Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies

Treating chronic pain in the context of opioid misuse can be very challenging. This paper explores the epidemiology and potential treatments for chronic pain and opioid misuse and identifies educational and regulation changes that may reduce diversion of opioid analgesics. We cover the epidemiology of chronic pain and aberrant opioid behaviors, psychosocial influences on pain, pharmacological treatments, psychological treatments, and social treatments, as well as educational and regulatory efforts being made to reduce the diversion of prescription opioids. There are a number of ongoing challenges in treating chronic pain and opioid misuse, and more research is needed to provide strong, integrated, and empirically validated treatments to reduce opioid misuse in the context of chronic pain

The grinch who stole wisdom

Dr. Seuss is wise. How the Grinch Stole Christmas (Seuss, 1957) could serve as a parable for our time. It can also be seen as a roadmap for the development of contemplative wisdom. The abiding popularity of How the Grinch Stole Christmas additionally suggests that contemplative wisdom is more readily available to ordinary people, even children, than is normally thought. This matters because from the point of view of contemplatives in any of the world's philosophies or religions, people are confused about wisdom. The content of the nascent field of wisdom studies, they might say, is largely not wisdom at all but rather what it's like to live in a particular kind of prison cell, a well appointed cell perhaps, but not a place that makes possible either personal satisfaction or deep problem solving. I believe that what the contemplative traditions have to say is important; they offer a different orientation to what personal wisdom is, how to develop it, and how to use it in the world than is presently contained in either our popular culture or our sciences. In order to illustrate this I will examine, in some detail, one contemplative path within Buddhism. Buddhism is particularly useful in this respect because its practices are nontheistic and thus avoid many of the cultural landmines associated with the contemplative aspects of Western religions

The association between baseline persistent pain and weight change in patients attending a specialist weight management service

To quantify the influence of baseline pain levels on weight change at one-year follow-up in patients attending a National Health Service specialist weight management programme.We compared one-year follow-up weight (body mass) change between patient sub-groups of none-to-mild, moderate, and severe pain at baseline. A mean sub-group difference in weight change of ≥5kg was considered clinically relevant.Of the 141 complete cases, n = 43 (30.5%) reported none-to-mild pain, n = 44 (31.2%) reported moderate pain, and n = 54 (38.3%) reported severe pain. Covariate-adjusted mean weight loss (95%CI) was similar for those with none-to-mild (8.1kg (4.2 to 12.0kg)) and moderate pain (8.3kg (4.9 to 11.7kg). The mean weight loss of 3.0kg (-0.4 to 6.4kg) for the severe pain group was 5.1kg (-0.6 to 10.7, p = 0.08) lower than the none-to-mild pain group and 5.3kg (0.4 to 10.2kg, p = 0.03) lower than the moderate pain group.Patients with severe pain upon entry to a specialist weight management service in England achieve a smaller mean weight loss at one-year follow-up than those with none-to-moderate pain. The magnitude of the difference in mean weight loss was clinically relevant, highlighting the importance of addressing severe persistent pain in obese patients undertaking weight management programmes

Comorbid Pain and Opioid Addiction: Psychosocial and Pharmacological Treatments

Treating comorbid pain (nonmalignant) and opioid addiction is a complex endeavor that requires cooperation of multi-modal treatment teams incorporating pharmacological, psychological, and social components. There are multiple barriers for patients, mental health practitioners, and physical health practitioners to provide complete treatment for this difficult treatment population. In this article, we will review which treatments have been empirically validated in this treatment population, where further research is required, and considerations for potential best approaches to use for patient treatment while waiting for empirically validated treatment data. We will also discuss some complementary and alternative medicine approaches that have empirical validity in treating either pain or addiction individually, though empirical validity for the treatment of comorbid pain and addiction has not been established

Cambios en la ocupación de los adultos mayores recientemente jubilados

The objective of the present study is to understand how the retirement process influences the occupational performance of the recently retired elders. To achieve this, retirement related concepts are studied and analyzed from the point of view of different disciplines. The comprehension of the “occupation” concept is also needed, to be able to associate the occupational performance that retired elders adopt in different areas (Activities of Daily Living, Productivity and Play Activities) with the approach given by the Model of Human Occupation. To be able to identify this relation, several interviews were done to participants of both sexes and that were retired for no more than three years. The interviews were designed using an evaluation instrument created from the OPHI-II. The results of this study show that the retirement process does not cause an occupational unbalance, and that these individuals are able to adapt to the process, creating a new structure in their lives and allowing them to reach a competent level in the different occupations in which they are involved.El presente estudio tiene como objetivo comprender cómo el proceso de jubilación influye en el desempeño ocupacional de los adultos mayores recientemente jubilados. Para ello, se indaga sobre conceptos relacionados con la jubilación y cómo se entiende ésta desde las distintas disciplinas. A su vez, es necesario comprender el concepto de ocupación para poder asociar el desempeño ocupacional que adoptan los jubilados en las diversas áreas de desempeño (Actividades de la Vida Diaria, Productividad y Esparcimiento) desde el enfoque del Modelo de Ocupación Humana. Para identificar esta correlación fueron efectuadas entrevistas en profundidad a participantes de ambos sexos, que tuvieran como máximo tres años de retiro laboral. Las entrevistas fueron diseñadas utilizando un instrumento de evaluación creado a partir del OPHI-II. Los resultados obtenidos permiten observar que el proceso de jubilación no provocaría un desequilibrio ocupacional y que estos individuos lograrían adaptarse a dicho proceso, creando una nueva estructura en sus vidas y permitiéndoles alcanzar el nivel de competencia en las distintas ocupaciones en las que se involucran

Transcriptional Profiling of Resistant and Susceptible Buffalograsses in Response to \u3ci\u3eBlissus occiduus\u3c/i\u3e (Hemiptera: Blissidae) Feeding

ABSTRACT Understanding plant resistance mechanisms at a molecular level would provide valuable insights into the biological pathways impacted by insect feeding, and help explain specific plant tolerance mechanisms. As a first step in this process, we conducted next-generation sequencing using RNA extracted from chinch bug-tolerant and -susceptible buffalograss genotypes at 7 and 14 d after chinch bug feeding. Sequence descriptions and gene ontology terms were assigned to 1,701 differentially expressed genes. Defense-related transcripts were differentially expressed within the chinch bug-tolerant buffalograss, Prestige, and susceptible buffalograss, 378. Interestingly, four peroxidase transcripts had higher basal expression in tolerant control plants compared with susceptible control plants. Defense-related transcripts, including two peroxidase genes, two catalase genes, several cytochrome P450 transcripts, a glutathione s-transferase, and a WRKY gene were upregulated within the Prestige transcriptome in response to chinch bug feeding. The majority of observed transcripts with oxidoreductase activity, including nine peroxidase genes and a catalase gene, were downregulated in 378 in response to initial chinch bug feeding. The observed difference in transcript expression between these two buffalograss genotypes provides insight into the mechanism(s) of resistance, specifically buffalograss tolerance to chinch bug feeding

Advancing our understanding of religion and spirituality in the context of behavioral medicine

Recognizing and understanding the potentially powerful roles that religiousness and spirituality (RS) may serve in the prevention and amelioration of disease, as well as symptom management and health related quality of life, significantly enhances research and clinical efforts across many areas of behavioral medicine. This article examines the knowledge established to date and suggests advances that remain to be made. We begin with a brief summary of the current knowledge regarding RS as related to three exemplary health conditions: (a) cardiovascular disease; (b) cancer; and, (c) substance abuse. We then focus on particular concerns for future investigations, emphasizing conceptual issues, possible mediators and moderators of relationships or effects, and methodology. Our discussion is framed by a conceptual model that may serve to guide and organize future investigations. This model highlights a number of important issues regarding the study of links between RS and health: (a) RS comprise many diverse constructs, (b) the mechanisms through which RS may influence health outcomes are quite diverse, and (c) a range of different types of health and health relevant outcomes may be influenced by RS. The multidimensional nature of RS and the complexity of related associations with different types of health relevant outcomes present formidable challenges to empirical study in behavioral medicine. These issues are referred to throughout our review and we suggest several solutions to the presented challenges in our summary. We end with a presentation of barriers to be overcome, along with strategies for doing so, and concluding thoughts