drifting around in bubbles and thinking it was us that carried them
When we finally got it figured out that we had truly missed the boat

Oh, and we carried it all so well
As if we got a new position
Oh, and we owned all the tools ourselves
But not the skills to make a shelf with
Oh, what useless tools ourselves

Incompletely controlled physical pain results in identical behaviors to classic addiction...

May 24, 2008 - 5 comments

PAIN TOPICS

What is Pseudoaddiction?
Thomas E. Quinn, MSN, RN, AOCN

This article first appeared in Pain Relief Connection Vol 2 #1, January 2004. “Pain Topics” and Pain Relief
Connection are services of MGH Cares About Pain Relief,
http://www.massgeneral.org/painrelief

Pseudoaddiction is the term for an iatrogenic syndrome that appears to mimic behaviors that are commonly
believed to be associated with addiction. It may present in a patient with or without a history of or risk
factors for drug abuse or true addiction. It usually occurs with acute pain, including acute pain that is
overlaid on a chronic pain condition. It is characterized by a climate of distrust and conflict between the
patient and the care team related to the use of opioids for pain. Its etiology is pain that is inadequately
treated, leading to patient demands for opioid analgesia that are interpreted by the care team as being
excessive. The result is a progressive cycle of patient complaints of inadequate pain relief, sometimes
accompanied by exaggerated pain behaviors, and care team resistance to providing opioids, sometimes
compounded by avoidance and isolation of the patient.

In published case reports of pseudoaddiction, the patient’s report of pain is not believed, despite the presence
of a progressive disease or painful condition, or the potential for tolerance due to prior opioid use is not taken
into consideration by the care team. Inadequate analgesia is therefore inevitable due to either a dose that is
too low or a dosing interval that is too long. There is a tendency in such cases to provide even less analgesia,
further exacerbating the problem. In the case of Pseudoaddiction, “drug seeking” behavior is incorrectly
interpreted as evidence of addiction; it is more accurate it see it as “relief seeking” behavior.

The “treatment” for pseudoaddiction is to redesign the analgesic regimen so that analgesics are provided at
an appropriate dose and dosing interval. Ongoing and thorough pain assessment with corresponding
adjustment of dose (i.e., titrating to effect), as with any patient, is essential. Frank discussion with the patient
about the goals of pain treatment and the care team’s concerns are key to re-establishing a therapeutic
relationship between the patient and the care team. As David Weissman puts it, “pseudoaddiction is
something that we do to patients through our fears and misunderstanding of pain, pain treatment, and
addiction. . . Any time there is a suggestion, because of escalating pain behaviors, that a patient on opioids
may be ‘addicted,’ pseudoaddiction should be ruled out.”*

To learn more about pseudoaddiction, see (cited articles are available in Treadwell Library; Journal
of Palliative Medicine is also available free online via
MAGIC
on MGH computers)
1. Kowal N. What is the issue: pseudoaddiction or undertreatment of pain? Nursing
Economics 1999;17(6):348-349
2. Porter-Williamson K, Heffernan E, Von Gunten CF. Pseudoaddiction. Journal of Palliative
Medicine 2003;6(6):937-939
3. Weissman DE, Haddox JD. Opioid pseudoaddiction--an iatrogenic syndrome. Pain
1989;36(3):363-366
4. Weissman DE. Understanding pseudoaddiction Journal of Pain and Symptom Management
1994;9(2): 74
5. *Weissman DE. Pseudoaddiction.
http://www.eperc.mcw.edu/edmats/detail.cfm?matl_id=333&query_id=&srchType=edmats
&secSrchType=fastFact&sessn_id=5849682845650567882571529
(free registration
required at
http://www.eperc.mcw.edu
, then click on ‘Fast Facts and Concepts’ and navigate
to #069, Pseudoaddiction). Accessed 18 Jan 2004.
MAGIC catalog at Treadwell Library:
http://magic.mgh.harvard.edu/