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A harrowing, bloody story of heroin addiction that puts films like Trainspotting to shame, Gringo mixes documentary footage with staged scenes to show the life of addict John Spacely. Perhaps you've seen him somewhere and just can't remember his name. The face is about an enigmatic as they come: classic Roman features topped by a greasy dyed matt of slicked back blond hair, pirate-style patch covering his right eye and cigarette dangling from an ever-present smirk. Or maybe you've never really noticed him and could frankly care less who he is or was. To you, John Spacely is just another loser, a human being throwing their life away by indulging in the most shameless of self-satisfactions: drug abuse. The minute you learn he's a card-carrying member of the Riders of the White Horse, you're thoughts turn to how selfish and stupid he is, how addiction is for the weak and lazy. You now no longer wish to know anything about him, his life, or how he ended up strung out in New York City. Instead, you sneer down your self-righteous nose and blame him and his kind for all the problems of the world. Maybe it would help you to learn a little about who John Spacely is. Perhaps your perceptions will change when you learn what drove him to drugs and what he has to do on a daily basis to survive. One thing's for sure, the minute you see the horrifying docudrama Story of a Junkie, you will think twice about ever attempting to use drugs. This film is as successful a PSA warning about the terrors of dependency that you will probably ever see. It makes the Hollywood glamorization of such struggling souls that much more laughable. Part documentary, part confessional, this occasionally brilliant but always brave movie is an incredibly searing indictment on the use and abuse of drugs. Whereas Tinsel Town tripe likes to romanticize the ritualistic intake of mind and or mood altering substances as a photogenic character flaw, Story of a Junkie tells it like it really is. Never once white washing or trivializing the life of a heroin addict, director Lech Kowalski and his cast of real life drug users draw us directly into the warped urban war zone where the vast majority of pusher and partakers exist. Never cringing from the sights, the sounds, the smells and the surreality of the real drug culture, the desperation is palpable and the danger, predominant. From how fixes are 'cut' to the hierarchy in a shooting gallery, you'll be hard pressed to find another film that tackles this terrible subject with more authenticity. It is drug abuse as slasher film, a frightening, sometime funny and often fatalistic representation of people living a life with a maniacal monkey on their back. It's impossible for us non-addicts to understand the struggles and the will to survive if only for the next score of the person hopelessly obsessed with using. But for some reason, we are no longer a society that accepts brutal honesty. Everything needs to be sugarcoated with a small fraction of hope inserted to keep us feeling safe and secure. Frankly, the plain truth is all that Story of a Junkie has to offer. But because of the tales it tells and the people who tell them, Story of a Junkie transcends its trappings to become a work of astounding power. DOA - 90 MN.

the films of lech kowalski © revolt cinema

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Official websites use. Share sensitive information only on official, secure websites. Each co-author contributed to the preparation of the manuscript, including the creation of the tables. The other authors declare that they have no competing interests. This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The use of opioid analgesics for postoperative pain management has contributed to the global opioid epidemic. It was recently reported that prescription opioid analgesic use often continued after major joint replacement surgery even though patients were no longer experiencing joint pain. In a review of 11 million patients undergoing elective surgery from to , both opioid overdoses and opioid dependence were found to be increasing over time. Opioid-dependent surgical patients were more likely to experience postoperative pulmonary complications, require longer hospital stays, and increase costs to the health-care system. The Centers for Disease Control and Prevention emphasized the importance of finding alternatives to opioid medication for treating pain. In the new clinical practice guidelines for back pain, the authors endorsed the use of non-pharmacologic therapies. However, one of the more widely used non-pharmacologic treatments for chronic pain namely radiofrequency ablation therapy was recently reported to have no clinical benefit. Pain is a common cause of disability and is extremely costly to society at large. The excessive reliance on opioid analgesics for treating both acute and chronic pain has contributed to the current global opioid epidemic. In light of the growing opioid crisis, we have emphasized the importance of using non-opioid analgesic drugs and techniques for acute and chronic pain management 1 — 3. Currently, 5—8 million people in the USA use opioids for chronic pain management 5. Excessive reliance on opioid analgesics for postoperative pain control can lead to prolonged opioid dependence after both major 6 and minor 7 surgery. More recently, Goesling et al. More recently, Cauley et al. Although opioid-related side effects for example, nausea, vomiting, constipation, ileus, bladder dysfunction, pruritus, sedation, visual hallucinations, and ventilatory depression are well known, there are growing concerns regarding long-term physical dependence and addiction liability with continued opioid use after surgical procedures. Prolonged use of opioid analgesics is associated with an increased risk of more serious complications, including opioid use disorder, overdose, and death Interestingly, no study of prolonged opioid use has ever demonstrated long-term benefits for the users. An epidemiological study by Eriksen et al. More recent studies suggest that long-term opioid use can actually retard functional recovery. A article in Time magazine described a new paradigm for treating opioid addiction Predictably, the solution being offered by the pharmaceutical industry involves giving more drugs! The use of non-pharmacologic modalities has been questioned by medical practitioners because of the perceived lack of prospective, randomized, double-blind sham-controlled studies supporting their use in clinical practice. Although this skepticism may be warranted for some so-called alternative pain therapies, there are in fact many well-controlled studies confirming the benefits of using electroanalgesia and laser therapy for improving acute and chronic pain management. Nevertheless, these non-pharmacologic analgesic modalities remain grossly under-utilized in clinical practice. In a clinical commentary regarding a study involving the use of complementary alternative therapies for reducing postoperative pain after open heart surgery 15 , Oz and Olivo 16 suggested that it was time to consider incorporating complementary and alternative medical practices into conventional medical treatments. Other studies have suggested that perioperative imagery, massage, and music can reduce pain and anxiety after surgery 17 , Sadly, 10 years later in the face of an opioid epidemic, the emphasis of the medical community remains on pharmacotherapy. In this F Faculty Review, we discuss clinical studies describing the benefits of using electroanalgesia and laser therapy as adjuvants in the management of acute and chronic pain. Electroanalgesia is a form of neuromodulation therapy which encompasses electro-acupuncture EA , ultrasound-guided acupotomy, percutaneous electrical nerve stimulation PENS , transcutaneous electrical nerve stimulation TENS , and peripheral nerve stimulation PNS. Patients who experience significant improvement in pain and disability with PNS may be candidates for implantation of a spinal cord stimulator 20 , However, the risk of mechanical failure, infection, and neurologic complications, as well as the high costs, are strong deterrents to using this highly invasive electro-analgesic technique. The less invasive forms of electroanalgesia for example, TENS, EA, PENS, and PNS have been reported to produce significant short-term reductions in the levels of acute and chronic pain and should be used prior to even considering the use of an implantable device. Gan et al. TENS also reduced pain and improved patient satisfaction during minor office procedures However, in a comparison of TENS and parasternal local anesthetic blocks for pain management after cardiac surgery 29 , the local anesthetic-based technique was found to be significantly more efficacious. However, a recent review of electrotherapy modalities for treating chronic rotator cuff diseases 42 concluded that, in contrast to more invasive electroanalgesia modalities for example, EA , TENS was not consistently superior to placebo treatments. In patients undergoing total knee arthroplasty procedures, TENS offered no significant advantage with respect to improving pain control and functional recovery compared with placebo treatments Finally, Salazar et al. However, these investigators found moderate-quality evidence for the effectiveness of EA in treating fibromyalgia-related pain Thus, the current evidence suggests that TENS techniques are significantly less effective than electroanalgesia techniques such as EA and PENS, which involve the insertion of multiple acupuncture-like needles Sator-Katzenschlager et al. In a recent study involving elderly patients undergoing spine surgery, Zhang et al. These EA studies are consistent with studies involving the use of PENS in patients with chronic low back pain 47 and sciatica A growing body of literature supports the short-term benefits of EA and PENS techniques when administered as an adjuvant to conventional medical approaches in the management of a wide variety of acute and chronic pain syndromes, including post-surgical pain, low back pain, sciatica, neck pain, knee osteoarthritis, headaches, peripheral neuropathic pain, and fibromyalgia 33 , 44 , 47 — In a recent comparative study, EA was also found to be more effective in facilitating functional recovery in patients with knee osteoarthritis than the potent non-steroidal anti-inflammatory drug meloxicam Interestingly, acupotomy EA was reported to be superior to conventional EA in patients with knee osteoarthritis with respect to pain control and functional recovery Despite numerous controlled studies in the peer-reviewed literature supporting their clinical efficacy Table 1 , minimally invasive electroanalgesia techniques have failed to gain widespread clinical acceptance because they are time-consuming to perform and insurance reimbursement is extremely low compared with other medical procedures. Compared with electroanalgesia and exercise therapy, laser therapy is a relatively recent development in medicine. High-intensity laser therapy HILT , also known as laser heat therapy, is an even more recent development; initial publications appeared in Cellular chromophores are presumed to be the receptor sites responsible for the beneficial effects of the laser light beam, including both cytochrome c oxidase with absorption peaks in the near-infrared range and photoactive porphyrins Mitochondria are also thought to be a site for the therapeutic effects of infrared light, leading to increased ATP production, modulation of reactive oxygen species, and induction of transcription factors. These effects lead to increased cell proliferation and migration by fibroblasts; reduction in the levels of cytokines, growth factors, and inflammatory mediators; and increased tissue oxygenation, leading to enhanced control of the inflammatory process, reduced pain, and improved wound healing 56 — Studies with laser therapy have confirmed enhanced wound healing in both diabetic 60 and non-diabetic 59 , 61 , 62 patients. Applying LLLT within the first 5 days of herpes zoster eruption also significantly reduced the incidence of post-herpetic neuralgia Many sham-controlled studies have reported that LLLT is effective in alleviating acute pain associated with a variety of superficial medical and surgical conditions for example, oral surgery 64 — 66 , nipple pain associated with prolonged breastfeeding 67 , plantar fasciitis 68 , 69 , and carpel tunnel syndrome In women with chronic myofascial pain, LLLT reduced the pain intensity Interestingly, LLLT has been reported to reduce acute pain after coronary artery bypass graft surgery 72 , Recent studies also reported that LLLT could improve sensory function in patients with peripheral somatosensory neuropathy and neuropathic pain 74 , However, other investigators have reported sham-controlled studies with negative results using LLLT in patients with superficial medical conditions for example, plantar fasciitis Despite early clinical studies reporting benefits from LLLT in patients with fibromyalgia 77 , 78 , a recent study by Vayvay et al. Several studies have described the use of LLLT for treating dental pain after oral surgery, with reduced orthodontic pain at 6 hours, 24 hours, 3 days, and even 1 week after surgery Alan et al. More recently, LLLT administered after maxillofacial surgery was reported to accelerate healing and enhance quality of life related to oral health However, Chen et al. LLLT has been reported to be a useful adjunct treatment for oral mucositis in patients with cancer 85 — However, in patients with breast cancer and unilateral lymphedema, LLLT failed to significantly improve their quality of life, pain scores, grip strength, or limb volume In contrast, long-term beneficial effects have been reported with pulsed HILT in the treatment of post-mastectomy pain syndrome A recent literature review 93 suggested that LLLT might be a promising option for the management of cancer treatment-related side effects for example, oral mucositis, radiodermatitis, lymphedema, and chemotherapy-induced peripheral neuropathic pain. Although LLLT has been reported to have a suppressive effect on cancer cells 94 — 97 , studies using rodent models suggest that it might modify cancer cell behavior and actually lead to stimulation of dysplastic cells 98 — For example, Rhee et al. In a sham-controlled, prospective safety and efficacy study of LLLT in patients with subacute musculoskeletal back pain, Basford et al. Glazov et al. However, these investigators suggested that greater pain-relieving benefits were achieved when higher laser dosages were administered that is, HILT versus LLLT. This speculation was confirmed by Boyraz et al. HILT also appeared to be an effective alternative to spine surgery for reducing pain and improving the performance of activities of daily living in patients with chronic back pain In a recent review 42 , the authors stated that LLLT has only short-term benefits versus sham in treating rotator cuff disease; however, HILT was effective in minimizing pain and disability and increasing range of motion in patients with shoulder pain In contrast, Alayat et al. Chow et al. Dundar et al. Kim et al. Alayat et al. Kheshie et al. HILT was also effective in the short-term management of pain and disability related to subacromial impingement syndrome, frozen shoulder and lateral epicondylitis — HILT at wavelengths of and 1, nm was better than TENS in improving control of pain and paresthesias secondary to carpal tunnel syndrome Analogous to LLLT, HILT has also been used to treat acute headache pain — , degenerative joint conditions — , — , neuropathic pain syndromes 64 , — , and a wide variety of musculoskeletal disorders, including fibromyalgia 77 — 79 , , Huang et al. The energy density in joules per square centimeter or power in watts appears to be strongly related to the efficiency of laser radiation in reducing pain and inflammation. The more powerful HILT devices are also referred to as laser heat devices Therefore, the laser beam produced by these devices can penetrate more deeply into the soft tissue because of their enhanced power and the reduced absorption of the laser beam by melanin and hemoglobin Figure 1 3. Profound and long-lasting analgesic effects have recently been reported with this HILT device in patients with chronic post-surgical pain requiring the use of opioid analgesics , professional athletes with degenerative joint disease requiring non-opioid analgesics , and a woman with long-standing drug-resistant fibromyalgia Importantly, LLLT studies have reported that photobiomodulation therapy produced greater improvement in muscular performance and accelerating recovery when it is administered prior to exercising , Although Foley et al. These spectra are available from online sources. Larger-scale studies are clearly needed to verify the benefits of HILT compared with both LLLT and electroanalgesia in decreasing acute and chronic pain and improving long-term clinical outcomes. For example, de Oliveria et al. These authors also recommended using a wavelength of nm for achieving optimal results with LLLT. However, Bordvik et al. In a sham-controlled study, Leal-Junior and colleagues reported that a super-pulsed laser was effective in decreasing pain and improving the quality of life in patients with non-specific knee pain. Of interest, a recent study by de Marchi et al. Notarnicola et al. Prescription opioid addiction and misuse have also contributed to a resurgence in heroin use and the spread of HIV and hepatitis C However, in the recent FDA response to the opioid crisis, Califf et al. The new Clinical Guidelines Committee of the American College of Physicians also endorsed the use of non-invasive treatments such as laser therapy for the treatment of acute, subacute, and chronic low back pain The CDCP has also recently emphasized the importance of finding non-pharmacologic alternatives to opioid analgesic medications for treating pain Of importance, Barnett et al. Altering the prescribing habits of physicians and their surrogates will clearly help; however, in order to effectively deal with the current opioid crisis, more innovative non-pharmacologic approaches for treating acute and chronic pain are clearly needed In this review, we have described numerous clinical studies published within the last 5 years which support the use of non-pharmacologic electro-analgesic and laser therapies for managing both acute and chronic pain. The consequences of the widespread reliance on opioid-containing medication for managing acute and chronic pain should not be surprising. Many different electro-analgesic and laser therapy techniques have been described in the peer-reviewed literature for treating acute and chronic pain. Although the use of powerful HILT devices appears to produce more profound and sustained beneficial effects than electroanalgesia and LLLT in the treatment of acute and chronic pain, this therapeutic modality has also failed to achieve widespread acceptance in the medical community because of a lack of knowledge regarding the potential long-term benefits of HILT among health-care providers, low third-party reimbursement rates, and the high cost associated with purchasing these more powerful laser devices. The mechanism of action of both electroanalgesia and laser therapy appears to involve neuromodulation of peripheral nerves using low-level electrical currents and infrared light , , respectively. Acustimulation, a popular form of electroanalgesia, has been reported to trigger the release of neurotransmitters and endogenous opioid-like substances and to activate c-fos within the central nervous system CNS. Laser photobiomodulation appears to induce direct inhibitory effects on peripheral nerves, which reduces acute pain input into the CNS. In chronic pain patients, laser-induced changes in the spinal cord produces longer-term suppression of pain in the CNS. A simple, safe, and effective non-invasive pain therapy without side effects could significantly reduce the dependence on oral opioid-containing medications in the post-discharge period after surgery. These non-pharmacologic therapies would also be cost-effective alternatives to opioids for treating chronic pain not responding to non-opioid analgesic medications. It would appear that both electroanalgesia and laser therapy are safer and more cost-effective for managing chronic pain than the long-term use of opioid analgesics. Finally, HILT could prove to be a valuable therapy for treating patients who have become addicted to opioid-containing prescription medications. F Faculty Reviews are commissioned from members of the prestigious F Faculty and are edited as a service to readers. In order to make these reviews as comprehensive and accessible as possible, the referees provide input before publication and only the final, revised version is published. The referees who approved the final version are listed with their names and affiliations but without their reports on earlier versions any comments will already have been addressed in the published version. Stephan A. This research did not receive any grant funding from agencies in the public, commercial, or not-for-profit sectors. As a library, NLM provides access to scientific literature. Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management Paul F White Paul F White 1 P. Find articles by Paul F White. Find articles by Ofelia Loani Elvir Lazo. Find articles by Lidia Galeas. Find articles by Xuezhao Cao. Accepted Dec 11; Collection date Open in a new tab. However, there is no reason to expect that they would not respond as well or better. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Transcutaneous electrical nerve stimulation TENS Acupoint-like transcutaneous electrical nerve stimulation. Minimally invasive Acupuncture needles inserted through skin. Superficial postoperative pain Osteoarthritis Low back pain Neck pain Plantar fasciitis Dental pain Mucositis-associated pain Acute and chronic pain related to herpes virus Trigeminal neuralgia Wound repair The pain of muscle injury Shoulder pain Carpal tunnel syndrome Fibromyalgia-related pain Headache Opioid dependency. Postoperative pain Osteoarthritis Hemophilic arthropathy Low back pain related to herpes virus Myofascial pain syndrome Shoulder pain Fibromyalgia-related pain Opioid dependency Note: Several of the applications listed for low-level laser therapy have not been studied using high-intensity laser therapy devices.

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