Pain Pod: Recent Episodes
Pharmacy Podcast Network
One of the most common definitions of pain describes pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” When we are exposed to something that causes pain, if able, we quickly or reflexively withdraw. The sensory feeling of pain is called nociception. Our Host: Mark Garofoli, PharmD Clinical Assistant Professor WVU School of Pharmacy (Department of Clinical Pharmacy) WV School of Pharmacy curriculum education in areas of expertise such as pain management, substance-use disorder, medication therapy management, managed care, geriatric care, management, leadership, and experiential learning.
Let’s face it, when it comes to pain management, one of the most painful efforts of the last few years has involved, in one way, shape, form, or fashion: Morphine Milligram Equivalents (MMEs). As we discussed with the PharmD author of the 2022 CDC Opioid Guideline Update , there are no MME factor changes on the horizon, so just when will we have our minds wrapped around the concept?!? Join the Mark “Pain Guy” Garofoli on the Pain Pod for a dynamic discussion on wrestling (yes, you read that right!), pain management, our healthcare system, and the “street” version of MMEs. Wait, there’s a street version of MMEs? Yes, yes there is, so tune in now to the Pain Pod as you’ll only utilize the edge of your seat even though ya paid for the whole seat! Come one, come all, to the Pain Pod!!! Episode Notes Pre-2016 MME Charts Review · Nielson S. et. al. A synthesis of oral morphine equivalents (OME) for opioid utilization studies. Pharmacoepidemiology and drug safety 2016; 25: 733–737 2016 CDC Chronic Pain Opioid Guideline MME Chart · CDC Chronic Pain Opioid Guidelines: MMWR March 2016. Updated 2017. o Tramadol: 0.1 o Codeine: 0.15 o Tapentadol: 0.4 o Morphine: 1 o Hydrocodone: 1 o Oxycodone: 1.5 o Oxymorphone: 3 o Hydromorphone: 4 o Methadone (Up to: 20mg, 40mg, 60mg, >60mg): 4, 8, 10, 12 o Transdermal Fentanyl: 7.2 (Divided by the # of Days Applied) o Transdermal Buprenorphine: 12.6 (Divided by the # of Days Applied) o Buprenorphine (SL or Buccal): 0.03 (for mcg calculations) or 30 (for mg calculations) 2015 Cat and Dog MME Article · https://burrardvet.com/2015/04/08/pain-control-in-dogs-cats 2016 CDC Chronic Pain Opioid Guideline MME Chart · CDC Chronic Pain Opioid Guidelines: MMWR March 2016. Updated 2017. 2022 CDC Opioid Guideline Revision Resources · https://www.federalregister.gov/documents/2022/02/10/2022-02802/proposed-2022-cdc-clinical-practice-guideline-for-prescribing-opioids 2010 to 2014 MME Relative Risk of Overdose/Death · https://i1.wp.com/face-facts.org/wp-content/uploads/2017/04/Opioid-dose-vs-overdose-risk.jpg Missouri Marijuana Equivalents (MMEs) · https://north.life/demystifying-missouri-medical-marijuana-equivalency-units-mmes/ Audio Add-in’s Let’s Get Ready to Rumble (Michael Buffer) · https://www.youtube.com/watch?v=jgopHWACUXs Cash sound · https://www.youtube.com/watch?v=ZeET7Z1ZGlw Ron Burgundy “That Escalated Quickly” · https://www.youtube.com/watch?v=FONN-0uoTHI Learn more about your ad choices. Visit megaphone.fm/adchoices
https://www.rx-summit.com/
Dr. Mark Garofoli was live and in person at the 2022 RxSummit Conference which hosted anyone and everyone affiliated with and touched by our country's Drug Crisis. The "Pain Guy" spoke with many federal and state leaders (including our U.S. Drug Czar Dr. Gupta, our NIDA Director Dr. Volkow, DEA leadership, and so on), along with fellow conference presenters and attendees alike. Many of those conversations were recorded and contained within this dynamic conference summary episode of the Pain Pod! Learn more about your ad choices. Visit megaphone.fm/adchoices
MAJOR ANNOUNCEMENT (in Pain Management)!!!
The 2022 CDC Opioid Guideline Revision (from 2016)!!!
Join the Mark “Pain Guy” Garofoli on the Pain Pod with special guest Dr. Christopher Jones, PharmD, DrPH, MPH from the CDC for a dynamic discussion on the 2022 CDC Opioid Guideline Revision. No questions avoided, no topic left behind, as Mark and Chris review all aspects of this incredibly important advancement in pain management.
You may want to listen to this episode twice, if not ten times!!!
Come one, come all, to the Pain Pod!!!
2022 CDC Opioid Guideline Revision Resources • https://www.federalregister.gov/documents/2022/02/10/2022-02802/proposed-2022-cdc-clinical-practice-guideline-for-prescribing-opioids • Email: opioids@cdc.gov Learn more about your ad choices. Visit megaphone.fm/adchoices
THUG DRUGS! With a name like that, it has to be good! Even better than Smuckers (Age old ad slogan for jelly/jam)! Grab your Cup of Joe and sit back, or better yet, work out, go for a jog, as this episode will pump, you, UP!
From Caffeine to Cocaine with a jolt of Meth, the PAIN GUY on the PAIN POD will discuss legal and illicit stimulants in the realms of pain management, substance use disorder (addiction), and our communities, and globe for that matter.
Get ready for some homework, as you’ll definitely end up watching Breaking Bad, The Wire, and maybe even Scarface for the 222nd time (only pharmacists will get the pun there!).
Come one, come all, to the Pain Pod!!!
FreeCE Substances of Abuse Specialty Pharmacist (SASP) Certificate https://www.freece.com/Programs/SeriesCertification/ab66a419-b5e5-458b-9494-0acb6af1be92
Drug/Overdose Trends
https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
https://www.iqvia.com/insights/the-iqvia-institute/reports/prescription-opioid-trends-in-the-united-states
2005 Combat Meth Act & State Pseudoephedrine Restrictions
https://www.deadiversion.usdoj.gov/meth/cma2005_general_info.pdf
https://odcp.ky.gov/Pages/Cold-Allergy-Medication-Restrictions.aspx
Wasping
https://amp-livescience-com.cdn.ampproject.org/c/s/amp.livescience.com/65954-wasp-spray-overdose-meth.html
https://abcnews.go.com/Health/dangerous-drug-trend-called-wasping-combines-meth/story?id=54068422
Methgators!!! https://time.com/5627237/tennessee-flush-drugs-meth-gators/
Illicit Substances Resources
Erowid
DEA Reports
Drugs of Abuse
National Drug Threat Assessment
INCB (International Narcotics Control Board)
UNODC (United Nations Office on Drugs and Crime)
European Monitoring Centre for Drugs and Drug Addiction
CESAR (Center for Substance Abuse Research)
NIDA (National Institute on Drug Abuse)
Online Blogs
Blue Light
Drug Forum
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What do Mexico, drugs, society, the Bible, and whiskey have in common? Join us on this episode of the PAIN POD, as Mark “Pain Guy” Garofoli chats with Sam Quinones, author of “Dreamland” and “The Least of Us”, with the later having just released in October 2021. It’s often hard to see the forest within the trees, but Sam clears the fog for all of us to whittle it down on how to provide patient care for those in pain and/or with addiction. Come one, come all, to the Pain Pod!!!
Sam Quinones https://samquinones.com/
Drug/Overdose Trends
https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
https://www.iqvia.com/insights/the-iqvia-institute/reports/prescription-opioid-trends-in-the-united-states
FreeCE Substances of Abuse Specialty Pharmacist (SASP) Certificate https://www.freece.com/Programs/SeriesCertification/ab66a419-b5e5-458b-9494-0acb6af1be92
CDC Opioid Guideline Updated Draft for Public Comment https://www.regulations.gov/docket/CDC-2022-0024/document
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On this episode of the PAIN POD, Mark “Pain Guy” Garofoli will chat with Dr. Eric Christianson, a nationally recognized pharmacology expert, about drug interactions with particular attention in the pain management realm. CYP-450, of course, Serotonin Syndrome, we’ll give the down and dirty on explain what all the hub bub is about, and might even have a conversation for our snowbirds out there and everyone else who enjoys grapefruit juice! Considering drug interaction database flag every medication known to mankind, and yet with completely different recommendations, it’s best to hear it from the source as to how in the world to best help our patients in pain. Listen in, right here, right now, on the Pain Pod. Come one, come all, to the Pain Pod!!!
MedEd101 https://www.meded101.com/
Real Life Pharmacology (Grapefruit Juice Interaction Podcast Episode) https://www.reallifepharmacology.com/grapefruit-juice-interactions/
AGS Beers List (2019) https://geriatricscareonline.org/toc/american-geriatrics-society-updated-beers-criteria/CL001
Chicago Tribune Drug Interaction Secret Patient Article (2016) https://www.chicagotribune.com/investigations/ct-drug-interactions-pharmacy-met-20161214-story.html
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On this episode of the PAIN POD, Mark Pain Guy Garofoli chats with Dr. Laura Meyer-Junco, PharmD, BCPS, CPE, an international expert on Over-the-Counter (OTC) self-care pain management, about the complexities of pain medications that are readily available for anyone and everyone in our society in dollar stores, gas stations, grocery stores, hotel gift shops, and pharmacies alike. Just how much info can be crammed into one analgesic pharmacy aisle? Tons! Laura provides some pearls and pointers to help us all help others with OTC pain medications. Join the discussion right here, right now, on the Pain Pod. Come one, come all, to the Pain Pod!!!
Resources Pediatric OTC Pain Medication Dosing https://medlineplus.gov/ency/patientinstructions/000783.htm Dr. Laura Meyer-Junco Bio https://www.painweek.org/media/read/laura-meyer-junco Pain News Network (Pain Guy’s Recent PAINWeek Poster Video Interview) https://www.painnewsnetwork.org/
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On this episode of the PAIN POD, Mark Pain Guy Garofoli will chat with Dr. David Brushwood, a world-renowned pharmacy law expert, about all things pain management, controlled substances, drug diversion, and pharmacy law. You may be sitting down listening, but it turns out you’ll only be using the edge of the seat! Corresponding legal responsibility, check. Professional conversations between prescribers and dispensers alike, check. DEA Red Flags, check. An attempted prescription from a zoo, check, wait, what? Yes, check. You name it, if it’s pharmacy law and pain management related, it’s discussed, right here, right now, on the Pain Pod. Come one, come all, to the Pain Pod!!!
DEA Red Flags Info
Prescribers
Cash only patients and/or no acceptance of worker’s compensation or insurance
Prescribing of the same combination of highly-abused medications
Prescribing the same (high) quantities of pain drugs to most/every patient
High number of prescriptions issued per day
Geographically out-of-area patient population
Dispensers
High percentage controlled to non-controlled medications
High volumes of controlled substances generally
Same Medication(s)/Quantities prescribed by the same prescriber for many patients
Large geographical distances between pharmacy, prescriber(s), and patient
Multiple patients with the same last name or address
Sequential prescription #s for highly diverted drugs from the same prescriber
Patients receiving controlled substances from multiple prescribers
Patients seeking early prescription refills paying out-of-pocket
NABP ”Red Flags” Video https://nabp.pharmacy/initiatives/awarxe/pharmacist-resources/
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PAINWeek remains the US pain conference with the most expansive curriculum and is the favorite destination for frontline practitioners to enhance their competence in pain management.
Dr. Mark Garofoli, PharmD, the host of the Pain Pod, is joined by the Public Health Pharmacist, Dr. Christina Madison, PharmD interviewing participants of the event September 7—11 at The Cosmopolitan in Las Vegas.
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On this episode of the PAIN POD, Mark Pain Guy Garofoli will take you on a journey of a pain guy in pain, and just what our patients hear from us as healthcare professionals, and what the healthcare system experience can be like when not being the one wearing the stethoscope, and rather being the patient in pain.
Can anyone imagine being dropped off at the ER by your Wife and toddler on Friday the 13th during a pandemic to only begin a 3 month long excruciating journey of pain? Pain Guy Garofoli can tell you all about it, and provide a few clinical pearls to improve patient care along the way! This is not a campfire conversation, but you can feel free to download and listen while camping, swimming, biking, walking, or however, you’d like, just be forewarned that Mark will not be sparing any painful details. You’re welcome and he’s sorry, all at once!
COVID & NSAIDs Info https://www.bbc.com/news/51929628 Jeong HE, et al. Association between NSAIDs use and adverse clinical outcomes among adults hospitalized with COVID-19 in South Korea: A nationwide study. Clin Infect Dis. 2020 Jul 27. https://clinicaltrials.gov/ct2/show/record/NCT04334629
NSAID COX-1 & COX-2 Studies Feldman, M, et al. Do Cyclooxygenase-2 Inhibitors Provide Benefits Similar to Those of Traditional Nonsteroidal Anti-Inflammatory Drugs, with Less Gastrointestinal Toxicity. Ann Intern Med. 2000; 132: 134-143 Herndon, C. et al. Management of Chronic Nonmalignant Pain with Nonsteroidal Anti-inflammatory Drugs. Pharmacotherapy. 2008; 28 (6): 788-805. Masso Gonzalez EL, et al. Variability among nonsteroidal anti-inflammatory drugs in risk of upper gastrointestinal bleeding. Arthritis Rheum 2010; 62: 1592-601.
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How many times a day are YOU asked if you’re the pharmacist? Countless!
Well join us in this episode of the PAIN POD while Mark “Pain Guy” Garofoli chats with literally THE Pharmacist, Dan Schneider, famous for all of his amazing efforts within the Opioid Crisis, as highlighted on the Netflix series “THE Pharmacist”.
Every 7 minutes an American dies of a drug overdose, and that’s soon to be every 5 or 6 minutes based on upcoming data confirmation. Conversely, every 30 minutes a baby is born dependent, not addicted, to opioids. Headline after headline sensationalizes a reality that many times heroin utilizers begin their respective diacetylmorphine (that’s Heroin folks!) utilization via prescription opioids. Check out this JAMA article as the foundation for so very many headlines: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1874575.
Dan Schneider’s life work, and “story”, were first highlighted in this article: https://www.nola.com/news/crime_police/article_934b7d20-a78a-535a-8691-26cfc7f9bee7.html, and he joins us in this podcast to dive much, much deeper into the saga, culminating with avenues for all of us to join the efforts, via his “Tunnel of Hope” organization: https://tunnelofhope.org/.
How did we get into the “War on Drugs”, or perhaps better yet, how in the world do we get ourselves out? There’s 330 million Americans waking up everyday, living day in and day out as the solution. If every one of us helped one person, imagine the world.
So listen in to this episode of the PAIN POD now, to hear THE Pharmacist chat with the Pain Guy, in an effort to do just that, help save and improve lives, one at a time!
This episode is sponsored by the Ultiguard Safe Pack. UltiGuard Safe Pack is the only pen needle product that comes with an all-in-one sharps container. Learn more about why UltiGuard Safe Pack is the best choice for your patients and your pharmacy.,
Learn more about the UltiGuard Safe Pack:
https://www.ulticare.com/ultiguard-safe-pack/podcast
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March Madness inspired us, and our audience has waited long enough. What better time, than during a pandemic, to dive into “OPIOID MADNESS” and crown “The Greatest Opioid of All Time”!!!
In this episode of the “PAIN POD”, Mark “Pain Guy” Garofoli will continue the conversation from Opioid Madness Part 1, the opioid bracketology, or perhaps an “Opioidology”, but definitely a whole bunch of “Opioid Madness”. The battle of poppy versus poppy, and of course a bunch of man-made opioid opponents as well. Cool names and fancy formulations only get one so far, and we simply have no room for bias, thus pharmacology will rule as law of the land, to ultimately crown, “THE GREATEST OPIOID OF ALL TIME”.
The blood thirsty, constipating, yet definitely not sedating championship opioid brawl continues. One opioid, an opioid of all opioids, will remain standing atop the mountain of Mu, declaring its victory over all other opioids from all lands near and far. Which opioid will it be? The PAIN POD crowns the champ!
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March Madness is upon us, and what better time, than during a pandemic, to dive into “OPIOID MADNESS”!!!
In this episode of the “PAIN POD”, Mark “Pain Guy” Garofoli will talk us through an opioid bracketology, perhaps an “Opioidology”, but definitely a whole bunch of “Opioid Madness”, in order to pit one opioid against another. A battle of poppy versus poppy, and of course a bunch of man-made opioid opponents as well. Cool names and fancy formulations only get one so far, and we simply have no room for bias, thus pharmacology will rule as law of the land, to ultimately crown, “THE GREATEST OPIOID OF ALL TIME”.
We’ll start with a “Sweet 16” of opioids, mention a few bubble busting first four out, and navigate our way through the “Elite 8” and “Final 4” to culminate in a blood thirsty, constipating, yet definitely not sedating championship opioid brawl. One opioid, an opioid of all opioids, will remain standing atop the mountain of Mu, declaring its victory over all other opioids from all lands near and far. Just as Rocky Balboa declared his presence on top of the mountains of Russia, there will remain one opioid for all ages. Yet, all this opioid bracketology madness may not be the main point after all, tune in today to enjoy a brief journey through all things opioids, and learn more about what this madness is actually all about. Let the brackets begin!!!
To get amped up for this “PAIN POD” episode, checkout Rocky training for “OPIOID MADNESS” in Russia via this Fandango Movie Clip: https://www.youtube.com/watch?v=hHC_R7ATGuI (No anabolic steroids were used in the development of this episode, as we have learned from Drago that cheaters never win!)
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PAIN POD EPISODE 0
One of the most common definitions of pain describes pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” When we are exposed to something that causes pain, if able, we quickly or reflexively withdraw. The sensory feeling of pain is called nociception.
What Does It Mean to Call Chronic Pain a Brain Disease? by Mark D. Sullivan
https://www.jpain.org/article/S1526-5900(12)00560-3/pdf
Multiple investigators have recently asked whether neuroimaging has shown that chronic pain is a brain disease. We review the clinical implications of seeing chronic pain as a brain disease. Abnormalities noted on imaging of peripheral structures have previously misled the clinical care of patients with chronic pain. We also cannot assume that the changes associated with chronic pain on neuroimaging are causal. When considering the significance of neuroimaging results, it is important to remember that ‘‘disease’’ is a concept that arises out of clinical medicine, not laboratory science.
Our Host:
Mark Garofoli, PharmD
Clinical Assistant Professor
WVU School of Pharmacy (Department of Clinical Pharmacy)
WV School of Pharmacy curriculum education in areas of expertise such as pain management, substance-use disorder, medication therapy management, managed care, geriatric care, management, leadership, and experiential learning.
Brian Regan - The Emergency Room
https://youtu.be/d2Vg3iSd5ms
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