Managing your pain, health, and health care costs plus medication and hospitalization


Making wise medical choices, decisions


Choosing Wisely (Consumer Reports and the American Board of Internal Medicine (ABIM) Foundation) Helps consumers/​patients choose care that is truly necessary, is supported by evidence, and doesn’t duplicate tests or procedures already received.
Consumer Health Choices (Consumer Reports, free resources for more sensible healthcare decisions)
Preventing Overdiagnosis (winding back the harms of too much medicine)
Right Care Weekly (Lown Institute)
Modifying use of some prescription drugs may reduce fracture risk in older adults (Liz Seegert, Covering Health, AHCJ, 9-13-16) Some fragility fractures – those that occur at standing height – may be preventable by modifying a patient’s prescription drug regimen. 21 drug classes have been associated with increased fracture risk. These include commonly prescribed medications such as antidepressants and antacids.

Diseases and conditions
Diseases and conditions (PubMed Health, alphabetical)
Blood disorders (National Heart, Lung & Blood Institute)
Infectious Disease Information, A to Z (CDC National Center for Infectious Diseases)



Buying drugs and procedures smartly, cheaply, safely


Buying Cheaper Drugs Online (Anahad O'Connor, NY Times, Ask Well, 11-11-13)
Best Buy Drugs campaign (Consumer Reports)
CR Price Reports (Consumer Reports' valuable "bluebook" surveys of national and local fair prices for brain MRI, breast augmentation, breast reduction, chest x-ray, colonoscopy, complete blood count, comprehensive metabolic panel, fetal ultrasound, hip replacement, hysterectomy, knee arthroscopy, knee replacement, laminectomy, lap-band surgery, laparoscopic cholecystectomy, liposuction, rhinoplasty, septoplasty, tubal ligation, TURP (transurethral prostatectomy), and vasectomy.
5 signs your doctor might be an overprescriber (Consumer Reports, 9-28-16) Too often, patients get unnecessary medication
Pharmacy Checker (compare drug prices among reputable online pharmacies)
GoodRx (compare prices and find coupons to save up to 80%)
Costco’s Prices for Generic Medications as of October, 2013
Buying Prescription Drugs From Canada: Legal or Illegal? (ElderLaw Answers)
VIPPS (VIPPS information and verification site of the National Association of Boards of Pharmacy) Enter a site's URL to verify if it meets industry standards.
Find a VIPPS online pharmacy (National Association of Boards of Pharmacy)
Ratings for hospitals, doctors, surgeons, home health agencies
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Which medications, tests, procedures, and treatments to question

"Don't cling to a mistake just because you spent a lot of time making it."

Choosing wisely (Evidence-based advisories on various medical procedures, produced by Consumer Reports, working with the ABIM Foundation). You can download a pdf of all specialty society lists of procedures to avoid. Two examples follow:
Five Things Physicians and Patients Should Question (American Academy of Hospice and Palliative Medicine, Choosing Wisely, an initiative by the American Board of Internal Medicine Foundation and Consumer Reports, to alert doctors and patients to problematic and commonly overused medical tests, procedures and treatments)
1. Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.
2. Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.
3. Don’t leave an implantable cardioverter-defibrillator (ICD) activated when it is inconsistent with the patient/​family goals of care.
4. Don’t recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis.
5. Don’t use topical lorazepam (Ativan), diphenhydramine (Benadryl), haloperidol (Haldol) (“ABH”) gel for nausea.

Five Things Physicians and Patients Should Question (American Geriatrics Society, Choosing Wisely)
1. same as above
2. Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.
3. Avoid using medications to achieve hemoglobin A1c <7.5% in most adults age 65 and older; moderate control is generally better.
4. Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.
5. Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.

For the Elderly, Medical Procedures to Avoid (Paula Span, New Old Age, NY times, 10-23-13)
Drugging dementia: Are antipsychotics killing nursing home patients? (David Martin, America Tonight, Aljazeera, 3-11-15) Antipsychotic drugs are approved for patients with bipolar disorder or schizophrenia, not for dementia. They are often given to dementia patients, because when they are zonked out, they are easier to control. A body of research has shown "a correlation between lower staffing levels and higher use of antipsychotics."
Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (American Geriatrics Society, based on evidence-based recommendations. See additional material.

Doctor Groups Issue List of Overused Medical Tests (Laurie Tarkan, Well, NY Times, 2-21-13)

Doctor Panels Recommend Fewer Tests for Patients (Roni Caryn Rabin, Health, NY Times, 4-4-12) Nine medical specialty boards plan to recommend that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered (for example, EKGs done routinely during a physical, even when there is no sign of heart trouble, M.R.I.’s ordered whenever a patient complains of back pain, and antibiotics prescribed for mild sinusitis

Conflicts of interest associated with drugs and medication (Health Care Reform and Medical Error and the Affordable Care Act, links to key articles on the subject, on Pat McNees website)

When Demented Patients Receive Feeding Tubes (Paula Span, NY Times, Health, 5-9-11). Do not use feeding tubes for patients with advanced dementia.

Ratings for hospitals, doctors, surgeons, home health agencies
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The truth about private screening tests


Annual physicals and health care screening tests Physicals, yes--just not annually. Definitely get a physical when something is wrong.
A Check on Physicals (Jane Brody, Well, 1-21-13) A 'Danish team noted that routine exams consist of “combinations of screening tests, few of which have been adequately studied in randomized trials.” Among possible harms from health checks, they listed “overdiagnosis, overtreatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, adverse psychosocial effects due to labeling, and difficulties with getting insurance.”'

Which screening tests are worth getting? , sidebar to story Annual physical exam is probably unnecessary if you’re generally healthy (Christie Aschwanden, Washington Post, 2-8-13).
Private health screening tests are oversold and under-explained (UK physician Margaret McCartney, The Guardian, 9-17-14) The message in this article for the UK is equally valid for the USA: "Health screening can cause more harm than it prevents, so companies have a duty to provide full information to customers." Life Line Screening markets its for-profit tests without providing fair information and an evidence base for taking them. She provides examples and links, particularly to PrivateHealthScreening: What to Think About When You’re Thinking About Screening Tests. (Click on and read all the links there.) Links below (via Gary Schwitzer) get more specific. Unless your doctor recommends them, there are reasons to think twice about screening tests for which you receive marketing material--say, for aortic aneurysms.

Screening For Asymptomatic Carotid Artery Stenosis (PDF, Agency for Healthcare Research and Quality, Evidence Synthesis No. 50)
Screening Asymptomatic Adults With Resting or Exercise Electrocardiography: A Review of the Evidence for the U.S. Preventive Services Task Force (Annals of Internal Medicine, 9-20-11)
Effect of Screening on Ovarian Cancer Mortality (JAMA, The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial, June 8, 2011)
The UK NSC policy on Osteoporosis screening in women after the menopause (Systematic screening in postmenopasual women is not recommended.)
Liver function tests in patients with computed tomography demonstrated hepatic metastases (Springer, 1989) "Although liver function tests (LFTs) (enzyme levels) are inexpensive and simple to perform, they failed to detect a significant number of patients with liver metastases."
Incidental Findings on Brain MRI in the General Population (New England Journal of Medicine, 11-1-07). "Incidental brain findings on MRI, including subclinical vascular pathologic changes, are common in the general population. The most frequent are brain infarcts, followed by cerebral aneurysms and benign primary tumors. Information on the natural course of these lesions is needed to inform clinical management." See full discussion.
"Preventive health screenings" that are hardly a Life Line (Dr. Kenny Lin, Common Sense Family Doctor, 2-7-11)
How Doctors and Patients Do Harm (Tara Parker-Pope, Well, NY Times, 4-20-12). "That was the beginning of Otis Brawley becoming a loudmouth in the prostate cancer screening debate. We’re making promises to patients and making them think we know things we don’t know and making money off of them. There is a subtle little corruption in medicine. We’re selling chemo to people who don’t need it, giving prostate screening when it might save lives, but we make them think it definitely does..."
Articles about screenings (Covering Health, Association of Health Care Journalists).
Iowa hospitals drop controversial mobile testing firm ( Tony Leys, Des Moines Register, 9-5-14). University of Iowa Health Alliance plans to stop using HealthFair, "a mobile heart-testing company that has been accused of 'fear-mongering' to induce healthy people to undergo scans of their hearts and arteries." This came about after the advocacy group Public Citizen called for an investigation and a halt to recommending tests for most patients. "Such widespread screenings are not recommended by medical experts because each of the six tests either benefits only appropriately selected high-risk patients or has not been scientifically shown to provide any clinically meaningful benefit to anyone.
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Reducing medical costs


Managing a patient's medical costs
Guroo.com, which "shows the average local cost for 70 common diagnoses and medical tests in most states...based on a giant database of what insurance companies actually pay." Guroo is produced by the Health Care Cost Institute. See KHN story: Attention, Shoppers: Prices For 70 Health Care Procedures Now Online! (Jay Hancock, Kaiser Health News, 2-25-15).
Surprisingly Little Evidence for the Accepted Wisdom About Teeth (Aaron E. Carroll, The New Health Care, NY Times, 8-29-16) There’s good evidence that brushing twice a day with fluoride toothpaste is a good idea, especially with a powered toothbrush. For children, there’s good evidence that the use of fluoride varnish or sealants can be a powerful tool to prevent cavities. The rest? It’s debatable; we don't have good studies. With flossing, which is cheap and easy, it still might be worth doing. And fluoride is important.
5 Tips for Handling Early-Year Medical Expenses (AP, NY Times, 2-5-15) Which refers to:
---Co-Payment Assistance Organizations (Patient Access Network Foundation)
---Partnership for Prescripton Assistance (PPA)
Cost Conundrum: What a Texas town can teach us about health care (Atul Gawande, New Yorker, 6-1-09)
Drug information resources you can trust (top consumer health sites, CAPHIS)
PatientAssistance (helping patients get medication). See list of Top 50 drugs
CountyRxCard (up to 75% discount on all FDA-approved drugs at 56,000 pharmacies nationwide)
Be a Prepared Patient Center for Advancing Health, CFAH)
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6 Ways to Lower a Massive Medical Bill (Lacie Glover, The Fiscal Times, 6-16-14)
How to Catch Costly Errors on Your Medical Bills (Lacie Glover, The Fiscal Times, 6-8-14)
30 Ways to Cut Health Care Costs (Kimberly Laskford, Kiplinger, April 2011) How to pay the lowest price without sacrificing quality.

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Managing hospitalization and after


How To Fight For Yourself At The Hospital — And Avoid Readmission (Judith Graham, Kaiser Health News, 9-1-16) This new column explains what older adults and their families can do to avoid hospital readmission. Kaiser Health News columnist Judith Graham writes: "Everything initially went well with Barbara Charnes’ surgery to fix a troublesome ankle. But after leaving the hospital, the 83-year-old soon found herself in a bad way. Dazed by a bad response to anesthesia, the Denver resident stopped eating and drinking. Within days, she was dangerously weak, almost entirely immobile and alarmingly apathetic. “I didn’t see a way forward; I thought I was going to die, and I was OK with that,” Charnes remembered, thinking back to that awful time in the spring of 2015. Her distraught husband didn’t know what to do until a long-time friend — a neurologist — insisted that Charnes return to the hospital."
When You Need a Home Health Aide (Orly Avitzur, Consumer Reports)
Diagnosis: Unprepared (KHN) Hospitals can be hazardous places for elderly patients, who are at increased risk of falling, drug-induced injury and confusion.
But as the nation’s senior population grows, many facilities are ill-equipped to address their unique needs. Kaiser Health News visited hospitals around the country, reviewed data and interviewed dozens of patients, family members and health providers to document the extent of the problem and highlight possible solutions.
Read the stories in this series:
Elderly Hospital Patients Arrive Sick, Often Leave Disabled (Anna Gorman, KHN, 8-9-16)
Geriatric ERs Reduce Stress, Medical Risks For Elderly Patients (Anna Gorman, KHN, 8-23-16) Geriatric emergency rooms, which are slowly spreading across the country, provide seniors with more expertise from physicians, nurses and others trained specifically to diagnose and care for the elderly, researchers said.
Elderly Patients In The Hospital Need To Keep Moving (Anna Gorman, KHN, 8-16-16) “People walk in the door of a hospital and think it’s OK to stay in a bed. It’s not,” said Middlebrooks. The Affordable Care Act explains some of the reluctance by staff at many hospitals to get patients moving, experts say. Under the law, hospitals are penalized for preventable problems, including falls. Researchers believe that hospital staffers, to ensure their patients don’t fall, often leave them in their beds. The impact of remaining so sedentary in the hospital can be devastating for older patients: It is puts them at greater risk for blood clots, pressure ulcers and confusion. Immobility hurts older patients more than younger ones, in part because the elderly are generally weaker, have less bone density and are at higher risk of falling. Ironically, keeping a patient in bed, which is often intended to prevent falls in the hospital, can increase their risk of falling after they are discharged, experts said.
‘America’s Other Drug Problem’: Copious Prescriptions For Hospitalized Elderly (Anna Gorman, Kaiser Health News, 8-30-16)
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Managing medications, tests, procedures, and treatments


Blood tests and results, explained
Blood Pressure Monitors (those validated as reliable, dabl Educational Trust)
Types of blood tests (National Heart, Blood, and Lung Institute, NHBLI)
Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack (NHBLI)
Questions and Answers on Cholesterol and Health with NHLBI Nutritionist Janet de Jesus, M.S., R.D. (NHBLI)

Genetic testing fumbles, revealing ‘dark side’ of precision medicine (Sharon Begley, STAT: Reporting from the frontiers of health and medicine, 10-31-16) 'Enthusiasm for precision medicine, from the White House down to everyday physicians, is at an all-time high. But serious problems with the databases used to interpret patients’ genetic profiles can lead to “inappropriate treatment” with “devastating consequences,” researchers at the Mayo Clinic warned on Monday....“This is the proverbial dark side of genetic testing and precision medicine,” said Ackerman. Because databases that companies use to interpret DNA tests are riddled with errors, “we’re starting to see a lot of fumbles,” with patients told that a DNA misspelling is disease-causing when it actually isn’t....That raises the very real concern that some people treated with “precision” approaches will be misdiagnosed and given useless or even harmful treatment.'
Genetic test costs taxpayers $500 million a year, with little to show for it (Casey Ross, STAT, 11-2-16). Unnecessary medical care is estimated to cost the United States between $750 billion and $1 trillion dollars a year, accounting for nearly a third of its overall spending on health care. Wasteful testing is one of the primary drivers of those costs. In the case of inherited thrombophilia, said Dr. Christopher Petrilli (a University of Michigan hospitalist who coauthored the study cited), doctors appeared to be complicit in the waste — possibly due to fear of litigation or simply a shared desire to get the answers for their patients. “You can explain to them that getting a test is not going to change therapy and that it’s just going to lead to more anxiety, unclear results, and more testing,” said Dr. Nitin Damle, president of the American College of Physicians.

The cold facts about colds and flu (Consumer Reports article on the difference between a cold and the flu and how best to treat them)
Does Biotene cure dry mouth? (Stephanie Watson, HowStuffWorks, Oral Care Products) Dry mouth, a lack of saliva despite drinking fluids, can be caused by different health conditions and treatments. Does this product relieve the symptoms?
A Prescription for Confusion: When to Take All Those Pills (Paula Span, NY Times, 12-18-15)
Reference pricing for ‘shoppable’ health care services steers consumers to low-cost providers (Joseph Burns, Covering Health, Association for Health Care Journalists, 8-15-16) "Using reference pricing, Safeway saved $2.57 million over the three years of the study (2011 to 2013). Of that amount, $1.05 million (41 percent) went back into consumers’ pockets, and the remaining $1.70 million accrued to Safeway, the study showed. Also, reference pricing led to a 32 percent drop in the average price that consumers paid for 285 different lab tests."
Preventive Care (Publichealth.org). Under Resources , find curated links to journals, open courseware, research and professional organizations, and awareness campaigns on addiction, aging, cancer, environmental health, heart disease, HIV/​AIDS, infectious disease, maternal and child health, mental health, nutrition, obesity, poverty, and sexual abuse.
Maybe You Should Rethink That Daily Aspirin (Maanvi Singh, Shots, NPR, 4-27-15) "Aspirin thins the blood and can help prevent blood clots that can clog blood vessels and cause strokes and heart attacks. But long-term use of the drug also increases the risk of ulcers, gastrointestinal bleeding and bleeding in the brain. "Everyone agrees that for people who have already had a cardiac event, the benefits outweigh the risk," pharmacologist Craig Williams says. But for most other people, the chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects, research suggests."
Dental amalgam or resin composite fillings? (helpful Delta Dental explanation)
Autism and the Agitator (Frank Bruni, NY Times Op Ed, 4-21-14) For much of the past decade, Jenny McCarthy has been the panicked face and intemperate voice of a movement that posits a link between autism and vaccinations. "When did it become O.K. to present gut feelings like hers as something in legitimate competition with real science?"
When More Medicine Isn't Better (Leana Wen, Huff Post blog, 8-11-13)
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Recognizing, managing, and reporting medication side effects


We need to pay better attention to medication side effects (Marlene Beggelman, MD, Kevin MD, 2-22-17) Clinicians often misdiagnose problems caused by medications, especially when patients take multi-drug combinations. Physicians don't actively report side effects from medications and often deny those patients tell them about. When doctors fail to connect symptoms to medications, not only do they fail to help their patients, but they also fail to report the side effects to the Food and Drug Administration. As a result, the FDA is likely underestimating the reactions, leading other doctors and patients to believe some drugs are safer than they are. "Patients may be the most reliable sources to report side effects. In fact, they are often the only information source about reactions to medications. Their observations deserve serious consideration. Federal money for drug research and safety has declined to the point that pharmaceutical companies now fund over 85 percent of all research, medical journal publications and medical conferences, where physicians receive much of their educational information –- a clear case of the fox guarding the chicken coop."
When the Immune System Thwarts Lifesaving Drugs (Gina Kolata, Health, NY Times, 5-15-17) "The body’s immune system produces antibodies, blood proteins, in order to attack molecules the body recognizes as alien, often carried on viruses and bacteria. But antibodies also are deployed against other foreign substances, and this may include drugs given to patients." With several serious medical conditions, patients sometimes develop antibodies to the drug that might save them and perhaps to other drugs that the immune system might see as foreign. Understanding the cause of these antibodies would be valuable "if you could say, 'This one patient out of 20 should not take this drug.’” Also, "drugs that might have been abandoned could be developed for the patients who can tolerate them."
Do Best-Selling Drugs That Calm Stomachs Damage Kidneys? The Answer’s Unclear. (Sydney Lupkin and Pauline Bartolone, Kaiser Health News, 5-17-17) Recent research has linked proton pump inhibitors, or PPIs, such as Nexium and Prilosec to serious side effects, including chronic kidney disease. The risk of chronic kidney disease is as much as 50 percent higher in people who’ve taken the drug compared with those who’ve not — although no causative link has been proven and manufacturers like AstraZeneca insist they are safe. Although their labels recommend limiting treatment to a few weeks or a few months, it’s not uncommon for patients to take the heartburn pills for years--producing sales worth many billions of dollars a year for pharmaceutical companies.
Learning About Side Effects (Food & Drug Administration)
Daily Med (National Library of Medicine, NIH) Go to the Daily Med website, enter a drug name, click on the name when it appears, and scroll down to Adverse Reactions.
MedWatch Online Voluntary Reporting Form (U.S. Food & Drug Administration) Here is where both doctors and patients can report serious problems with human medical products including drugs.
What are the possible side effects of a drug and where can I find the most current information about my drug? (FDA)
What is a Serious Adverse Event (FDA)
MedShadow (blog about Balancing Drug Risks and Benefits)
Physician response to patient reports of adverse drug effects: implications for patient-targeted adverse effect surveillance. (BA Golum et al., Drug Safety, on PubMed, 2007)
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Good e-resources for patients/​consumers/​patient advocates and e-patients

ePatient Dave (a voice of patient engagement)
Kevin MD (doctors' voices blog)
Kaiser Health News (thorough coverage of medical news)
e-patients.net (because health professionals can't do it alone).
• On Symptom Checkers: e-Patient Dave's "A Turing Test for Diagnosis: BMJ evaluates online symptom checkers" ( BMJ 2015;351:h3480). See also Tools to diagnose symptoms online often get it wrong, study finds (Boston Globe).
Health Net Navigation Never trust a librarian… unless you want good information.
Health videos (Medline Plus)
Medical Encyclopedia (Medline Plus)
Medical Dictionary (Medline Plus)
Patiient Empowerment (About.com)
e-patients.net (because providers can't do it alone)
Journal of Participatory Medicine
Empowered Patient (Elizabeth Cohen's column, CNN)
Not Running a Hospital (Paul Levy, former CEO of a large Boston hospital, shares thoughts about hospitals, medicine, and health care issues)
The Health Care Blog
Blogs and news for science and medical writers (Writers and Editors)
Geek Doctor (life as a healthcare CIO)
The New Life of e-Patient Dave "In 2007, supported by an extraordinary team of family, friends, and medical staff, I stomped the snot out of a nasty cancer that was on its way to killing me. I've since learned that the way I did it has a lot in common with the advice of the "e-patients" movement, so I've changed my blogger name from Patient Dave to e-Patient Dave."
Women With Cancer
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Telemedicine and virtual medical visits


More Than Half of Kaiser Permanente's Patient Visits Are Done Virtually (Kia Kokalitcheva, Fortune, 10-6-16) "For the first time, last year, we had over 110 million interactions between our physicians and our members," said Tyson, adding that 52% of them were done via smartphone, videoconferencing, kiosks, and other technology tools. "What were now seeing is greater interaction with our members and the health care system," said Tyson. "They're asking different questions, they're behaving more like consumers, and medical information now is becoming a critical part of how they're making life choices."
Get Your Checkup by Phone or Video (Beth Howard, The Investing Revolution, US News, 8-26-16) "When 11-month-old Jack Causa's eyes became red and developed a yellow discharge last winter, his mother Izzy immediately recognized the problem: pinkeye. Because the pediatrician's office was closed, she used a service called Teladoc, provided through her health benefits, to reach a physician on her smartphone....Teladoc is one of several services, including MDLIVE, American Well, and Doctor on Demand, offering secure access to a doctor anytime, anywhere to anyone with a smartphone or tablet. "
Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Apps Treating Skin Disease (Jack S. Resneck Jr, MD, et al., JAMA Dermatology, 5-1-13) Telemedicine has potential to expand access to high-value health care. Our findings, however, raise concerns about the quality of skin disease diagnosis and treatment provided by many DTC telemedicine websites. Until improvements are made, patients risk using health care services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality, and care coordination. We offer several suggestions to improve the quality of DTC telemedicine websites and apps and avoid further growth of fragmented, low-quality care.
Charlotte patients take control of their medical records, doctor visits with virtual care (Karen Garloch, Charlotte Observer, 12-20-14) After downloading a new app to her iPhone, within minutes Beth Straeten was talking face-to-face with a physician assistant. As Straeten described the poison ivy rash on her arms, PA Dimple Joshi sat across town at Carolinas Medical Center-Pineville, in front of two computer monitors. On one, Joshi could see Straeten and on the other she could read Straeten’s medical record. This has been called medicine’s “Gutenberg moment” by Dr. Eric Topol, one of the nation’s leading cardiologists. Much like the printing press liberated knowledge from control of the elite class, Topol says digital health technology is poised to democratize medicine in ways that were unimaginable until now. “It goes from being the doctor’s medical record to being the patient’s medical record,” said Dr. R. Henry Capps Jr.
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Managing ordinary (not chronic) pain

Pain (MedlinePlus)
• See full separate section on Managing chronic pain
Beyond pills and shots: Pain patients seek other options (Felice J. Freyer, Boston Globe, 12-30-16). Part of a series on chronic pain.
Pain Relievers: Understanding Your OTC Options (FamilyDoctor.org)
Pain Relief: What You Need to Know (Consumer Reports, 4-28-16) 125 million people are in pain, spending some $300 billion on pills, pot, procedures, and natural ‘cures’ to find relief, but are they worth it?
Pain Management: Which Treatment Is Right for You? (Consumer Reports, 4-28-16)
Addictive Pain Medication: How to Protect Yourself (Theresa Carr, CR, 4-28-16) Many painkillers can be highly addictive
Try This Instead of Drugs to Treat Neck and Shoulder Pain (CR, 4-28-16) Strengthening weak neck muscles with exercise and applying heat can alleviate the pain
How to Get Rid of Lower Back Pain (Consumer Reports, 4-28-16) If you don't feel better after four weeks, see a doctor because it could be another condition, like osteoporosis
Best Ways to Treat Joint Pain (CR, 4-28-16) Stiff or swollen joints can result in pain, especially first thing in the morning and after resting. Here's what you can do to ease it.
Acetaminophen Is the Best Pain Reliever for Heart Patients (Orly Avitzur, Consumer Reports, 6-19-16) "Tylenol is a good choice for those needing relief from the physical pain caused by osteoarthritis in the joints or from headache pain and who also have heart troubles such as high blood pressure, heart failure, heart attacks, chest pain due to narrowed coronary arteries (angina), or stroke. Using acetaminophen is a much safer bet than most over-the-counter pain relievers like ibuprofen (Advil and generic) and naproxen (Aleve and generic)....That’s because acetaminophen is unlike other common, over-the-counter pain medications, like ibuprofen and naproxen, which can aggravate high blood pressure, and in turn raise a person's risk of having a heart attack. "
Tension Headache Treatment and Prevention (CR, 4-28-16) A few simple steps like drinking water and doing neck exercises can relieve your pain
Speak Up: What You Should Know about Pain Management (Joint Commission)
Chronic Pain Medicines (FamilyDoctor.org).
When Pain Remains (Jerome Groopman, New Yorker, 10-10-05) What should patients do when doctors can't figure out how to diagnose or treat reflex sympathetic dystrophy (RSD), reclassified in 1994 as complex regional pain syndrome (CRPS), the hallmark of which is excruciating pain.
When Pain Remains: Q & A (sidebar to the Groopman piece on CRPS). What should patients do when doctors can’t figure out how to treat their suffering?
How OxyContin's Pain Relief Built 'A World Of Hurt' WHYY's Fresh Air interviews Barry Meier, author of A World of Hurt: Fixing Pain Medicine's Biggest Mistake (Kindle single)
Neuroplastix Change the Brain; Relieve the Pain; Transform the Person. Read the book free online.
The disturbing reason some African American patients may be undertreated for pain (Sandhya Somashekhar, Wash Post) African Americans are routinely under-treated for their pain compared with whites, according to research. Whites are more likely than blacks to be prescribed strong pain medications for equivalent ailments. Unconscious stereotypes about African Americans likely contribute to this problem, as well as physicians' difficulty empathizing with patients whose experiences differ from theirs.
Ways to Reduce Pain Naturally
Who Has a Right to Pain Relief? (Rebecca Davis O'Brien, The Atlantic, 8-18-14). The legal, medical, and pharmaceutical industries have all struggled to locate the line between analgesia and drug abuse.
Keith Wailoo on the politicization of pain (Book TV, C-Span, 3-3-15) Professor Keith Wailoo talked about his book, Pain: A Political History, about the politicization of treating pain in the U.S. since the 1950s. How do we decide who is or is not (really) in pain and how to treat that pain. Is chronic pain a disability that should be compensated? Are we exercising compassion in treating pain or creating a generation of dependents. It's the judges, not the doctors and not the scientists, who make significant decisions about pain. (Listen, watch, or read transcript.)
Pain: A Political History by Keith Wailoo. A "well-rounded discussion of the politics of pain and pain relief in post WW II America." Wailoo examines how pain has defined the line between liberals and conservatives from just after World War II to the present. From disabling pain to end-of-life pain to fetal pain, the battle over whose pain is real and whose pain deserves relief has created stark ideological divisions at the bedside, in politics, and in the courts -- and the interests and arguments of media, politicians, and medical professionals often work against the voice of the individual suffering pain. What about managing pain in end-of-life care?
Kratom Users Say Ban Will Lead to More Drug Abuse (Pat Anson, Pain News Network, 9-20-16) Kratom is a safe and surprisingly effective treatment for chronic pain and a wide variety of medical conditions, according to a large new survey of kratom consumers. Many say banning the herbal supplement will only lead to more drug abuse and worsen the nation’s opioid epidemic. (An online survey of 6,150 kratom consumers by Pain News Network and the American Kratom Association was conducted after plans were announced by the U.S. Drug Enforcement Administration to classify two chemicals in kratom as a Schedule I controlled substances.)
Why Banning the Controversial Painkiller Kratom Could Be Bad News for America's Heroin Addicts (Maia Szalavitz, Vice, 1-20-16) "It sounds like the perfect drug. At low doses, it's stimulating, like a strong cup of coffee; at higher doses, it's sedating and kills pain. And it's a legal, natural plant that has been used in Asian medicine for centuries. Indeed, a growing number of Americans are finding it to be a useful alternative to heroin and prescription pain relievers. But of course, there's a catch. Like the opioid drugs it is used to replace, this stuff can be addictive, and it can also cause serious nausea. Unlike other opioids, however, it seems to have an extremely low overdose risk, which has caught the eye of people working to fight the record high level of overdose deaths."
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Managing pain and improving health with yoga


Yoga overview (National Center for Complementary and Integrative Health)
What the Science Says About Yoga "Current research suggests that a carefully adapted set of yoga poses may reduce low-back pain and improve function. Other studies also suggest that practicing yoga (as well as other forms of regular exercise) might improve quality of life; reduce stress; lower heart rate and blood pressure; help relieve anxiety, depression, and insomnia; and improve overall physical fitness, strength, and flexibility. But some research suggests yoga may not improve asthma, and studies looking at yoga and arthritis have had mixed results." From
Effectiveness of Iyengar yoga in treating spinal (back and neck) pain: A systematic review. (Crow EM, Jeannot E, Trewhela A, Intl J Yoga, on PubMed, Jan. 2015). "This systematic review found strong evidence for short-term effectiveness, but little evidence for long-term effectiveness of yoga for chronic spine pain in the patient-centered outcomes. "
Health conditions benefited by yoga (Timothy McCall, MD, from Yoga as Medicine ), a list followed by links to many references.
Western Science vs. Eastern Wisdom (PDF, Timothy McCall). See also Does Yoga Kill? Yoga, Truthiness and the New York Times, in which McCall argues against New York Times writer William Broad's claims that yoga is responsible for hundreds of strokes per year, the emotional linchpin of his yoga-wrecks-your-body arguments. About which, see next entry:
How Yoga Can Wreck Your Body (William J. Broad, NY Times, 1-5-12) and this follow-up piece: The Healing Power of Yoga Controversy (William Broad, The 6th Floor: Eavesdropping on the Times Magazine, 1-10-13) "Yet, for all the bad news about yoga, I still see the rewards as outweighing the risks. A century and a half of science shows the benefits to be many — and the serious dangers to be few and comparatively rare."
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