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A watchful eye is needed on adolescent opioid use

If previous studies are to believed, most adolescents do in fact use their opioids appropriately but the subgroup who don’t have been a major cause for concern. The study, which was conducted by the American Pain Society and published in The Journal of Pain, looked at around 3,000 adolescents in two districts in Detroit, US. The idea was to assess the prevalence of motives in the misuse of prescription opioids.

Ethnicity, diversion behaviours, substance abuse and gender were all taken into account.

The results were interesting — they found that pain relief was the sole motivation for four out of five adolescents who were misusing their pain meds.

They also found that females were almost 100 per cent more likely to have misused opioids in the past year, compared to males.

African-Americans were more likely than Caucasians to misuse their opiates, with three-in-four responding that they were motivated by pain relief alone.

However, the researchers pointed out that the racial differences could be linked to poor communication with their doctor, under-prescribing among African-American patients, insufficient opioid availability and an inadequate pain management treatment plan.

Moreover, misuse of non-pain-relief opioids was associated with a much greater probability of substance abuse and a greater likelihood of ‘diverting’ meds.

As you might expect, in their conclusion the authors called on doctors to keep a watchful eye out for unusual patterns of opioid misuse.

We are all becoming more aware that pain is a complex process that requires tailored solutions — the ‘one-size-fits-all’ approach to pain management is long gone at this stage.

I think this applies particularly to chronic pain, a totally useless type of pain that doesn’t raise a ‘red flag’ to alert that something is wrong and needs to be treated. But this study is a welcome reminder that we also need to pay heed to the psychosocial aspects of pain management, in all its complexities.

I would be delighted to hear your views on the issue.

Up, up and away

Like friendly but cautious neighbours, the disciplines or medicine and engineering have a long history of borrowing from each other. Medicine has drawn on engineering concepts for a raft of reasons, such as robotics, while the ultimate aim of engineering seems to be to effectively mimic biology and nature to foster advancements.

Now there is ongoing research in the field of robotics that is borrowing from the biology of how the human penis becomes erect.

Prof Diane Kelly of the University of Massachusetts, US, has been studying the mechanics of the penis and the process of penile erection for more than 20 years (stop sniggering down the back, please!).

“One day I started thinking about the mammalian penis. It’s really an odd sort of structure,” she said in a TED lecture. “Before it can be used for internal fertilisation, its mechanical function has to change in a really dramatic fashion.”

She was referring to the process whereby chemicals in the brain signal the body to relax the corpora cavernosa, two chambers inside the penis. Blood flows in through vascular openings and becomes trapped as the body restricts outflowing veins. Meanwhile, the corpus spongiosum does not inflate, keeping the urethra open so that semen can pass.

This has all the hallmarks of a hydrostatic skeleton, Prof Kelly observed, noting that “the tensile stresses…  are twice as great around its circumference as the stresses along its length”.

Now a US company called Otherlab has been speaking with Prof Kelly about the concept of fibre orientation in designing their “all-fluidic, membrane-based robots” .

Innovation truly can come from any source, it seems.

Degrees of separation

With the centenary of the 1916 Rising just passed, it seems appropriate to include a particularly old-fashioned Irish joke. Many thanks to the reader who emailed this one to me and I’m always grateful to receive contributions at the email address below.

“Well, Mrs O’Connor, so you want a divorce?” the solicitor asked his client. “Tell me about it. Do you have a grudge?”

“Oh, no,” replied Mrs O’Connor. “We only have a car port.

The solicitor tried again. “Well, does the man beat you up?”

“No, no,” said Mrs O’Connor, looking puzzled. “I’m always first out of bed.”

Still hopeful, the solicitor tried once again. “Well, does he go in for unnatural connubial practices?”

“Sure now, he plays the flute, but I don’t think he knows anything about the connubial.”

Now desperate, the solicitor pushed on. “What I’m trying to find out is what grounds you have.”

“Bless you, sir. We live in a flat — not even a window box, let alone grounds.”

“Mrs O’Connor,” the solicitor said in considerable exasperation, “you need a reason that the court can consider. What is the reason for you seeking this divorce?”

“Ah, well now,” said the lady, “sure, it’s because the man can’t hold an intelligent conversation.”

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