Photos Make Chronic Pain Visible

If you live with chronic pain, you have vast quantities of company. The estimates range from a few million to one-quarter of Americans in long-lasting pain. But you might never know it. Pain is not visible. There’s no 12-step group for it. And if you’re hurting for long, you’re likely to retreat into isolation rather than reach out to others.

Enter the US Pain Foundation (US as of only this January; it began as the CT Pain Foundation), a volunteer-based group founded by Paul Gileno, a former chef who had to find a new calling after a broken spine left him in constant agony. It runs support groups; does advocacy work; and tomorrow, beginning at noonish, is holding a free-lunch session at the Tufts School of Dental Medicine that features The INvisible Project, which documents in photographs and text the lives of people with chronic pain. (One example is here.)

The project’s aim is to educate others about the lives of people with pain, Paul said: “I think the biggest perception for people who don’t have chronic pain all the time is that if they don’t see it, then it’s almost like they don’t believe it after a while. In the beginning, if you get injured, people say, ‘Are you okay?’ But after a while, that chronic pain stays and it’s a year later and people tend to say, ‘Okay, when are you going to get better?’ Well, I wish I could get better right now but my pain is still there. We’re saying, ‘It’s real and we want you to know this is real.'”

Also, Paul said, “We want to show other people with pain that their new normal isn’t much different than everybody else’s who suffers with chronic pain. We want to show them that it’s okay if you’re home one day and not feeling well, it’s okay if this is all that you can do. We want to show them that this is the new normal and they’re not alone.”

The people featured in the project have diagnoses ranging from arthritis to fibromyalgia to lupus to obscure syndromes few have heard of, but they have two things in common: They’ve been chosen by fate to be physically tortured, and they soldier on.  Continue reading

Three Recent Warnings On Antidepressants; Latest Is Stroke Risk

As we all know, three of anything makes a trend in journalism, and my trend alarm has just gone off concerning scary news about antidepressants. First, there was this review three weeks ago finding a “modest link” between antidepressants and cancer — though not in studies funded by the drug companies.

Then, author and former Globe staffer Alison Bass reported a week ago on her blog here that a researcher has found that serious flaws tended to skew the biggest study ever of antidepressants toward making the drugs appear more effective than they really are.

And now, Dr. Adam C. Urato, assistant professor of medicine at Tufts, has just sent over the latest: a paper in the current American Journal of Psychiatry that suggests that antidepressants increase the risk of stroke. He emailed:

This is an important study with real public health implications. We have so many patients on these drugs and use seems to be ever-increasing. If they are associated with stroke, as they seem to be, that’s information that patients and the public need to know.
When you combine this type of study showing a risk of stroke like this with the other studies that now show that antidepressants don’t appear to have a clinically significant benefit for most patients with mild to moderate depression (i.e. most users) then you really have to question why so many patients are on these drugs.

I leave it to others to defend antidepressants, but here are the basics on the latest study: It appears in the May edition of the American Journal of Psychiatry. It uses a “case-crossover” design, which aims to identify triggers for events. In this case, the event is a stroke. It included more than 24,000 patients who’d had strokes in Taiwan. The findings:

We found that antidepressant use was associated with a 48% greater risk of stroke, Continue reading

Squeaker in Mass. Health Plan Ratings

You may not feel yourself overflowing with love and appreciation as you pay your premium, but the fact is that several Massachusetts insurance plans are considered excellent — in fact, tops. (Our premiums also tend to be higher than elsewhere, by the way.) Massachusetts dominated the top ten in the latest national rankings that the non-profit National Committee for Quality Assurance issued. The top of the rankings looked like this:

1. Harvard Pilgrim Health Care

2. Tufts Associated Health Maintenance Organization

3. Harvard Pilgrim Health Care of New England

4. Capital Health Plan

5. Geisinger Health Plan

6. Grand Valley Health Plan

7. Group Health Cooperative of South Central Wisconsin

8. Fallon Community Health Plan

9. Kaiser Foundation Health Plan of Colorado

10. Health New England

11. Blue Cross and Blue Shield of Massachusetts

All the top-rated Massachusetts plans are non-profits. And just a bit of inside baseball: If you look at the complete list here, you’ll see that Harvard Pilgrim edged out Tufts for the top spot by just a hair: an overall ranking of 90.5 vs. 90.4. Last year’s scores followed a similar pattern, and the two plans have been neck-and-neck at the top for five years now. Readers, what do you think is up?

Hospital Execs Get Million-Dollar-Plus Pay

The Boston Globe headline reads: “Hospitals Spent to Keep Talent.”

An alternative headline might be: Top Boston hospital executives earn large salaries. Or at least, they did in 2008, before the economic crisis hit full blast. It would be interesting to read what their pay is like in these days of layoffs and cutbacks. Any volunteers?

Newly required public filings obtained by the Globe include these 2008 pay packages:

Elaine S. Ullian, now retired as Boston Medical Center’s chief executive: nearly $4.8 million, including $3.5 million in deferred compensation

James J. Mongan, former Partners chief executive: $3.6 million in total compensation.

Gary L. Gottlieb, president of the Partners-owned Brigham and Women’s Hospital: $1.6 million total package.

Peter L. Slavin, then president of Partners’ Massachusetts General Hospital: $1.4 million total.

Paul F. Levy, chief executive of Harvard-affiliated Beth Israel Deaconess Medical Center: nearly $1.3 million.

Ellen M. Zane, chief executive at Tufts Medical Center: about $1.2 million.

Ralph de la Torre, chief executive of the Catholic hospital chain Caritas Christi Health Care: $1.2 million in total in 2008.