High-frequency stimulation in pain medicine

You can do something similar with brushes of differing stiffness...
http://goo.gl/IeQbpy

Due to disease-related changes in their brain, pain patients often suffer from an impaired tactile ability in their hands. In a pilot study conducted by scientists at the Ruhr-University Bochum, high frequency repetitive stimulation was investigated as a therapeutic approach for these patients. The results of this study have now been published in the journal Frontiers in Neurology. They show that passive stimulation of this kind is a promising new therapy option.

Recent research, for example using a special therapeutic glove for stroke patients, has shown that passive stimulation, like active physical training, can improve sensory performance. The underlying mechanisms are based on neural plasticity - the brain's ability to constantly adapt. Impaired areas of the brain can reorganize themselves through passive stimulation. A team of researchers around PD Dr. Hubert Dinse of the NeuralPlasticity Lab at the Institute for Neuroinformatics, Prof. Dr. Martin Tegenthoff, Director of the Neurological Clinic, and Prof. Dr. Christoph Maier, senior physician of the Department for Pain Medicine, both at the Bergmannsheil University Clinic, have now investigated the effectiveness of this approach in pain patients.

The scientists were able to show a significant improvement of tactile performance after the stimulation. Despite no significant pain relief overall, individual patients reported substantial improvement. "Some participants had at least 30% less pain after the intervention," reports PD Dr. Hubert Dinse. "Further studies must now be conducted, to find out whether a more intensive and longer period of treatment can not only improve tactile acuity, but also considerably lower pain levels in defined CRPS subgroups."


Individual Differences in Premotor Brain Systems Underlie Behavioral Apathy

Commonly described as laziness, but reflected in brain structure...

http://goo.gl/46bFCZ

These findings reveal that effort sensitivity and translation of intentions into actions might make a critical contribution to behavioral apathy. We propose a mechanism whereby inefficient communication between ACC and SMA might lead to increased physiological cost—and greater effort sensitivity—for action initiation in more apathetic people.

Scurvy Is a Serious Public Health Problem

The most devalued persons in our society often have medical conditions that are only superficially a part of typical medical training....

http://goo.gl/MJvTXE

The middle-aged man had shown up with bleeding gums, unexplained swelling, bruises, and fatigue. His team of internists suspected a skin infection, but every bacterial test came up negative. They were stumped until, Churchill recalls, “someone eventually thought to ask about this person's diet.”

It turns out the man, who was mentally ill and lived alone in one of the city’s poorest neighborhoods, had eaten nothing but white bread and American cheese … for years. “And this had led to these very severe nutritional deficiencies,” Churchill says.

The man’s vitamin C levels were so low, he qualified for a disease Churchill hadn’t thought about since medical school: scurvy. The same scurvy made famous by pirates and British sailors from the 1700s, who would go for months or years at sea without fresh produce, experiencing symptoms from rashes to hemorrhaging. Back then, scurvy killed more seafarers than storms and shipwrecks combined.

Over the next five years, the Springfield doctors measured vitamin C levels in about 120 patients who came in with a range of mysterious symptoms, such as fatigue, mood changes, rashes, headaches, or joint pain.  

Twenty-nine had vitamin C deficiencies severe enough to qualify for scurvy—more than had been found in any other recent study. (The closest was a study from the Mayo Clinic that found 11 cases between 1976 and 2002.)

The results were especially surprising, Churchill says, because the nutritional bar for preventing scurvy is so low. “You can have a handful of McDonald’s ketchup packets a day, and that’ll give you enough vitamin C to keep you from contracting scurvy,” he says.

That meant these patients were eating virtually no fruits or vegetables. And since their general fitness was poor, their symptoms had been attributed to other conditions. This was the first time, for any of the patients, that a doctor had mentioned scurvy.


Results from head to head study comparing Qutenza with pregabalin in PNP published

Capsaicin is derived from peppers and has been used in various forms for pain for a long time (as well as a form being used in pepper spray). A patch is a great idea...
http://goo.gl/xadSMo

The authors conclude that the capsaicin 8% patch provided non-inferior pain relief compared with pregabalin, in addition to a shorter median time to pain relief, fewer systemic side effects and greater treatment satisfaction.2

"This is an important and well-conducted study that was designed to mimic everyday practice, allowing those patients randomised to the pregabalin arm to be individually titrated to the optimal tolerated dose. We found that topical treatment with the capsaicin 8% patch was non-inferior to the current standard of care. This means that there is now another treatment option for people with peripheral neuropathic pain, especially those patients who are very sensitive to the side effects of systemic medication or for those who do not wish to take tablets every day."

Secondary endpoints included optimal therapeutic effect (assessed using a composite endpoint including pain relief, adverse events and treatment discontinuation), median time to pain relief (defined as when 50% of patients had a 30% reduction in NPRS score) and treatment satisfaction.2 Results showed a difference in patient perception of treatment effectiveness, side effects and treatment satisfaction that were in favour of the capsaicin 8% patch.2


Study Highlights Health Risks For Those With Autism

https://goo.gl/TRXsnJ

Adults on the spectrum have higher rates of health conditions ranging from seizure disorders and depression to hypertension, high cholesterol, allergies and anxiety, according to findingspublished recently in the Journal of General Internal Medicine.

For the study, researchers looked at 255 adults with autism ages 18 to 71 and a similar group of typically-developing individuals.

Seizure disorders were eight times more common in young adults with autism ages 18 to 29 as compared to others the same age. And, that differential doubled for those over 40, the study found.

Meanwhile, the research suggests that rates of hypertension and depression are more than twice as high among young adults on the spectrum. However, those with autism were less likely to have sexually transmitted diseases, use tobacco or abuse alcohol.


MCO Common Formulary Stakeholder Meeting

For those who have an interest in how the creation of the common formulary for Medicaid is going, this page gives the current draft and other docs from the work group. The final version is supposed to be available on 1-1-16. Do yourself  a favor and don't print out the draft formulary, but read it electronically or online. The font is small enough to qualify as a symptom of micrographia...

http://goo.gl/80pGQT

In order to streamline drug coverage policies for Medicaid and Healthy Michigan Plan beneficiaries and providers, the Michigan Department of Health and Human Services has decided to pursue a formulary that is common across all contracted health plans for the next Comprehensive Health Plan contract.  A Common Formulary will better align coverage across health plans.  The intent is to reduce interruptions in a beneficiary’s drug therapy due to a change in health plan.

The Common Formulary also includes certain drug utilization management tools, such as prior authorization criteria and step therapies.  Health plans may be less restrictive, but not more restrictive, than the coverage parameters of the Common Formulary.

The list of drugs that are currently covered under the Fee-for-Service benefit will remain unchanged.

To promote safe medication transitions and minimize the burden on prescribers and patients, all contracted health plans will be required to follow one set of policies and procedures on transition of care and grandfathering of drug therapy.


POTUS Signs Innovation Act, Expands Home Health Opportunties

http://goo.gl/vrjMHQ

resident Obama recently signed the Innovation Act, opening up the Programs of All-Inclsuive Care for the Elderly (PACE) for people in need of nursing home level of care to receive these services at home. The bill was approved by Congress earlier this fall.

Some of the major changes to the programs included getting rid of the age restriction for eligibility. Under the new regulations, anyone over the age of 21 who meets the criteria for nursing home care is eligible to be enrolled in a PACE program, rather than just those over the age of 55. The programs provide high levels of care for eligible patients in community-based settings, with the aim of keeping people out of higher-cost care settings such as nursing homes.


Veterans Experience Yearlong Waits for Home Care

http://goo.gl/bz4Ma9

The OIG conducted an investigation at the prompting of Sen. Barbara Mikulski (D-MD), who brought attention to a complaint she received involving a nearly yearlong wait for a nurse to assist a particular veteran at home three times per week. The complaint purported that the patient, who was in his 70s, died while on a waitlist and before ever receiving HCBS.

The report concluded that the Washington, D.C., VA Medical Center had wait times longer than one year for patients requiring homemaker/home health aide (H/HHA) services, a component of HCBS. The patient who served as the subject of the complaint was approved for H/HHA and placed on a waitlist in October 2013.


NIH announces new effort to tackle chronic fatigue syndrome

https://goo.gl/nFOCfP

NIH Director Francis S. Collins said in an interview that medicine “desperately needs some new ideas” in the fight against the syndrome and the closely related neurological disorder myalgic encephalomyelitis. At the moment, there is no test, cause or treatment for the condition, which causes overwhelming, often disabling fatigue in more than a quarter of the people who have the disorder.

“There’s something going on here, and we ought to be able to come up with an answer with the tools we have,” Collins said.

Collins said the agency will move forward on two fronts. It will launch research at the NIH Clinical Center to intensively study a small number of individuals who have the disorder and will revive a working group focused on encouraging more research on the disorder outside of NIH. But no budget for the efforts has been developed yet, Collins said.


Medicare Backs Off Plan To Limit Coverage For Advanced Prosthetics

http://goo.gl/82bgEs

MS had issued a draft proposal, known as a Local Coverage Determination for Lower Limb Prostheses, that critics feared would limit access to prosthetics for amputees, including veterans. Following a public comment period that ended in August and a review of those comments, CMS on Monday announced it would not finalize the draft policy.

"Both CMS and its contractors have heard concerns about access to prostheses for Medicare beneficiaries," according to a statement provided by CMS spokeswoman Helen Mulligan.

CMS said it would convene a work group in 2016 to examine the lower limb prostheses issue.

"The purpose of the workgroup is to develop a consensus statement that informs Medicare policy by reviewing the available clinical evidence that defines best practices in the care of beneficiaries who require lower limb prostheses," the statement said.

Critics of the draft policy had included the Amputee Coalition, a Virginia-based advocacy group, as well as U.S. Sen. Richard Blumenthal, D-Conn., and leaders of the House and Senate Veterans' Affairs Committees. Blumenthal, himself a veteran, said the plan would have affected tens of thousands of disabled veterans nationwide.