Pain Wars


September is Pain Awareness Month – and people should be aware of what chronic pain patients go through.

To read the media, you’d think we are pill-popping complainers. We aren’t addicts, and it’s definitely not all in our head. We are real people living every day with high chronic pain illnesses. We do whatever is requested; whether it be to urinate in a cup, give blood or jump through any and all of the other hoops asked of us, we just do it. The National Survey on Drug Use and Health, has done studies that say “75% of all opioid misuse starts with people using medication that wasn’t prescribed for them” but obtained from a friend, family member or dealer”. ? As Maia Szalavitz wrote in the Scientific American, “Do you know that new addictions are uncommon among people who take opioids for pain in general All of this means that steps to limit prescribing opioids for chronic pain run a great risk of harming pain patients without doing much to stop addiction.”

We have seen our lives change in the last couple of years – and not for the better. There are things that are happening around us that we feel no control over. Our feelings are correct.

The people who use opioids are under attack and the lead attack dog is Dr. Andrew Kolodny. I read an article where he says that Tylenol essentially works to combat pain as well as prescription pain meds.

“And medications that can be just as effective as, or even more effective than opioids are Tylenol and Advil”. He says that these two OTC medications “work differently, so it’s safe to take them together.” He also states in this same article that “They really are safer than opioids, and we sometimes forget how helpful they can be”. In another article, “Kolodny states “many Americans are truly convinced that Opioids are helping them”. They can’t get out of bed without them”.

One would surmise, after reading several of these articles, that Kolodny thinks that we as pain patients should just accept the pain as if it is just a nuisance. If it were as easy as taking a Tylenol, (which on the bottle it actually states that it’s for “minor aches and pains”); there’d be no rising suicide rates within the pain community.

In 2015, the New England Journal of Medicine published a commentary in which two physicians, Dr. Jane Ballentyne and Dr. Mark D. Sullivan argued their position on chronic pain and acceptance. Our own National Pain Report published an article on November 29, 2015, “Accepting Pain More Important Than Reducing Pain Intensity Because Opioids Are Harmful, Docs Write in NEJM Commentary”. The first line of the article is “People suffering in chronic pain need to learn to accept it because achieving a balance between the benefits and potential harms of opioids has become a matter of national importance. Dr. Bellantyne, the president of PROP (Physicians for Responsible Opioid Prescribing), says that “patients should pursue coping and acceptance strategies that primarily reduce the suffering associated with pain and only secondarily reduce pain intensity. Dr.’s Bellantyne & Sullivan (Dr. Sullivan is the Executive Director of Collaborative Opioid Prescribing Education (COPE), stated that the patients who report the greatest intensity of chronic pain are often overwhelmed, are burdened by coexisting substance use or other mental health conditions. Instead of opioids, these doctors say that an interdisciplinary and multimodal treatment coupled with coping and acceptance strategies are critical. In addition, they conclude that a willingness to accept pain and engagement in life activities despite pain, may reduce suffering and disability without necessarily reducing pain intensity. The two Dr’s also said that “patients should not focus on reducing the intensity of their pain, but their emotional reactions to it” (NEJM 2015 Commentary). I’m thinking that maybe all of those who, in my opinion, feel that we just need to accept and cope better, need to take a “pain challenge”.

Maybe they should volunteer to be part of an experiment where they somehow feel the pain that many of us feel and they don’t know the time frame for how long they will feel that way? I’m not sure they would feel the same way afterwards, are you?

Kolodny and his minions appear to feel that pain patients and drug addicts are not two distinct groups. He says “the opioid crisis is about addiction, and the reason that overdose deaths are at historically high levels and the death rate for middle-aged white Americans is going up, is due in large part to the epidemic of opioid addiction with overdose deaths occurring most commonly in people with legitimate prescriptions.”

Dr. Kolodny this is wrong! The problem is actually illicit, NOT MEDICAL, drug use. A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care. A more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent. What this truly means to us is that all of these limits on opioid prescribing for chronic pain patients puts us, the pain patients, at great risk of harm. But guess what? It is not going to do much to stop addiction!

We, the chronic pain community not only have to live with physical agony but with this “Opioid Crisis”. The true crisis is that the chronic pain community is losing access to reduction of their pain. This is affecting the patients’ work, if they in fact are still able to work. It is also affecting our families, relationships and at its worst, our sanity! The American Academy of Pain Medicine says that there is a “civil war” going on in the pain community. Their president, Dr. Daniel B. Carr, says that “One group believes the primary goal of pain treatment is curtailing opioid prescribing. The other group looks at the disability, the human suffering, the expense of chronic pain”. We must continue to stand up and keep fighting for what we need. Andrew Kolodny says that “in the end, chronic pain patients need more and more opioid medications in order to curtail the pain”. But there are an abundance of pain patients who never increase their dosage of opioid medications throughout many years.

As pain patients, we simply must fight back. The people at PROP have grabbed the initiative and turned concerns about opioid addictions into an attack on millions of chronic pain patients.

It must be pointed that people who own drug treatment facilities are benefiting from Dr. Kolodny’s efforts at demonizing the pain patient.

In the meantime, state agencies, federal bureaucracies and others simply stay silent on what will happen to pain patients if opioids go away.

We cannot allow that to happen!

 **The views and research in this article are solely my own and may not necessarily be the views of the U.S. Pain Foundation. 

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4 thoughts on “Pain Wars

  1. After 30 years with severe Crohns Disease…23 years of prednisone.. 15 surgeries..15 years on immuno thrpy my bones and joints are shot. Methadone made my livable. Kaiser won’t allow prescribing anymore. I’ve never considered suicide till this last year of HELL.

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    1. I’m so very sorry! I’m fearing more He’ll ahead for us all. I’m truly trying to do something to help. I’m speaking to legislators and I’m writing and doing all that I can. Don’t give up hop, please? Not yet

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