Voices of pain patients and doctors

http://www.medpagetoday.com/PainManagement

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
04/04/15
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
04/04/15

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
04/03/15
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
04/03/15
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
04/04/15
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!

BOHICA
04/03/15
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..

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9 thoughts on “Voices of pain patients and doctors

  1. Interesting. I was hoping to find this Dr> McGowan on twitter but too many of them and no one as MD.
    I have trigeminal neuralgia. The cause is unknown in the majority of cases. To McGowan this is then a questionable pain, questionable pain disorder, and one for which patients may be faking to get opiates.
    Ummm. No.
    All you need to do is check out some of the online pain support groups to see that the blue answers, at least to opiates improving lives, to enable some folks to work, some to merely be able to get out of bed or tie their shoes.
    It is appalling that too many of the docs who “treat” chronic pain seem to disbelieve most of their patients and think of them in negative terms.

    Carol Jay Levy, B.A., CH.t
    author A PAINED LIFE, a chronic pain journey
    founder, administrator, Women In Pain Awareness Group
    Blog. The Pained Life, 30 years, and counting.
    accredited to the U.N. Convention on the Rights of Persons with Disabilities member U.N. NGO group, Persons With Disabilities
    columnist Pain News Network
    (signature added to show my bona fides as a chronic pain patient)

    Liked by 1 person

    • Trigeminal neuralgia is a bitch, no question. Some experts say that facial pain is one of the worst, and the rate of suicide for these patients is one of the highest.

      I remember participating in a comment section over at CNN about a year ago for an article about TN, and the comment section had like over 1,000 comments… I learn a lot more from patients than I do from medical “experts.”

      And part of the reason doctors don’t believe patients is because of the media frenzy over the opioid “epidemic,” along with their fear of the DEA. You’d think doctors would be above that…

      Your advocacy is impressive, and I’ll check out your blog. But you don’t need to prove your bona fides to me… just saying you suffer from TN is enough.

      Liked by 1 person

      • Thanks. Your advocacy is terrific as well. This kind of info we do not see in media.
        I agree wholeheartedly with you as to the media “frenzy” over the so called “opiod epidemic” They love writing and talking about it but they never go deeper then the press releases they get so you don’t hear about the facts such as death from opiods often ignores other meds in their systems, the condition they are in, if fragile for instance, etc.

        Liked by 2 people

  2. When they speak of the patient they forget that it is a person they are talking about,it’s as though we don’t exist but only the treatment does,no one knows your body better than the person who needs,but when to go to the Dr and tell them what’s wrong it’s that they can’t hear you and all they want is to no your wrong,it’s all a broken system that needs to be fixed but no one has the solution,this has frustrated me so I can’t begin to say
    As always Sheldon

    Liked by 2 people

  3. re:
    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.)

    Among other things, YEAH 😦

    Liked by 2 people

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