Dear Dr. Bonakdar

Robert Bonakdar, MD, is Director of Pain Management at the Scripps Center for Integrative Medicine, immediate past president of the Academy of Integrative Pain Management and co-author of the 2016 book Integrative Pain Management. Follow him on Twitter @DrB_Well.

While I wait for things to change, I will go back to the office, sign Dr. Murthy’s pledge, and wait for the day that the sales reps come to detail me on the benefits of group exercise for pain, and the denial letters I keep getting start using more truthful language: “We regret to inform you that this therapy is being denied because we simply don’t want to deal with the real issue. Pain, as you know, is a real bummer…”

My comment:

So many of you “experts” are pushing alternative therapies, as if most chronic pain patients haven’t already tried (and paid for out-of-pocket) most of these treatments (and more). When these alternative treatments only have a success rate equal to a strong placebo effect. What do you propose for the majority of pain patients who don’t respond to all of these alternative treatments? Just suffer, right?

Sure, let’s go backwards in the treatment of pain, like back to the 1980s, when doctors would only prescribe antidepressants for chronic pain — antidepressants, now prescribed like candy, even though sugar is probably a better drug.

“…opioids for pain care has not created any significant improvement in pain and disability…”

Opioids are not miracle drugs. Their purpose is not to cure, but to manage. Have antidepressants created any significant improvement in depression (or made it worse)? Have anti-addiction drugs cured drug addicts, or do some patients have to take them for the rest of their lives? Does insulin cure diabetes? Why are doctors requiring opioids to do more than any other drug?

The most successful treatment for pain is opioids. That’s a fact. The treatment that’s being denied to many chronic pain patients — and cancer and terminal patients — is opioids. Stop acting like most pain patients haven’t already tried all of these alternative treatments (and then been forced into poverty). Stop acting as if these alternative treatments can replace opioids, when all they can really do is help reduce their use (but only in a small percentage of patients).

It’s not chronic pain patients who are abusing their medications, it’s mostly those who suffer from addiction. The opioid war isn’t about the treatment of pain, it’s about the treatment of addiction.

Living with constant pain isn’t a “real bummer.” Donald Trump running for president is a real bummer. Suffering from intractable and incurable pain makes a person wish for death. Because death is preferable to living with constant pain without any hope of relief.

While all of you “experts” are living in a fantasy world, those who suffer from intractable pain are living in the real world. Why don’t ya’ll join us down here in hell?

We Are The Enemy

The internet says there is a mural in New Orleans, buried in the 8th Ward, that has a quote from an artist named Rajko Radovanovic:

“A precondition to doing violence to any group of people is to make them less than human.”

Doing violence to a group of people — like war — means that both sides believe they’re right. And with war, it doesn’t really matter which side is right. Lots of people are criminalized. Lots of people die. The end.

You might think that the drug war is about drugs. That drugs are the enemy. Our country has certainly spread that theory throughout the world. It’s a war without end because there will never be an end to drugs, legal or illegal.

Who is the real enemy in the drug war? Those who suffer from addiction:

And now, those who suffer from chronic pain. We are considered the enemy, at least to state and federal governments. Doctors and other drug dealers are also the enemy:

Federal funds will be used to form a Heroin Investigation Team consisting of Louisville police detectives and DEA agents that will investigate heroin overdoses as crime scenes. Investigators are planning to crack down on local drug dealers, larger suppliers and track doctors at the center of pill mills. Dealers whose drugs cause overdoses will now face a minimum 20-year prison sentence without parole, U.S. Attorney John Kuhn said…

It’s important to know your enemy. It’s also important to know if you’re considered an enemy. Look in the mirror. We are the enemy.

A solution in search of a problem

A requirement that edible marijuana products come with a diamond-shaped stamp and the letters T-H-C — not just on the packaging but on the brownies, candies and other edibles themselves — takes effect Saturday…

The stamping requirement comes in addition to exhaustive labeling and packaging rules that include childproof zippers and lids, along with warnings that the product should be kept away from children and not eaten before driving or while pregnant or nursing.

“We want to ensure that people genuinely know the difference between a Duncan Hines brownie and a marijuana brownie, just by looking at it,” said state Rep. Jonathan Singer, a Democrat who sponsored the law requiring stamped edibles…

Marijuana ingestions remained relatively rare, though, with the hospital reporting 81 children treated for accidental pot ingestion between 2009 and 2015…

My comment (awaiting moderation):

Since cosmetics, personal care products, and cleaning substances are the most common substances implicated in pediatric poison exposures, it’s now time for each of these products to be stamped with a similar label, along with every pill produced by Big Pharma. Because it’s been proven that kids always pay attention to labels.

The difference between a cannabis brownie and one from Duncan Hines? The cost. Anyone who buys an edible is very aware of how much it costs and will not pass it around like candy. If they can afford to do that, I’d like to be their friend.

Mr. Singer, how much of your political funding comes from the alcohol and prison industries or Big Pharma? Why would you sponsor and pass such a nonsensical regulation?