Run Forest, Run!


This was written by Dr Mark Ibsen, MD, who has become a close friend of mine; as has Dr Tennant. My thoughts and blog post on this subject will be forthcoming ASAP! But for now, just for this moment, here are Dr Ibsen, MD’s words regarding this abhorrent situation with Dr Forrest Tennant:

Dr Tennant recently came to Montana to testify for Dr Christensen. Sadly, while in the home state of many of his intractable pain refugee patients,

His home was invaded and business ransacked by agents who allege he was “overprescribing”. 

Just what IS overprescribing?

And what would Underprescribing look like?

This term would imply that there is a ceiling dose of a medication that has been prescribed. 

It would also imply that there is a “Goldilocks Dose” that is not too high

Not too low, but “just right”. 

Dr Tennant,

An endocrinologist,

Has been on the forefront of research and therapy for the intractable pain that patients developed after years of medical or interventional management, or mismanagement. 

These are patients with adhesive arachnoiditis, complex regional pain syndrome, trigeminal neuralgia, failed back syndrome, traumatic brain injury, and various other accidental and iatrogenic pain syndromes. 

The law enforcement and regulatory agencies Who are threatened by the Obi-Wan Kenobi of pain medicine do not have the sophistication,

compassion,

Or training to realize that they are not dealing with El Chapo. Drug dealers don’t actually care how their clients are doing. In fact, when a drug addict dies of an overdose, sales most often go up. Dealing drugs that are unregulated and often fatal is not what doctors do. 

Most people who suffer cardiac arrest have some type of medication on board. We don’t arrest their doctor for prescribing a Statin or aspirin or blood pressure medication in an attempt to enhance or prolong a persons life. 

People have hypoglycemic reactions every day,treated for their diabetes. We do not arrest their doctor for “overprescribing insulin”.

All doctors are required by their oath to do no harm-to try to hit that “Goldilocks dose”

When cancer patients die,

Do we blame there oncologist for killing them?

There’s a reason medical doctors train for 12 to 20 years, then continue to study and research the literature their entire careers. Could it really be true that Dr. Tennant is sidelined by a DEA agent with 12 weeks of training?

Are doctors no longer protected by the regulations outlined in the Controlled Substances Act?

Dr. Tennant treats the sickest of intractable pain patients. I too have referred intractable pain patients to him, I have taken his courses and follow his protocols.

Now, who will testify for me and protect my patients?

According to the World Health Organization North America provides the best pain care management on the planet. Dr. Tennant has always recommended following the world health organization pain ladder. 

Doctors like forest Tennant, William Hurwitz MD, Ronald Myers, and Chris Christiansen are simply guilty of trying to relieve the suffering of their intractable pain patients. 

This often requires us to

“Increase the dose”

If we as a culture continue to punish pain patients and the doctors that serve them no one will be safe accessing the incredible medical system we have developed in the US. 

Yes, complications occur. 

Yes, people are dying. 

From heroin/ fentanyl injection ODs,

Not

From responsible informed and well researched treatment of those in intractable pain who have failed every other therapy available.

“Run, Forest, run!”

We Are Not A “One Size Fits All” Society


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I’ve had a few interviews recently, with people who want to know about “my story” mostly. But I’m finding out more and more that so many in mainstreamed society do not understand chronic illnesses or pain whatsoever.  There are 100 million people living in the USA, who live with daily chronic pain. We truly need to “talk about” this.  I’ve even been speaking with legislators to try and get some of these House Bills to NOT be permanent law. The people who are sitting on these committees do not understand anything about chronic pain, yet these are the persons making the medical decisions for us instead of our physicians. Most or many chronic pain patients visit their pain management physicians, now monthly. The pain doctors are the ones who went to school for many many years to learn about how to treat people who live with real pain on a daily basis. Why are these Bills being turned into laws without the consent of a pain Dr.? Why were there no pain management physicians sitting in on the meetings when the CDC guidelines were being discussed?

The CDC guidelines that were put into place in 2016, were done behind “closed doors” and in “secret”; without any pain management physicians there to guide them at all. No, there was only PROP (physicians for responsible opioid prescribing), including their guy, Andrew Kolodny; who is a Psychiatrist.  He is an addiction specialist, not a Physician trained in the treatment of chronic pain. Why would the CDC set guidelines like these and allow them to be done like this in secret, by a person who is not even trained in the management of pain? Next, these guidelines are supposed to be just that, “guidelines”.  Somehow they have become the “law” without actually going through the right chain of events to become a “law”.  Physicians, pharmacies and others are now adhering to these “guidelines” that were meant for general physicians, not even for Pain physicians.  But some pain management Dr.’s have seen their colleagues have their livliehoods taken away by the DEA now, and they are fearful.  They fear losing their practice and everything that they went to school all of those years  to do.

These CDC guidelines are not the law but Dr.’s are being “bullied” into making them the law in their own practices.  They have famlies and a life outside of pain management. They don’t want to lose everything and I undertand that.  But someone has to stand up for what is good, lawful and right!  We need to remind our physicians that these are just guidelines and not anything that legally must be done right now.  The guidelines, after all, were also supposed to be about stopping the overprescribing of opioids right after an injury or a surgery.  They weren’t meant to take the very lives away from the chronic pain patients; yet that is what’s happening.  People are dying and suicides are rising even though in the last several years, the prescribing for opioids has actually gone down.  Did you know that legacy chronic pain patients, those who were already on an opioid pain medication plan that was working for them, before the  2016 guidelines came into effect; are supposed to be exempt from them? But that’s not what is happening in many cities and states.

Today, in 2017, in our United States of America; people are being tortured. Yes, it is true.  Our service men, the Vets who came back from combat, after fighting for their country, return home to live with terrible and painful wounds.  They were the first to be denied pain medications and now everyone else is following. How can a country let those who lost a limb or more, fighting for them; just live with pain and not try to ease that pain?  If you read the CDC guidelines in the link that I’ve provided above (in the second paragraph), you will be able to read that the guidelines spell out these words “reduce opioids UNLESS THERE IS HARM BY DOING SO”.  So many in our country are now being harmed by these guidelines that are being abused and played out as “law”. Do you know that the elderly in nursing homes are now being denied opioids and left to live out their days in agony and chronic pain at various advanced ages? This is called “torture” and “abuse” and it’s just wrong! Just as it is wrong to make everyone be at the same dosage of opioid pain medication.  We are not  “one size fits all” human beings. Just as 90MME or less, will not work the same for everyone. We all metabolizes differently.  Some physicians & legislators are listening again, to the non-pain management Dr.’s, who think that 90 MME is the highest amount that every single person should be allowed to take, no matter the circumstances.  This is truly torture for patients who are in need of more than that amount.  There are patients who must take more than that in order to have some semblance of a life outside of their bed. They are not groggy or high.  They are just trying to get by and live their lives the best way that they possible. To the surprise of the journalists and legislators that I’ve spoken with, the chronic pain community that I know and love, doesn’t want more opioids for pain relief.  They want only what is needed to get by;  to live some kind of life with lessened pain.  I was asked “If I could have more opioid pain medication, would I want more?” I responded vehemently, “Absolutely not!” If I did not need to take the medications that give me some pain relief, then I would not take them.  I don’t want more and more pain medications.  I only want the amount that is necessary for me to have some kind of life outside of my bed.

Of course, I understand that opioids normally are not the very first course of action for a chronic pain patient.  We have to go through the rigorous pain clinic “steps”.  There are the trigger point injections, different kinds of Nerve blocks, biofeedback and occasional trip to see their pain Psychologist. Once found to “not have an addictive personality” they will try different medications.  There are persons who have tried many non-opioid pain medications and either they got deathly ill from them, were allergic or they didn’t work. The next step is usually invasive and expensive surgery to either get an intrathecal pain pump or a spinal cord stimulator. People have varying views regarding these surgeries and the outcomes. I don’t think anyone should be forced to have an invasive surgery.  One in which a catheter or electrodes are stuck into the patients spine.  The patient is then given a remote control device that controls the amount of stimulation they receive for pain relief (if it works). Otherwise the pain patient has pain medication filled into a “hockey puck” -like device (pump) placed inside of the abdomen area.  They visit their pain Dr. monthly to get this pump filled. The intrathecal pain pump, I was told, is equal to about 1/300 of the amount of oral pain medication. It is dripped slowly into the spinal cord to help with pain. Dangerous granulomas can form and there may be other complications. I must also mention that afterwards, you are then “married” to that specific pain Dr. for the rest of eternity (for the most part).  I also must add that most everyone who has these invasive surgeries, still need oral opioid pain medication for “breakthrough pain”.

There are persons who aren’t candidates for one reason or another and they are not able to get a Spinal cord Stimulator or an Intrathecal Pain Pump.  After trying many non-opioid medications and not being a candidate for either of these surgeries; there are not a lot of other options.  But I want the decision to be between my Pain Dr. and me, alone.  I don’t want the government in my patient room, uneducated in pain management but trying to make all of the decisions.  I honestly believe that me and my pain management physician, who went to school for approximately 13 years, or more, to specialize in taking care of people who live with pain; should be the ones to decide whats best for me. In my opinion, no one should ever be forced to have invasive surgeries; if there is a pill available that has little or no side effects, when taken responsibly.  All medications should be taken responsibly because a person can overdose on insulin, heart medication or anti-depressants. It’s not just opioids that are harmful if too much is taken. Lastly, I was asked if I am “pro-opioids”.  My answer is “No, I am pro-patients”.

 

So Called “Opioid Epidemic” Is Harming Real Patients


A very close friend of mine, Sheryl Pietrick Donnell, wrote an article recently,that was posted in the Chicago Tribune Newspaper!  I think it’s  wonderfully written & thought out. I want to share it here with you, & with her permission:  ***************************

This is so outrageous. The so called epidemic is harming real patients. Of the 76 million prescriptions filled last year, there were a total of 18,893 total Opioid related deaths. Mind you, this is a very sick population you begin with and this number includes suicides and stolen medication related deaths as well as the ever increasing number of deaths from suicidal patients who have had their medication reduced so dramatically, their pain has made them feel suicide is their only hope. It also includes all benzodiapams. These are sedative like drugs such as Valium and Xanax, another entirely different class of drug used for completely different purposes.
Compare the 18k of Opioid deaths to the 88k of Alcohol related deaths annually. Is anyone calling for prohibition? Why not? It doesn’t work? Right. Guess what? It doesn’t work for Opioids either. We have seen a dramatic increase in Heroin related deaths since this Crack down on opioid prescriptions too.

What’s the solution? First, chronic pain patients are not addicts. We are in pain and need relief to function. Leave us out of this. We aren’t the problem. Our medication use has been stable and we need to be helped.

Second, TREATMENT CENTERS! If you have an addict, removing one source of a drug does not cure them. Addicts will find a way to get their fix, unless they can get treatment and studies show it is cheaper to treat than incarcerate or hospitalize long term from brain damage from accidental over doses.

There are so many things that are far more dangerous in this country right now than pain medicine for legitimate pain patients. And pain patients need your voices. No prohibition for sick patients. This country would never stand for taking away medication from diabetics, why is it OK to do it to us?

The Heart of a Chronic Pain Warrior!


I wrote a week ago, a response from my heart; regarding the new CDC prescribing guidelines for …but actually “against” Opioids. Here is my shortened version: “From The Heart, About The War Against True Chronic Pain Sufferers!!”
Remember the “War” against carrying a gun? The “bad guys” will always have access & “good guys” die because their weapons are taken away! It’s happening now to pain patients! We are fighting against being “robbed” of the “weapons” we need to fight against the debilitating nerve pain, such as CRPS, that “WE” live with daily. I’m fighting the battle to live not “pain free”; but with less pain and more living!
Those in positions to help, need to take the time to do so! All 50 states now have Proclamations that explain the burning, “fire-like” pain of CRPS. They discuss Allodynia, or extreme sensitivity to touch; and the pain it brings.
But all of this means nothing if the Government, FDA,CDC, Physicians & Pharmacies take away the means of lessening our pain!
We follow the rules, sign contracts with our pain Dr’s & we have to jump through hoops to get what we need to try and live some kind of life.
The other side of the spectrum are those who don’t follow rules & who break laws! BUT they have a different disease called “addiction” and “they” ruin it for all of us. ( I read that only 5% of Opioid prescribed patients, are “addicted”)
Would these same agencies and officials take anti-depressants from the hopeless, or Insulin from a Diabetic?
“They” are trying to make us feel like criminals. Many of us have been through the rigors of the Auto claims adjusters, who have the power to take everything away with the swipe of a pen! It’s ruthless today for people living with chronic pain!
In 2016,conditions will continue to worsen unless we rally and try to do something about this travesty! This year the prescribing guidelines are getting worse. The Physicians are refusing to give medicine for pain when it is truly needed. Those who who are true “addicts” always find a way to get what they need! While law abiding citizens, suffering daily, have no means other than self advocating!
Remember we aren’t “addicts”! We are patients who are suffering daily with nerve pain and who’s bodies are “dependent” upon a medication that helps us live! Without proper pain control, after caring for daily basic needs, there’s nothing left.
It is despicable that some pain Dr’s now are being forced to “push” invasive surgeries on more patients than they would have in the past. Physicians who’ve pledged to “Do No Harm” will do surgery, instead of being scrutinized for prescribing the medicine so desperately needed for the REAL chronic pain population?
There are new controversial prescribing guidelines coming and some already in effect. These are leading to more and more restrictions put upon our GP’s and even tying the hands of our pain management Dr’s. The CDC, FDA, and other groups think that they know more about pain and pain management, when they have never studied such things? They are making it about a fake “war on prescription drugs”! This is some kind of smokescreen for saving money!
I say “Pick on the real criminals”, not the chronic pain sufferers! I feel uneasy & concerned. I went through an awful experience last year, when my Dr. of 12 years left unexpectedly! He left his practice under a cloud of suspicion. I never wanted to take any of these meds. I never smoked or drank! I was just naive enough to think that I could finally trust someone in this life and then the rug was pulled out from under me!
I’ve read that they are taking most pain medications away from anyone with non-malignant pain. Who are the non medical personnel, these agencies, to say that malignant pain is worse than non malignant pain? Unless they’ve experienced either, how would they know? CRPS is #43 on the “McGill Pain scale”, right next to childbirth or amputation of a finger!
These lay people & agencies together are trying to say that exercise, healthy eating habits, along with PT and “behavioral therapy” are an alternative to medication for this kind of pain management! They say that the goal in all of this is to “stop the overdoses and the prescription drug abuse”. In all honesty, if the Dr. is a “good one”, he or she’ll only prescribe the amount needed. Why take it away if the patient & Dr. are doing everything right & when it gives some relief? The innocents should not suffer for the crimes of a few!
They’re saying that the pain meds stop working for everyone & that we all get “addicted”! We are all individuals whose bodies may become physically dependent but that’s very different from addiction.
Many patient advocate groups have written to the CDC and the FDA and explained that they are not being transparent. They used biased teams of people to make up these new “rules” and guidelines. They didn’t listen to the voices of the Dr’s and patients who live in the “Pain world”. They found that many of the people who put these new rules together have a monetary gain!.
One Physician wrote in the Pain Network News, that he has” had patients on higher doses of Opioids for over 20 years and they have some semblance of a life”. He even agrees that taking these meds from us and others like us, who’ve been on long term dosages and who will most likely have to stay on them for their lifetime; is cruel and inhumane treatment! He said that they are “forcing us into suffering, sickness and possibly even death!”
The “addiction specialists” tried to also scream “HYPERALGESIA” to everyone on Opioids for any length of time! If it is working and has been, then how can it be “Hyperalgesia”? If they really think that Hyperalgesia exists and is a problem with high or low dose Opioids, then this one Dr., who did not give his name, said that “we must remove all intrathecal Opioid pumps because these devices deliver a MEQ directly to the CNS receptors that is far in excess of any dosage we can achieve by peripheral administration.”(PNN)
Please use your voice and be heard! We need to form advocacy groups that will work together for the common good! Let’s stick together and not allow ourselves to be treated so inhumanely!