1. Pain and Addiction Common Threads

2. Land of Excess

3. Appalachian “Pillbillies”

4. Alabama is Number 1

5. Chronic Pain Has Become The Politically Correct Term for Addiction

6. Taking Action

7. “Operation Pilluted” arrested 22 Doctors and Pharmacist in 4 states earlier this year

8. May 13,2015, a 3 to 2 decision in the West Virginia Supreme Court ruled that doctors and pharmacist can be sued for medical malpractice for their role in pain medication abuse, even if the patient is dishonest with the doctor.

9. Assessing Risk for Abuse Family History of Chemical Dependence (Including tobacco, benzodiazepines and alcohol). Social History of Substance use ( Including tobacco, “benzos” and alcohol). Medical History of Depression or Chronic anxiety disorders (Chronic emotional pain)

10. Statistic show If a patient takes an opioid pain medication daily for 30 days, There is a 47% chance they will still be taking them in 3 years.

11. Mechanism of Dependence and Tolerance Dopamine receptor down regulation in the Periaqueductal gray matter and the Rostroventral Medulla. Loss of Glutamate inhibition of prefrontal cortex on the nucleus accumbens. Hyperalgesia Loss of Descending anti-nociceptive (pain) pathways

12. Pain and Behavior

13. The Osteopathic way