Mark's Musings - July 15

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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Retail Pharmacy Provides More Drug Disposal Options (201 views)

This is a great move by Walgreens. If you're not familiar with DisposeRx, Inc., it is an awesome tool in addressing the #opioid epidemic by making unused pills unusable (pills + warm water, shake, trash bin). I got to visit with them at the Prescription Drug Abuse & Heroin Summit in ATL in April 2017 and their founders are very passionate about making an impact. Whether unused Rx opioids are taken to anonymous kiosks / DEA takeback days for proper disposal or DisposeRx is used at home, taking these pills out of circulation for those that might abuse them is key. FYI, Walmart was the first to do the same thing on 1/17/18. I hope all pharmacies at some point adopt the same strategy. According to this Washington Post op-ed on 1/14/19 - written by the Head of Corporate Social Responsibility of Purdue Pharma (yes, them) - "up to 40 percent of dispensed prescription medications are not completely used during treatment and are likely to remain in the home ... 53 percent of people aged 12 or older who misused prescription pain relievers in the past year reported that they obtained the pain relievers most often from a friend or relative." So there are high stakes in carefully handling unused prescription medications that can be abused. Lock them up, dispose of them properly, or maybe don't get as many pills!

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Why changing how we view pain can help us address the opioid crisis (1.202 views)

Changing our expectations about #pain:

"Too many of us, too often, think of pain as something that needs to be eliminated, and so we focus on pain intensity, with the goal of no pain ... He was willing to be uncomfortable and work hard ... Part of why Colin was able to make it through is because he doesn’t expect life to be pain-free ... I knew that I didn’t want to be on the meds for too long so I went into it expecting for it to be pretty terrible ... Some pain is devastating and life-limiting, and sometimes that pain responds well to opioids. But we can be part of an important culture change. We can stop demanding from our doctors a pill for every pain, and we can try to take seriously the non-medication treatments they suggest."

If you're dealing with pain - or about to deal with pain (i.e. there's a surgery in your future) - please invest five minutes to read this article. Your perspective on pain before it happens has a lot to do with how you deal with it when it arrives. Three comments on this post add extra depth to the subject:

• From Maria Goodwin: "The idea of changing how we view pain and accepting that life is not going to be pain free, regardless of an injury, is one of the best arguments I can think of to help injured workers understand the need to accept the possibility of living with chronic pain, without relying on pain medication permanently. As a vocational counselor and manager in the workers' compensation system, I have seen the direct impact that permanent pain medication has had in an injured workers life. Helping the worker understand the impact of permanently taking prescription pain medication to their future career and quality of life has to begin with the physician's understanding and willingness to think outside the box of pain management."
• From Debbie Smith: "I complete agree! We can help people better prepare for pain by communicating directly and factually about the level and duration of pain that can be expected. I think it is also critical that we stress the importance of getting up and about after a surgery or injury. My husband recently had a knee replacement surgery that went better than expected due to the exceptional preparation by the medical team. They let us know up front exactly what to expect and discussed ways in which to keep pain at a tolerable level."
• From Rosemary McKenzie-Ferguson: "When I stopped taking all the opioid based stuff that the medical team was filling me with they all told me I would never cope with the amount of pain my body was in. My response was simple- I simply will not allow myself to think of myself the way that others believe. I am the first to admit it was hell on wheels my body went into shock as the withdrawal symptoms took hold, I was screaming in pain without making any external sounds. I put my family threw so much heartache as they watched and cared for me. Once my mind was clear and once I finally could grasp what the future would be like it was doable and workable to work with what was in place. It all comes down to understanding just what pain is."

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People who spend more time outdoors lead more fulfilling lives, new research shows (590 views)

This confirms my "anecdotal" evidence that hiking in the mountains, watching the ocean waves wash in, eating "al fresco", even watering the plants always makes me happy. I didn't realize there was a number (120 minutes) to target but that is typically achievable for me each week. Does being in nature solve all our problems? No - but nothing does. Can it help (for a multitude of reasons)? Yep. And the best thing? It's free! It does not require a doctor's prescription! You can do it at your own pace and time of choosing! Why do we like to over-complicate things? Because some times we feel like a complex issue requires complex solutions. In actuality, often it's the simplest solutions that work best.

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How Our Brains & Guts Work Together for Mental Health (881 views)

The dots are being connected ...

"The researchers found that two groups of bacteria, Coprococcus and Dialister, were reduced in people with depression ... You can’t think of your brain as some sort of stand-alone organ — it’s an integrated part of a holistic system ... This also helps to begin to explain why diet and exercise have been shown to help people with mental health concerns, even serious ones such as depression ... We can’t say whether these changes in bacteria cause depression or other mental health concerns, or are simply a byproduct of having such disorders already."

The more scientists study, the more they learn. And, often, what they learn confirms common sense. Your body is an interconnected system, and any component that is not well - or treated well - affects the whole. "Both types of bacteria appear to be responsible for breaking down dietary fiber in order to produce an anti-inflammatory compound called butyrate ... This also helps to begin to explain why diet and exercise have been shown to help people with mental health concerns, even serious ones such as depression. A balanced diet that includes lots of fiber helps keep your gut system running efficiently by helping to support a more diverse gut microbiome. And exercise helps keep your body’s internal systems like this one running well and as they were designed." And that's why I talk about (good) nutrition and exercise (a lifestyle of activity) as a component of managing pain to optimize quality of life.

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What Percentage is “Useless Orthopedic Surgery” Based on Research? (173 views)

"53% of orthopedic surgeries being performed are useless" is a pretty bold & provocative statement. It is an op-ed by a provider of alternative services to surgery but I think the author's estimates (even if not 100% accurate) raise a good point. If you're considering any of these following surgeries - Meniscectomy (24%), Lumbar Discectomy (14%), Knee Replacements (7%), Shoulder Acromioplasty (4%), Lumbar Fusion (2%) - make sure you know your options before making a decision. I know that exhausting conservative options can be exhausting, but it's a worthwhile journey to ensure when you have surgery that it's the right choice. We can argue whether the percentages are accurate. However, I think it's inarguable that surgery should be the final option in more cases than it is.

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In addition, I published three blogposts:

• "Mark's Musings - July 8" on July 9
• "Do You Remember When?" on July 11 by WorkersCompensation.com
• "Every Road to Recovery is Unique" on July 12 by WorkCompWire

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

#PreventTheMess + #CleanUpTheMess = The Answer.