Common sense in prescribing pain medications for the Louisiana physician.

Louisiana physicians often face difficult predicaments in treating patients with chronic pain complaints. On the one hand, there is a greater appreciation for the debilitating impact of chronic pain on quality of life and better recognition that chronic pain is a disease in its own right deserving treatment. On the other hand, we regularly learn of arrests of physicians for prescribing these medications and read reports of exploding pain medication abuse. This article dispenses common sense advice for the Louisiana physician in approaching chronic pain issues such as defining your treatment population, obtaining independent corroborating records, prescribing extended-release pain medications when possible, considering adjunctive treatments to reduce total opiate use, collaborating with colleagues regularly, utilizing treatment agreements, employing sensible verification methods of proper medication use, opening the doctor-patient relationship to include concerned family or friends, using psycho-social indicators of good functioning, and reappraising the success of treatment at appropriate intervals. By employing these common-sense approaches Louisiana physicians can approach pain management prescribing with more assurance and confidence.

Persistent Psychosis and Medical Complications After a Single Ingestion of MDMA "Ecstasy": A Case Report and Review of the Literature.

We describe a case report of persistent psychosis and severe medical complications in a previously healthy, 19-year-old African-American man after a single ingestion of what was purported to be "Ecstasy." We detail the psychiatric symptoms and medical complications that resulted in several weeks of hospitalization in both medical intensive care and psychiatric units. Furthermore, we describe changes in the demographics of the use of Ecstasy and present the current understanding of the cause of neurotoxicity after Ecstasy use when it occurs. We conclude by suggesting actions clinicians can take to ameliorate the negative consequences of Ecstasy use.

Pain management after Hurricane Katrina: outcomes of veterans enrolled in a New Orleans VA pain management program.

OBJECTIVE: To evaluate Hurricane Katrina's impact on patients with pre-existing chronic pain. Design. Review of literature about Hurricane Katrina and chronic pain or pain management and a qualitative interview of all identified patients enrolled in a behavioral pain management program. SETTING: Southeast Louisiana Veterans Healthcare System, Mental Health Service Line. SUBJECTS: In total, 42 of the 53 (79%) veterans enrolled in a chronic pain program prior to Hurricane Katrina were able to be contacted and evaluated with interviews and a review of their available medical records. OUTCOME MEASURES: Major impediments and facilitative factors in delivering pain management services were identified. CONCLUSIONS: Health care planning for large-scale emergencies must take into the need for prompt continuation of pain management services in patients with chronic pre-existing pain. Coordination between emergency clinics and pain management specialists, as well as the availability of electronic medical records, is an important factor in continuing established pain management services after a regional disaster.

The struggle for mental healthcare in new orleans-one case at a time.

Using cases publicized in the media, this article demonstrates key issues that have led to the crisis in mental healthcare in New Orleans. These cases demonstrate the plight of chronically mentally ill individuals returning to New Orleans, the emotional stresses faced by New Orleans residents rebuilding their lives, and the consequences of shunting mental health services from a healthcare setting to law enforcement. This article also describes preexisting deficits in Louisiana's mental health system that contributed to this crisis as well as factors that have hampered the rebuilding of the mental health infrastructure in New Orleans. Finally, this article suggests future changes for needed mental health services after a large-scale disaster.