Is Pain a Public Health Crisis?

Robert Kerns, PhD, of Yale and the Connecticut VA, who also chaired one of the report panels, said the strategy asserts that pain is a “public health problem — or, as some say, a public health crisis — that is in need of a national strategy to transform the way we think about [pain].”

The report was written by the Interagency Pain Research Coordinating Committee (IPRCC), which is comprised of representation from the FDA, the NIH, the CDC, the Agency for Healthcare Research and Quality (AHRQ), the Department of Defense, and the Department of Veterans Affairs.

The report does not make specific treatment recommendations; rather it acknowledges evidence gaps and calls for further research to better understand pain in order to treat it more appropriately…

Opioids have been a focal point of the debate about pain care. The report acknowledges that more liberal prescribing of the drug class has led to a rise in addiction, abuse, and overdose, but it maintains that the drugs are considered medically appropriate for acute and intractable pain that doesn’t respond to other therapies.

Still, it notes that there aren’t enough data to help tell which patients are candidates for opioid therapy, on appropriate dosing strategies, or on risk mitigation, and there’s a need for further research on the safety and efficacy of long-term opioids for chronic pain…

Voices of pain patients and doctors

The American Academy of Neurology and other groups have found no solid evidence that opioids are effective for chronic noncancer pain, yet many patients with such pain swear that opioids are the only treatment that helps them. 

Ya’ll forgot to add the reason there’s no “solid” evidence that opioids are effective for chronic non-cancer pain — because the research hasn’t been done yet.  And you know, there’s no “solid” evidence that cannabis can help chronic pain patients, either, but it just happens to be true.

And why don’t doctors consider the evidence available directly from patients themselves?  Is it because doctors don’t trust their own patients?  (That’s okay, because patients no longer trust doctors, either.)

James A. McGowan, MD, a pain management specialist at the Center for Interventional Pain Medicine, a part of Mercy Medical Center, in Baltimore

(If you’re a pain patient who lives in Maryland, don’t choose this doctor.)

James McGowan, MD: “On a whole, the use of chronic opiates over the last 20 years has done nothing to decrease rates of chronic pain in this country and very little to improve the lives of most patients who deal with chronic pain…

You act like opiates are supposed to decrease rates of chronic pain.  Isn’t that like saying opiates are supposed to be… preventative?  Huh?  Does insulin decrease rates of diabetes? And what the hell is a “chronic opiate”?  Do you use that term only when talking about chronic pain patients?

The improvement you may miss, standing up there on your pedestal, is the ability of opioids to allow pain patients to keep working and be productive.  To keep from filing for disability.  The improvement you may miss is the ability of pain patients on opioid therapy to participate in their own lives, as well as the lives of their family and friends. The improvement you may miss is the lower incidence of suicide for patients who have their pain adequately managed with opioids.

McGowan: “There are groups of patients whom I will sometimes treat with chronic opiates. In general, these are patients in whom I can clearly demonstrate an anatomic source of pain, such as severe arthritis, significant spinal degeneration, or a history of major trauma, as opposed to patients in whom the cause of pain is not easily identified.

So, you’re one of those doctors who don’t believe a patient is in pain unless they have expensive x-rays and MRIs?  Clearly demonstrable evidence?  (Like I said, if you’re a pain patient living in Baltimore, don’t go to see this doctor.)

McGowan: “I will usually avoid opiates in patients who seem fixated on opiates as ‘the only thing that works’ as opposed to those who are open to using other treatment modalities such as non-opiate medications, interventional pain techniques, and physical therapies. I also will generally avoid opiates in patients with history of misuse or abuse of prescription opiates, patients with other significant substance abuse problems, or patients with significant psychiatric issues. Although there is no 100% foolproof way to prevent bad outcomes with chronic opiates, I find that by sticking to these guidelines, chronic opiates can be used for the betterment of some patients.”

Funny, by the time most pain patients are forced to see a pain specialist like yourself, they’ve already tried all those other treatment modalities, including non-opiates.  And if you are unwilling to pay for all these additional treatments for your patients — because insurance companies won’t — then your opinion is useless.

Tell me, Dr. McGowan, how many chronic pain patients have you created, on your own, with the use of cortisone injections and other “interventional” pain techniques?

And considering the kinds of patients you avoid, including those with psychiatric issues (which many patients with chronic medical conditions suffer from), then who, exactly, do you treat? Rich people who can convince you that they’re not depressed or are able to cover up their past drug use?  

And what about veterans who suffer from both PTSD and chronic pain?  How about a woman suffering from PTSD from past child abuse or rape but also suffering from severe arthritis?  How about a police officer suffering from PTSD from 9/11 and also chronic pain from a major injury?

Refusing to treat someone’s pain because of their history or because of comorbid mental conditions just makes you a doctor who uses discrimination as a tool — so you don’t have to do your JOB.  And it makes you cruel. (You arrogant, sanctimonious asshole.)

Under comments:

jose a. jarimba
If you don’t know the origin of a symptom, how can you cure it? Pain is being managed, handled, relieved, controlled, and much more, you never hear that one can take a treatment and will no longer have pain. But now there is a permanent solution for pain, here in McAllen, Texas. For those that suffer from pain, you will hear about; The Human Mold project, soon, nationwide..

(This guy is just trying to sell his new book.)

w h, md

Patients lie. All the time. Not all, but a large number. Some of them very well. Experience a skilled Munchausen, if you want confirmation…

Patients lie all the time?  I wonder why patients have to lie or why a doctor would believe that most of them do?  And now chronic pain patients are being compared to that very rare patient who suffers from Munchausen?  That’s just… ridiculous.

Louise Dotter
OH – and I forgot to mention the chronic ITCH! from opioid use! Finally found a cream that helps but that is the first side effect!.

I’m not sure, but I believe itching can be a sign of too high of a level of opiates in your system.

dawn anewday
Interesting that not one of you health care professionals offered any alternatives to opiates for chronic pain. What do you do with a man who went over a freeway overpass upside down and had a flat bed truck land on him crushiing his arm, chest, pelvis and legs…..6 months in the hospital, 3 surgeries, crushed chest, multiple injuries……and is in agony every step? He did fine on oxycontin for years……then 6 years ago, the DEA seemed to transplant themselves onto his doctor. He’s been weaning off and in withdrawl almost all the time, complicated by PTSD. He’s embarrassed to tell his doctor that he cries almost all the time, is shrieking out in pain whenever he moves, whimpering, howling like an injured animal every day after 8 weeks of a lower dose. There is no description for withdrawl on the internet like he is having. He is bedridden now where he used to be able to ride in the car and go for short walks. He’s a mental basket case…….and all you professionals can think about is “opiates are bad.” Get your brains back……some people need these medications..

Jack Cain
Written by me to the American Legion Magazine, 4/15/2014: ___ “Sadly, the patient’s voice is getting lost as the pendulum swings toward the demonization of legally prescribed opioid medication. It’s almost as hard to live with these medications as it is to live without them. Even after 8 years on the same dose, here is this veteran’s reality. You are a person who is physically dependent on your medication. To everyone else, you’re an addict who takes drugs and gets high. Switching doctors for any reason becomes “trying to find Dr. Feelgood”. Physically presented prescriptions replace faxes and phones, and even then, your pharmacy may decline to fill them. Don’t lose it, or your medications, as your doctor will not replace them for any reason. Going to the ER expecting pain control, no matter the cause, is “drug seeking”. Major side effects include decreased testosterone and diminished sensation. There’s more. Don’t lose your job, as almost all companies now require a pre- employment illegal substance screening, which you cannot pass. Be prepared to lose everything you have if you drive. Unlike alcohol, which has legal guidelines, the level or legality of opioids present in your blood is no defense. You are liable in an incident, period. (Because of this, I no longer drive). At work or at school, be prepared to work harder to compensate for the mental effects. Finally, some states limit the amount of opioids your doctor can prescribe, limiting where you live. Opioids are a legitimate tool but hard to master. It takes fierce discipline to use all of the tools you have and not succumb to the mirage of a few hours of relief the “easy” way.” ___ Yet, I still choose to take them, because the alternative is suicide. Not because I am suicidal, or emotional unstable, but because the pain is so intense 24/7/365.25. If you experienced this, you would think quite differently about the use of opioid pain medication!

More armchair quarter backing. The AMA is crying wolf over specious data and deductive logic. Many many people do get great benefit for pain from opiates long term and short term. But the “baby is out with the bathwater” on this one. Leave doctors alone and let them do their jobs. Let them assess the need and methods of pain management. Get second opinions from physicians specializing in pain management. There should be no restrictions on physicians and patients freedom or choice(s) for pain management. AMA……mind your own business……if you actually have one other than telling strangers what to do. One of my colleagues patients was getting great pain relief with opiates. Pain resulting from terminal cancer. The patient was pulled off of opiates for “fear she would become addicted”. She agonized in pain for months before she (my mother) solved the problem herself by committing suicide. Thanks AMA. She suffered greatly thanks to you..

Chocolate is food too :)

African plant outlawed in US may offer treatment for addicts

One hypothesis of how iboga or ibogaine work is to “reset” levels of critically important neurotransmitters in the brain, notably serotonin and dopamine. Serotonin plays a key role in overall mood, and most anti-depressant drugs on the market are in some way designed to modify serotonin. Dopamine, on the other hand, is our major pleasure and satisfaction compound letting us know when we like or crave something. In addictions, these and other neurotransmitters are compromised. Resetting them would provide a potent tune-up to the entire central nervous system…

“How do you sleep while the rest of us cry?”

This song (Dear Mr. President by Pink) is dedicated to the members of the New Mexico Medical Cannabis program — patients, patient associations, producers and dispensaries, doctors, and the Department of Health.  And to the New Mexico State Medical Board and every politician in this state.

While all of you enjoy your holiday weekend, take a moment to think about those who can’t afford this program and have to suffer, and suffer, and suffer, without any pain relief.

“How do you walk with your head held high?  Can you even look me in the eye?”