Stress and a bad diet can cause chronic pain, just ask my cat

As a pain medicine physician one of the hardest parts of my job is to get people to buy into the idea that addressing stress or anxiety or sleep or nutrition doesn’t mean I think their pain is “all in their head” or that I am not taking their pain seriously. Or both. Chronic pain […]

When cause of death is opioid overdose is it murder or malpractice? The case of Dr. Tseng

Is a doctor guilty of malpractice or murder or is the patient responsible for his or her actions when there is a death by overdose? This is the question that a jury in Los Angeles will have to decide as they are presented the facts in the case of Dr. Lisa Tseng. The prosecution’s version […]

Hysterectomy for chronic pelvic pain? Ask these 7 questions first

Chronic pelvic pain (CPP, pain in the pelvis that is present for more than 2 weeks a month and has been there for more than 6 months) affects 15% of women and accounts for upwards of $2 billion a year in direct medical costs. To say it is a significant health burden is a gross […]

Vaginal Valium is ineffective for pelvic floor muscle spasm

A common cause (possibly the most common cause) of both pelvic pain and pain with sex is spasm of the pelvic floor (the levator ani and obturator internus muscles). Some physicians have promoted vaginal Valium as a treatment. There is a retrospective study of 26 patients (which has all the inherent problems of small retrospective […]

Low-dose naltrexone for fibromyalgia is not standard of care

This week I saw an interesting tweet about low-dose naltrexone for fibromyalgia purporting that this therapy is “standard of care.” I’m not that surprised since I’m asked about it now and then. Google “fibromyalgia and low-dose naltrexone” and the Internet is awash with efficacy claims. Even Medscape, a physician education portal, has a post from […]

The FDA’s new restrictions on hydrocodone are unlikely to solve any problem.

America consumes¬†80% of the world opioid supply (99% of the world hydrocodone supply), but has about 5% of the world’s population. If you don’t think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I’m going to discuss opioid use and misuse will not interest you. […]

Abortion, health care, HPV, chronic pain: what I’ve learned from my most popular posts of 2012

I published 97 posts in 2012 and during the year my blog was viewed approximately 970,000 times. ¬†I’m humbled that anyone took the time to read anything that I wrote. Some posts were read by a couple of hundred people and some posts by a couple of hundred thousand. I don’t think the writing on […]

The low oxalate diet and vulvodynia: how a case report becomes snake oil

Restrictive diets, the most common being the low oxalate diet, are widely reported in the lay press and on-line for vulvodynia (a chronic pain condition of the vulva). In one study, 41% of women with chronic vulvar pain reported trying a low-oxalate diet. The only problem? The low oxalate diet doesn’t work. How this diet […]

Probiotics for irritable bowel syndrome: what does the medical evidence tell us?

Irritable bowel syndrome (IBS) is a chronic gastrointestinal condition associated with abdominal pain and changes in bowel movements. It affects approximately 12% of the population, and in practices devoted to abdominal and pelvic pain (like my own), up to a 1/3 of patients have IBS. Irritable bowel syndrome is subclassified based on “typical” bowel movements:¬†constipation […]

Michael Jackson, Conrad Murray, patient empowerment, and why sometimes doctors must say, “No.”

I am a big advocate for patient empowerment. My ideal patient is both informed and engaged in her health. I try and remember that there are not always hard and fast rules in medicine. While acute appendicitis should be treated with appendectomy, there are many chronic conditions can be treated in a variety of ways. […]