Facebook comments that disappear

I use Facebook to make comments, but I’m not that familiar with how the software works. When I made a comment on this Consumer Affairs article through my Facebook account, I expected it to show up in my activity log. But my comment was deleted by Consumer Affairs, so it doesn’t appear in my Facebook account. (I guess everybody hates — and prefers to silence — a critic.)

That doesn’t seem right, but I guess it’s just another reason to dislike Facebook. After all, why would I want to use the same blogging platform as Mark Zuckerberg?

https://www.consumeraffairs.com/news/study-most-patients-getting-opioids-have-leftover-pills-061516.html

My censored comment:

Most deaths related to an opioid overdose are due to a combination of drugs, not just the opioid. If Consumer Affairs would like to see responsible reporting on the drug war, here’s one (lonely) example:

http://www.theguardian.com/us-news/commentisfree/2016/jun/08/opioid-epidemic-drug-mix-overdose-death

“Opioid use on its own is not dangerous, and it’s time we stop demonizing it.”

New York (with Bloomberg at the helm) is the poster state for how not to fight the drug war. That state (with help from Kolodny and PFROP) has been at the forefront of restricting access to prescription pain medications and increasing the amount of addiction clinics (along with the use of drugs like methadone, bupe, and Narcan).

http://www.huffingtonpost.com/2013/01/11/new-victims-in-the-war-on_n_2455917.html

And look where New York is at now — they’ve gone from bad to worse.

This study is a day late and a dollar short. The problems with diversion aren’t being caused by patients anymore, and it was only a small percentage of patients who were responsible for diversion anyway. If Consumer Affairs is going to “report” on the drug war, it should include other stories about diversion, like from DEA agents, pharmacies, hospitals, and nurses. The longer the medical industry blames patients, the more guilty it looks.

Drugs are a treatment, not a cure

Current Survey on MedPageToday.com:

A group of medical organizations has written to the Joint Commission, urging it to drop pain as a 5th vital sign in the wake of the opioid abuse epidemic. Is it time to get rid of pain as a 5th vital sign?

Under comments:

numa turner
Apr 16, 2016
The problem as I saw it was it was totally subjective. We don’t ask people what their blood pressure is. Granted that there is no objective way to measure pain, treating it as a vital sign can cause confusion for doctors and patients. I worked for the VA and our performance was often based on this “fifth vital sign ” and how we responded. I often saw patients on large doses of opioids who still claimed 8 out of 10 on the pain scale. What do you do with that?

This is all about money, not patients. Medicare is trying out different programs to reduce healthcare costs, and performance-based pay is one of them. How to determine if a doctor is doing his job? Ask the doctor or the patients? But PFROP is using the media- and government-hyped opioid “epidemic” to cozy up to all the doctors who hate patient reviews, especially if it’s costing them money. It’s a lesson on how to gain power and influence by increasing the number of people who support anything close to your agenda.

It’s like doctors think the only reason for a patient to give them a low score is because the doctor wouldn’t prescribe painkillers. Of course, the 400,000 patients who die every year due to the mistakes of doctors don’t get a chance to fill out a performance review. I’m guessing that many more doctors will be getting low scores because they will refuse to adequately treat both acute and chronic pain. And don’t you think they know that? This isn’t about patients, this is about money. And ideology.

Just think, if every tooth in your mouth constantly ached and throbbed, what would your pain levels be? My current pain levels average about a 7 on the 1-10 scale, but that hasn’t always been the case. I’m talking about the progression of an intractable pain condition over a 30-year period. How do you track that on a 1-10 scale? Even when I was on opioid therapy, my pain levels progressed, albeit more slowly than during the times when the pain was (and is) under-treated or untreated.

I also estimated that I received, on average, a 25% reduction in pain with opioid therapy. Did that change my average pain levels? Did my pain levels go from a 7 to a 5.25? No, that’s not what happened. The prescription drugs mostly kept me stable at a 7 (and away from a 10 and thoughts of suicide). After all, drugs are a treatment for pain, not a cure.

Let’s also acknowledge that rating pain on a scale of 1-10 is a very basic and inadequate measure of pain. Many things can affect how you rate your pain, like fear, anxiety, depression, insomnia, and anger. And also things like age, gender, and DNA.

“I often saw patients on large doses of opioids who still claimed 8 out of 10 on the pain scale. What do you do with that?”

As a doctor, you should try to understand all of these nuances, and that the pain scale is not an x-ray or blood test (none of which are 100% accurate). And as a doctor, stop putting so much pressure on pain patients to improve — why are you expecting miracles from drugs? Do you think drugs can stop the aging and degenerative processes? Do you expect all of your patients to improve from one treatment option? What kind of improvements are you demanding from your patients?

Patients are afraid to report any improvement in their pain levels. How are doctors going to change that dynamic? I’m guessing that doctors are now understanding how dentists feel, since most patients hate and fear going to the dentist. And do you know why? Because it’s freaking painful, that’s why.

Blatant discrimination and faulty science

http://www.pressherald.com/2016/03/27/maine-health-officials-working-to-prevent-unintended-consequences-from-opioid-prescribing-bill/

Dr. Christopher Pezzullo, Maine’s chief health officer, said the dosage maximum is important because the science does not support such high doses. The dosage cap of 100 morphine milligram equivalents proposed in the bill closely coincides with U.S. Centers for Disease Control and Prevention guidelines on prescribing opioids that were released last week…

Pezzullo pointed to recent research that shows over-the-counter pain medications are more effective than opioids at controlling pain…

As far as I can tell, this doctor is referring to a paper by this man at the National Safety Council, an alleged “nonprofit, nongovernmental public service organization.”

Donald Teater is responsible for advising National Safety Council advocacy initiatives to reduce deaths and injuries associated with prescription drug overdoses. Teater is a patient advocate who specializes in psychiatric services and opioid dependence treatment. Prior to joining NSC, Teater held positions at Blue Ridge Family Practice as a physician, and at the Mountaintop Healthcare and Good Samaritan Clinic of Haywood County as a physician and medical director. At present, along with his role at NSC, Teater treats opioid dependence at Meridian Behavioral Health Services and Mountain Area Recovery Center, along with volunteer work in the field.

Looks like Kolodny from PFROP has been cloned. From the National Safety Council Wikipedia page:  “The Board of Delegates develops the mission agenda, creates public policies, and tracks safety, health and environmental trends.” It seems everybody’s on board for the opioid war.

http://www.nsc.org/RxDrugOverdoseDocuments/Evidence-Efficacy-Pain-Medications.pdf

For example, when testing pain medications, the intervention is the dose of pain medication and the effect is usually 50 percent pain relief. Fifty percent relief of pain is considered effective treatment, allowing people increased functional abilities and an improved quality of life (Cochrane. org, 2014). So the question becomes, how many people must be treated with a certain dose of a medication for one person to receive 50 percent pain relief (effective relief)?

The whole white paper is based on this notion that pain medication can be 50% effective, and that it’s only effective if the patient experiences 50% relief. How many patients experience 50% relief with drugs? It can’t be that big of a percentage, because 50% relief seems almost miraculous to me. Most chronic pain patients, including me, estimate relief derived from drugs at 25% to 30%.

Dental pain:  A recent review article in the Journal of the American Dental Association addressing the treatment of dental pain following wisdom tooth extraction concluded that 325 mg of acetaminophen (APAP) taken with 200 mg of ibuprofen provides better pain relief than oral opioids. Moore et al. concluded, “The results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations.” (Moore, 2013, p. 898)

For one thing, there’s usually an end to dental pain, especially wisdom tooth extraction (although some patients experience phantom tooth and nerve pain afterwards). And the key words here are “with fewer untoward effects, than are many of the currently available opioid-containing formulations.”

Sure, for acute pain, the effects of taking over-the-counter drugs is mostly positive. That is, if they work. If a dentist told me to take Tylenol after a wisdom tooth extraction, I’d tell him to fuck off. No, before the procedure, I’d find out what the pain management program was going to be, and if I didn’t agree, the wisdom teeth would stay in.

The problem is the long-term effects of taking these drugs (along with their efficacy), although doctors don’t seem to care about that. Or else, they care more about the “epidemic” of addiction than the damaging results of long-term use of OTC drugs.

http://www.nsc.org/learn/about/Pages/Over-the-counter-pain-medications.aspx

(10/6/2014) National Safety Council: Over-the-counter pain medications are more effective for acute pain than prescribed painkillers

In certain circumstances, opioid painkillers are an appropriate treatment option. NSC Medical Advisor Dr. Donald Teater points to research showing short-term opioid painkiller use can be helpful when treating patients recovering from surgery. These medications also can be effective in treating chronic pain associated with terminal cancer because opioids have positive psychotherapeutic effects that help offset depression and anxiety.

So, cancer and terminal patients deserve these psychotherapeutic effects, but chronic pain patients don’t? This is what you call discrimination against the disabled.

The new standards would allow for exceptions for end-of-life care, palliative care, cancer pain and potentially other diagnoses. Also, those currently on higher doses – the 16,000 taking more than 100 morphine milligram equivalents per days – would be given until July 2017 to taper to lower doses.

This reminds me of medical cannabis programs, all of which have a list of qualifying conditions. Is there a list of qualifying conditions for other drugs? Yes, now for opioids, thanks so much to all who have contributed to this blatant discrimination.

Et tu, Guardian?

I’m surprised The Guardian published such a one-sided article. It’s like Kolodny from PFROP wrote it himself.

http://www.theguardian.com/us-news/2016/mar/17/cdc-guidelines-against-prescribing-opioids

Under comments:

hang3xc fortetoo 2d ago

They have stopped paying for pain meds too. Everyone I know has had problems since the first of the year. My insurance company (BCBS) had been paying for my pain meds since I got hurt in 1992. Jan 1st 2016 they denied payment. My doctor called and gave them everything they wanted yet they still denied me. Again, this is something I have been stuck with for 24 years, but NOW it is a problem? … As it is, my monthly prescription, which cost $20-$30 per month NOW costs me $250…

Thanks, Senator Warren

http://www.thecannabist.co/

Can pot help with the opioid crisis? This U.S. senator wants to know more

Massachusetts Sen. Elizabeth Warren is urging the CDC to look into marijuana as a possible antidote to painkiller deaths

My comment:

I thank Senator Warren for bringing up this issue. Hopefully, it will save the lives of some pain patients — at least, in the long run. Maybe she can also make a request to Medicare, asking it to cover medical cannabis. Too bad these actions weren’t taken before the CDC and FDA decided to join PFROP and the anti-opioid advocacy crowd, and BEFORE doctors began refusing to treat pain patients, forcing many into cold-turkey detoxes and suicide.

When more people die from suicide than from opioid-related causes, which is the epidemic?

It’s obvious that Senator Warren doesn’t understand what it means to suffer from chronic pain. Patients need equal and affordable access to ALL treatment options, not just the ones that politicians think we should have. Restricting access to one drug, while showing favoritism to another, is not really how medical science is supposed to work. After all, tens of millions of pain patients benefit from taking opioids, yet it’s only thousands who suffer from drug abuse and addiction.

The failed drug war has taught us that when restrictions are placed on one drug, it just results in the increase of more dangerous drugs. (For example, cannabis and Spice. And, of course, opioids and illegal heroin.)

We all know that drugs don’t cause addiction — it’s not that simple. And when you discriminate against one drug, you discriminate against all of them.

Dr. Jane Ballantyne of PFROP

Featured photo found at:

http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions-pose-danger-without-oversight.html

http://www.vitals.com/doctors/Dr_Jane_Ballantyne/reviews

by Anonymous on Apr 5th, 2013
This doctor has very poor bedside manner. She had an intern review my history and records and didn’t even ask me why I was in her office for a consultatation. She merely entered the room, sat on the edge of the table and sneered at me, apparently at my choice of blouses which was an imitation of an expensive designer silk in less expensive polyester. She has published books and articles about her disdain for American doctors’ irresponsible use of opioid prescription drugs in the treatment of chronic pain and apparently is on the lookout for any patient that according to her isn’t “dying, or completely incapacitated”, the only valid reasons, in her opinion for prescribing these types of drugs. When she offered me no other solutions to help with my chronic pain and I wept at her decision to deny me a prescription for pain medication that my previous doctor has written for the past 4 months, she looked away. The only thing that came out of this visit was a referral to a psychiatrist on her staff and a suggestion that I try an antideppressant for sleep and pain. I had already told her assistant and I had repeated that I could not tolerate the side effects for these medications. I think that because of my British surname she expected a white person but was disgusted by my appearance when she entered the room (I am Native American), it seems hard for her to hide her disdain for others. It seems she has been pumped up so much by her staff and peers. I do have a valid reason for medication use, and have never abused it. I brought evidence of this, conclusive radiological reports and physician chart notes. Had she reviewed these, even for five minutes, she would have agreed.

—–

CDC’s Primary Care and Public Health Initiative
Balancing Pain Management and Prescription Opioid Abuse
October 24, 2012

Lieutenant Commander Christopher M. Jones, PharmD, MPH, serves as the acting team lead for the prescription drug overdose team in the Division of Unintentional Injury Prevention in CDC’s National Center for Injury Prevention and Control…  Prior to joining CDC, Chris completed a one-year detail to the White House Office of National Drug Control Policy, serving as the senior public health advisor where he co-lead the development of the administration’s prescription drug abuse prevention plan…

Our next presenter is Dr. Jane Ballantyne, who is a professor of anesthesiology and pain management at the University of Washington in Seattle…

—–

Ballantyne, JC. Opioid analgesia: perspectives on right use and utility. Pain Physician 2007

https://www.ncbi.nlm.nih.gov/pubmed/17525783

Do you get the feeling that a few of Ms. Ballantyne’s patients were mean to her, and this is her revenge?

http://www.npr.org/2015/12/29/461409296/draft-of-cdcs-new-prescribing-guidelines-stirs-debate

BALLANTYNE:  If you give people opiates, they think you’re the best thing since sliced bread. They love you. They just worship the ground you walk on. The moment you suggest that you want to try and get them down on their dose or, worse still, say you can’t carry on prescribing – not that I do that myself; I never cut people off; I don’t think people should be cut off, but I do try and persuade them to come down on their dose – they are so awful. And you can see why people who are not seeped in this stuff – the young primary care physicians just don’t know what to make of it. They don’t want to be abused. They want to be loved like everybody else does. We go into medicine to try and help people. And when you get abused and, you know, insulted, you can see why it perpetuates itself.

I find it hard to believe that Ms. Ballantyne “never” cut a patient off. Maybe the reason is that she hardly ever prescribed any drugs that, in her opinion, patients needed to be cut off from. (Antidepressants for everyone!)

For 20 years, Dr. Ballantyne directed the Center for Pain Medicine at Massachusetts General Hospital in Boston…

If you are a pain patient who was abandoned by Ms. Ballantyne, please email me at painkills2@aol.com. I would love to hear your story.

The brain on chronic pain

It’s important for pain patients to know how to combat ignorance like this:

http://www.painnewsnetwork.org/stories/2015/12/31/all-things-considered-except-patients

Under comments:

Joan Anundson Ahr (a week ago)

My experience with family members who have rheumatoid arthritis, as well as in my job as an assistant to an orthopedic spine surgeon for many years, is that narcotic pain meds work for acute pain while waiting for surgery, pain relief immediately after surgery, and for emergency care for an acute severe injury. Using narcotics any other way, except perhaps for end of life pain relief, invites layering more problems on top of the original cause for chronic pain.

Functional MRI studies of the brain have shown the damaging effects from addictions to alcohol and narcotics. A person who’s brain has become accustomed to the drug doing the work of dealing with pain sensations loses his natural function of producing calming and soothing responses to pain signals…

When you look at the management of pain only from the side of addiction, you have a very narrow view. And you also begin to see all pain patients as having the potential for addiction (when, in fact, only a small percentage are in danger of it). You believe that dependence and addiction are the same thing. You believe that there is never a reason to abuse these drugs, even if the result of this abuse turns out to be either beneficial or of no concern to the patient.

How should we even define drug “abuse” and “addiction”? Only through the eyes of the psychiatric community? Only through the lens of certain drugs?

Even while we are learning more about the brain, we’re not really sure what it all means. If experts don’t know, what makes anyone think they know?

A person who’s brain has become accustomed to the drug doing the work of dealing with pain sensations loses his natural function of producing calming and soothing responses to pain signals…

Our ignorance of how the brain works often gets in the way, giving us beliefs that are, shall we say, incorrect.

So, do you think this woman knows what a brain on chronic pain looks like? Or is she only concerned with what an addicted brain looks like? Does she understand that many pain patients have already lost the natural ability to produce “calming and soothing responses” to continuous pain signals?

Like, duh. (I mean, seriously, duh.)

Without opioids, do pain patients regain this “natural function”?  Well, this pain patient didn’t, and from what I’ve read, other pain patients haven’t, either.

A question in my search terms today:

“Is hyperalgesia being used by dr to refuse opioids for chronic pain?”

Again I say, duh. And again, just like other doctors who blame pain patients:

“Ballantyne told the program that during her lengthy career in pain management she and other doctors were sometimes abused and insulted by ‘awful’ pain patients when they tried to wean them off opiates.”

Because pain patients should respond like robots, right? Why should we care when our suffering is increased because of opioid phobia? We should be happy that our doctors think they know what’s best for us, right? (Doctors suck.)

Opioids can give pain patients a synthetic version of their body’s own pain-fighting endorphins, allowing them to regain this ability. Cannabis does the same thing, only in a more natural way. But natural or synthetic, these drugs give pain patients the ability to be active in their own lives. And I’ll just add that, regardless of a patient’s activity level, opioids relieve suffering — and that has to count for something.

Hey, lady, drug addiction and chronic pain are two separate medical conditions. How often do I have to repeat this fact?

Janice Reynolds (a week ago)

If opioids do not work for Chronic Pain, why would they work suddenly at the end of life? …