Day: 12/06/2015

Dr. Shame

If you’re not a chronic pain patient, this post won’t interest you…

And it’s really (really) long, because the linked article is full of lies, hypocrisy, and voices of “experts” who aren’t really experts. In other words, there’s a bad word (or two) in this post, as I really (really) dislike liars. Don’t say I didn’t warn you…

You’re still reading? Seriously, since this is my blog, I get to rant, but you don’t have to read it. 🙂

http://www.mailtribune.com/article/20151108/NEWS/151109770

Patient reactions are ranging from dismay to newfound hope as doctors cut back on narcotic painkiller prescriptions for chronic pain in an effort to combat addiction.

Newfound hope?  Ummm, okay, this should be interesting…

And just so we get this straight:  Doctors are reducing or stopping medications to combat addiction, not treat pain. So, really, what doctors are doing is treating about 90% of pain patients for addiction — a condition they don’t have — while also refusing to adequately treat their pain.

Linda Stotts, who lives in the town of Rogue River, said she has tried almost every available painkiller since rupturing disks in her back while trying to lift a desk in 1987. She has taken methadone for four years to ease her pain, but has been told she must taper off the drug until she is methadone-free in two months.

As she reduces her dose and her pain worsens, Stotts said she is contemplating suicide… Stotts, 69, said she fears she no longer will be able to care for herself and will have to move to a nursing home. She said she has been classified as a drug addict because of her painkiller use…

Dr. Jim Shames, medical director for Jackson County Health and Human Services, has been spearheading the local effort to curb use of addictive opioid painkillers…

And so enters the black knight in tarnished armor…

“These drugs are powerful, addictive and dangerous,” Shames said. “But at the same time, people are in pain and we’re bringing their doses down. They’re in a tough place and I recognize that. The trick is how to compassionately put them in a safer place and give them better tools to manage pain. Nationwide, there are millions of legacy patients on high doses. No one is trying to be cruel.” …

“Legacy” patients — what an interesting term. I looked up the definition of that word, but I’m still not sure what this Dr. Shame (I mean, Dr. Shames) is referring to. One of the ways Google defines legacy is:

“denoting software or hardware that has been superseded but is difficult to replace because of its wide use”

If you’re a pain patient currently on opioid treatment, what do you think your chances are of being one of these legacy patients, allowed to continue on opioid therapy?

I read about another anti-drug doctor who suggested that doctors wait for legacy patients to die out, but not create any new ones. I think he said this would take a couple of decades. Isn’t it comforting to know that the medical industry is waiting for current pain patients to die out? Doctors don’t have to feel guilty about not treating us because we’re terminal.

Wait a minute…  If we’re terminal, are we now “legitimate” pain patients?

Shames said the pharmaceutical industry oversold the benefits of opioid painkillers. New research shows they are only about 30 percent effective in treating chronic, long-term pain.

Did Big Pharma oversell the benefits of opioids or did doctors just hear what they wanted to hear? And why would doctors trust their local pharma rep over their own experiences? Did you know that oxycodone has been in clinical use since 1916? (Per Wikipedia.)

Funny how easy it is for doctors to scoff at medication that’s 30% effective, although there’s no reference or link to the research, so I’m not exactly sure what Dr. Shame is talking about. Is he saying that opioids give a patient 30% relief from the pain? Or that 30% of pain patients show increased function with opioids?

Exercise, physical therapy, adequate sleep and cognitive behavioral therapy can yield better results, he said.

If doctors won’t tell you the truth, then I will:  Do you know what treatment yields the best results?  By itself, that would be opioids. But if you have enough money and time to include all these other treatments along with opioids, then the combination of treatments would provide the best results.

Some researchers have reported long-term use of opioids can leave patients hyper-sensitive to pain. Shower spray can feel like needles driving into the skin, for example.

Gosh, I really hate to nitpick (obviously not), but I haven’t read about too many patients who actually suffer from hyperalgesia. But I’m wondering, if you stop taking opioids and your pain doesn’t magically decrease or disappear, would Dr. Shame then allow you to access opioids again? Somehow I doubt it, which makes this doctor a freaking hypocrite.

Because of opioids’ addictive nature, patients become physically dependent on them. Without the medications, patients can suffer withdrawal symptoms such as nausea, vomiting, diarrhea, muscle pain, sweating, chills, insomnia, anxiety, irritability and low energy.

So, how about we don’t take these medications away from patients? Instead, increase efforts at educating (not scaring) patients about the drugs they’re taking. There, problem solved.

Touchstone Interventional Pain Center in Medford is among local medical groups working to transition patients to safer doses or off opioids altogether. A few months ago, the center sent a letter to 1,500 patients saying changes in the field of pain management likely will cause adjustments to pain medication prescriptions. The high risk of overdose death, coupled with studies showing many patients with chronic pain failed to show substantial improvements in pain, have caused a shift in policy about prescriptions, the letter said. Patients on high doses were told they would need to taper down to safer levels within three to six months…

I can’t imagine receiving one of these letters…  I’m sure the thoughts of many of these patients turned to suicide. Lucky for them, they live in Oregon, which is one of a very few states that have a right-to-die law.

“For the majority of patients, this transition can be done slowly and in a way that is tolerable,” the letter said. “Many patients may even notice an improvement in their pain as several studies suggest that pain medication over time may actually worsen pain.”

Let me translate:  I’m the doctor. I know what’s best. I paid hundreds of thousands of dollars for those fancy degrees on my wall. And I’ve decided that you should suffer. But hey, don’t worry about it, you could be part of a very small percentage of patients who actually feel BETTER after they stop taking medication to treat their pain. Anyway, there’s nothing you can do about it, so you can either agree, or… fuck off.

Dr. Shawn Sills, a pain expert with Touchstone, said most patients have been understanding about the changes. 

Most? Ah, Mr. Sills, just another liar and hypocrite…

He battled opioid addiction himself several years ago and was the subject of an Oregon Medical Board investigation. After undergoing treatment, Sills opened Touchstone in 2012 with firsthand knowledge of the addictive power of opioids. He is also the medical director for Addiction Recovery Center and Rogue Valley Fresh Start Detox in Medford.

Oh. My. God. Another ex-addict turns his personal experiences into a profit-making machine…

“If opioids worked, we would be happy to continue prescribing them,” he said. “But the majority of patients develop tolerance. Doses go up, they get tolerant, the dose escalates, and then they’re at risk of dying — even when they’re not abusing and they’re taking their medication as prescribed.”

If doctors admitted that opioids actually do work, your business would suffer, right Mr. Sills? And I have to wonder if your clinic prescribes bupe or methadone. (You hypocrite.) Or do you just over-prescribe antidepressants and anti-psychotics? (Still a hypocrite.)

The truth is that the majority of pain patients are not abusing their medications; they work just fine. And if patients are taking their meds as prescribed (including being careful of interactions), they’re not at risk for dying. Wow, they’ll let anyone be an “expert” these days, won’t they?

“As they cut down on medications, they experience withdrawal. It’s really hard for our patients, and not all of them understand why they’re being cut down,” he said. “They say, ‘I’ve been taking these for years and I haven’t died.’

Yeah, but tomorrow, you could become a drug addict.

We try to discuss research with them that opioids can make pain worse. If we slow down the taper and educate them, most understand. About 10 to 15 percent are really struggling and may need to be kept on those higher doses.”

Well, there you go. About 10 to 15 percent of current pain patients will be allowed to become “legacy” patients. Talk about death panels…

Continued opioid use may be appropriate for patients who experience pain relief and improvements in their ability to function.

What a thin line patients walk when trying to prove they deserve pain medications:  If you don’t show enough improvement, the meds are taken away. But if you show too much improvement, doctors will say you’re cured… and then the meds are taken away.

Some older patients also may be kept on their medication because they are less likely to escalate their dosages compared to younger patients, Sills said.

Another wow, because this doctor is basically (and publicly) discriminating against young people.  Especially when the age group allegedly abusing their meds is the older one. I wonder how he feels about women and black people?

Many insurance companies are now covering other pain treatment methods, including physical therapy and counseling. There are also procedures that can target pain generators, such as radiofrequency ablation, in which a current targets nerve tissue, Sills said.

I’m sure these treatments help some pain patients, but tell me Mr. Sills, if you burn nerve tissue and it makes the pain worse, how are doctors going to treat the resulting (and new) pain?

I think it’s important for patients to realize that if a treatment is unsuccessful, treating the new (and old) pain with opioids will not be an option (at least for very long). I assume that goes for surgery, too. If your pain levels haven’t been reduced within a couple of weeks or months after surgery, you won’t have access to pain meds.

I know a pain patient in the U.K. who was told at her last doctor appointment that from now on, opioids will only be prescribed for cancer patients. And even though she’s a cancer survivor, she’s technically in remission, so no opioids for her.

Sills is also using the new Senza spinal cord stimulation system, which was approved in May by the federal Food and Drug Administration as a method to combat pain…

Before you have an implant, be sure to check for recent FDA and international recalls.

While attending pain resiliency group sessions, Eshoo said she learned opioids can be appropriate to treat short-term acute pain from injuries such as a broken bone, but they can do more harm than good for chronic pain…

Brainwashing or placebo effect?

She learned relaxation, moving, breathing and stretching techniques, and how to manage the negative emotions and thoughts that come with chronic pain. Her quality of life has improved and she lost 70 pounds…

Okay, I’m gonna guess that this patient is an exception, not the rule.

Statewide, prescription opioid overdose deaths skyrocketed from 48 in 2000 to 239 in 2006, when deaths peaked. Deaths have been trending downward to 150 in 2013…

https://olis.leg.state.or.us/liz/2015R1/Downloads/CommitteeMeetingDocument/58819

Total number of suicides in Oregon (2013):  698

I think the use of the word “skyrocketed” says a lot. Funny, no one talks that way about the increased suicide rate. 😦

Yeah, that’s me.  Fighting hypocrisy.  (With my keyboard.)  Every. Single. Day. 🙂

Doctors running from pain patients

https://www.bostonglobe.com/opinion/editorials/2015/11/25/baker-opioid-plan-gets-only-half-right/MV3t8SOB8DkzhGKrPYEghK/story.html

When professors at one medical school asked graduating medical students what they would do when faced by a pain patient, one student spoke for many: “Run!” …

The state government has declared that substance use disorder is a “chronic, progressive, relapsing disease.”

So is chronic pain.