Out Of Focus

“You can’t depend on your eyes when your imagination is out of focus.”  Mark Twain

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“If you just focus on the smallest details, you never get the big picture right.”  Leroy Hood

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“When words become unclear, I shall focus with photographs. When images become inadequate, I shall be content with silence.”  Ansel Adams

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(Photos taken October 6 and 7, 2015.)

Do doctors think pain patients are grieving cattle?

The pain management industry (and our enemies in New York) are busy trying to prove that opioids don’t work. But no matter how they mess with the data, they’re not really proving anything — just publicizing how patients who suffer from lower back pain can expect to be treated in the ER.


“These findings do not support the use of these additional medications in this setting,” Benjamin W. Friedman, MD, MS, of Montefiore Medical Center, Albert Einstein School of Medicine in New York City, and colleagues reported online in the Journal of the American Medical Association (JAMA).

“Opioids, when combined with naproxen, are not more effective than naproxen alone for the majority of patients with low back pain,” Friedman said in an interview. “We demonstrated that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen is unlikely to benefit the patient. Emergency physicians should counsel their patients that passage of time will bring improvement and eventual relief to most patients,” he told MedPage Today…

ER doctors “should” tell their patients that time will help their pain. I think that’s what grief counselors tell their patients, too. And don’t you just love how these studies purport to tell us which medicines work for the majority of patients, instead of using a more personalized view? Are we cattle, our treatments decided by what the herd says (according to doctors)? That might work for vaccines, but it makes no sense to use that sort of mentality for treating pain.

Even though I don’t suffer from lower back pain (except from old age), I’ve taken my share of Anaprox and it never helped me at all. Just caused some nausea (at the larger doses). And this was during a time when my pain levels were lower than they are now.

What patients want doesn’t matter, because if you suffer from lower back pain and end up in the ER, they’re not going to treat your pain. Because opioid war:

“Our data leave clinicians and patients in a difficult position,” Friedman told MedPage Today. “Many patients have already taken NSAIDs for LBP before they arrive in the ED. Some patients may have taken insufficient doses at incorrect intervals and could be instructed to optimize their NSAID regimen. But for those patients who have already optimized their NSAID regimen, there are no additional evidence-based medical therapies available.” …

Acute low back pain is a frustrating condition, acknowledged Friedman in an interview. “In general, a majority of patients with acute onset LBP report persistent suffering 1 week later. By 3 months, however, the majority has improved.” …

Liar, liar, pants on fire. You can’t conclude that a majority improve with just this study of 323 people, especially since those patients only suffered from back pain for 2 weeks or less. But you know they’re going to use studies like this to say that those who suffer from chronic back pain are to be treated the exact same way in the ER — here, have some NSAIDs (and a ridiculous hospital bill).

And while doctors may believe that lower back pain is a “frustrating” condition, those who suffer from it feel quite differently. Patients are more worried about survival than annoyances. And you know what, doctors? You’re all becoming annoyances… doctors are the “frustrating condition” that all pain patients are suffering from.