by Myra Christopher, Director, PAINS Project
In July, the National Academies of Sciences (NAS) released a “consensus study report” titled Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Richard Bonnie, Professor of Medicine and Law at the University of Virginia, chaired the committee of eighteen. Their work was funded by a grant from the U.S. Food and Drug Administration (FDA) specifically for the purpose of helping the FDA to reassess the agency’s risk-benefit framework for opioid approval and monitoring. I encourage all those concerned about the tension between efforts to improve chronic pain care and to contain the opioid epidemic to download and read at least the thirteen-page summary, if not the full three-hundred plus page report.
The Preface of the report, written by the Bonnie begins, “Nature and human ingenuity have spawned a class of opioid drugs that alleviate pain and, not coincidentally, induce feelings of well-being. Unfortunately, overprescribing and misuse of these drugs pose serious risks to individuals who consume them and the population at large.”
The report is well-written and well-organized in two parts:
Part I: Pain Management and Research
Part II: Addressing the Opioid Epidemic
The committee appears to have attempted to do a balanced analysis and to make recommendations that will not unintendedly harm chronic pain patients. However, among the 21 recommendations made by the committee, only one is included in the Pain Management and Research Section:
Recommendation 3-1. Invest in research to better understand pain and opioid use disorder. Including but not limited to:
- Improving understanding of the neurobiology of pain
- Developing the evidence on promising pain treatment modalities and supporting the discovery of innovative treatments, including nonaddictive analgesics and nonpharmacologic approaches at the level of the individual patient; and
- Improving understanding of the intersection between pain and OUD (opioid use disorder), including the relationships among use and misuse of opioids, pain, emotional distress, and the brain reward pathway; vulnerability to and assessment of risk of OUD; and how to properly manage pain in individuals with and at risk for OUD.
Part II: Addressing the Opioid Epidemic, however, includes 20 recommendations. In fairness, some will without question help both patient populations, e.g., under “Strategies for Influencing Prescribing Practices,” Recommendation 5-3 is to “facilitate reimbursement for comprehensive pain management.” And under strategies for reducing Harm, Recommendation 5-10. Improve access to naloxone and safe injection equipment will also benefit chronic pain patients who may accidentally overdose on opioids they are prescribed.
The day the report was released, NAS hosted a webinar which I and many others listened in on. Presenters did a good job and tried to communicate clearly that they understood the importance of balancing these two public health issues. I was dismayed, however, that there was no mention of the National Pain Strategy during the webinar. Furthermore, review of the document revealed little more than a mention of the Institute of Medicine report, Relieving Pain in America or the National Pain Strategy. However, my concerns were somewhat assuaged by the statement of “Ethical Context” in the report’s introduction which revealed that the statement of task provided to committee members “directed the committee to make recommendations to the FDA and other policy makers that would properly balance the needs of pain patients and the (societal) need to address opioid misuse.”
Committee members did an excellent job of pinpointing the underlying tension that manifests itself at every turn as we try to advance better care for those living with chronic pain, i.e., as articulated by the committee, “one of the confounding features of the policy discourse on the regulation of opioids and opioid prescribing is that many physicians and patient advocates ground their arguments not in the aggregated balance of benefits and harms at the population level but in the patient-centered ethics of clinical medicine (ethics ‘at the bedside,’ so to speak).” The report acknowledges that the committee was “sensitive to the ethical tension between the population perspective of public health and the patient-centered perspective of clinical ethics.” Although they clearly state that their charge was to answer the question posed from a societal perspective, I am grateful that they concluded this section by acknowledging the importance of clinical ethics and challenging policy makers to be sensitive to the impact of alternative policies on public confidence in the healthcare system, including trust in the physician-patient relationship.
I couldn’t agree more and believe that the importance of addressing this underlying tension between the needs of the individual against the perceived needs of society is critical to resolving both these important public health issues. It is obvious that most of those making policy at the federal level have chosen to forgo the importance of balance. PAINS most recent policy and educational brief, Recognizing the Needs of Pain Patients in Substance Use Policy, makes this very clear.
I encourage those living with pain and those advocating on their behalf to speak out and to call out the imbalance that exists in current policy making, especially at the national level. We can no longer be silent.
I come from various sides of this issue. First, I’m an RN and lost my career due to chronic pain of fibromyalgia, degenerative disc disease an osteoarthritis. Secondly, my 22 y/o daughter passed away in March 2017 from two bone marrow failure diseases. Her pain was equal to that of bone cancer. Her pain medication was limited and she suffered horribly. This was tortuous to me. Others became distant, it was too great a challenge to see. She felt unloved and abandoned in her last years. There is much, much more to this story, but I assume I’m allowed only so many words. One thing to note, I do not take pain medication. I worked in an ER, many pain patients were called “drug seekers” or “frequent fliers.” I choose not to be burdened by that, it’s self preservation. I can’t tolerate the stigma and the hurtful comments by physicians that I have experienced since 2004. I choose to suffer, cry, use heat and creams. I no longer seek help and it’s inhumane that our medical professionals, DEA and our own government are more worried about those who choose addiction as their path. If I had my choice, it would be to have 4-6 pills per month for severe pain. Physicians are qualified and deemed responsible for their patients’ health. Government cannot solve all with a blanket approach.
Deaths will greatly increase if pain medications are no longer given to patients with chronic pain! I went through every treatment both standard and non standard treatment to control my pain. It can to the point where I was ready to take my life to stop the pain ! I finally found a doctor whom would prescribe Opioids were a life saver for me otherwise I would be dead. The government should not come between Dr. and patient on treatments that are known to work and save people!
Anthony,
I agree with you 100%!
It’s already happening. You don’t need to look far to find a suicide associated with the under treatment of chronic intractable pain or completely untreated.
It is a complete shame that the initiative to help addiction was not thought out more carefully.
Personally, it makes me wonder why. It also makes me wonder why the poppy fields of Afghanistan are flourishing.
I wonder when thr right people will start asking the right questions publicly?
Donna,
My heart goes out to you for the loss of your daughter and moreover for how she was forced to suffer.
I’m very sorry to read that you’ve given up your unalienable right to adequate pain relief due to the bias and bigotry that’s become an ubiquitous infection among physicians, pharmacists, and well, all medical practitioners.
I wish I had the power to help you. It simply is not fair nor is it right.
Every day I am amazed at the lack of solidarity among clinicians for the very people they swore to protect from pain and suffering. How the vast majority can sit idly bye and watch unsubstantiated policies kill good people every day is absolutely beyond me.
The entire PROPaganda backed by anti-opioid zealots is pure evil. Imho, it seems to be based solely on generating income for those that stand to benefit from driving the CP community into drug rehabilitation just to stave off suicide.
The ONLY say for evil to prevail is for good wo/men to do nothing. And this is exactly what we have seen from the medical community in large part. They sit in fear and use it as their justification. Well, historically many people have faught Tyranny and have lost everything because the greater good demanded it and they answered the call.
That call is upon the men and women of the medical community but thud far … nothing but crickets.
I pray we can end the suffering and bring about reform that’s practical, logically applicable, and moreover … compassionate.
Sending you many prayers and gentle hugs.
Edit: *way
The only way for evil to prevail.
Sorry, sometimes I’m all thumbs on this phone. 😉
We can’t thank you all enough for sharing your stories. You are why we do the work that we do to advocate for comprehensive pain care for all.
If you haven’t done so already, please make sure to sign up for our mailing list so that we can keep you apprised of opportunities to speak out and share these very real consequences of living with pain.
So sorry for your loss, dear. Owen should have to go through watching someone suffer like this. Pain advocacy should be provided in every hospital and clinic. They are not all the same and we shouldn’t be treated like we are. Your daughter is suffering should never have happened. This is what happens when we put people into a box and generalize everyone as if individuality no longer exists.
PAINS Project,
It is the CPC that thanks you for developing this well-organized platform to raise awareness for the very real plight of people with chronic intractable pain. We really must ban together to push for effective reform. I welcome you to contact me anytime should you have a course of action for which you need assistance.
The time is upon us. We must act now.
I also invite you to check out my page and group on FB called Chronic Pain Reform. Together we CAN turn the hysteria around and bring back appropriate care for everyone.
Sincerely,
Kara
Thanks, Kara. We’ll do that!
As a technically trained non-physician who has donated time for over 20 years in chronic pain patient support groups, I would offer some really basic and uncompromising thoughts to this article. Some of the proposals here seem constructive. But they are desperately inconclusive and incomplete.
1. The March 2016 CDC opioid prescription guidelines for adults with chronic non-cancer pain are fundamentally fraudulent, biased, and grievously incomplete. In their present form, the guidelines are actively dangerous to patient health and life.
2. The guidelines have already been responsible for an exodus of physicians out of pain management, and for the desertion and abuse of tens of thousands of people forced into agony and disability. At least hundreds have already committed suicide due to unbearable pain forced on them by doctors afraid of losing their licenses to an ongoing and largely extra-judicial DEA witch hunt.
3. The Draft report of the Presidents’ Commission on Combating Addiction and the Opioid Crisis is fundamentally misdirected and morally blind to the damage being done to people in pain. If finalized in its present form, it will compound the damage to both pain patients and addicts, by continuing a “War on Drugs” that has been an abject failure for the past 30 years.
4. We do have an opioid crisis in the US. It is fed by hopelessness and economic distress which lead people to street drugs and diverted or stolen prescription drugs — not by medications prescribed and properly managed for people in pain. Addiction risk in pain patients is small. 90% of all addicts begin abusing drugs and alcohol in their teens — long before the great majority are ever seen by a doctor for pain severe enough to warrant prescription of opioids.
5. The only ethically sound way forward from present conditions is for the CDC to immediately and unconditionally recall their opioid guidelines for a major re-write led by pain management specialists and patients rather than by financially self-interested addiction therapists. Restrictive State and Federal laws which reference or rely on the guidelines must be repealed.
6. For the intermediate term, major revisions are needed in the training of all doctors with respect to both pain management and addiction recovery. Most of what government bureaucrats think they know about addiction is wrong. And this group includes our present Attorney General and members of the Christie Commission.
It is time to stop the war against pain patients! NOW!
To be completely honest the United States of America they are the biggest drug dealers on the planet. All this is propaganda for the machine is about money and the politicians pocketbooks. It’s been proven the best medicine for pain when it’s chronic is hydrocodone. The problem is the doctors and the pharmaceutical companies can’t make the money they used to make because of exclusivity rights have ran out and it’s now generic. That’s why anything under the sun that’s a name brand if it’s been shown to help with pain in any way shape or form they start pushing it. And pain injections you know that are needed so often and cost so much still don’t seem to help many people. As an individual who suffered with chronic pain for about 8 years now and have actually been told to go to pain management and I don’t have insurance. So that route is been closed for me and the only alternative is the Emergency room. To which if the reasons you have to go to a medical facility is because of a pre-existing condition and happens to be related to pain be very very careful because if you go to the hospital and it’s about pain and if that’s what your problems are then they’re going to put you on a drug-seeking list. The pain problems that I suffer from our migraines, neck and back pain, my scapulla is off by 6 degrees which causes knots in my neck and back. I need another shoulder surgery on my right shoulder which will be number six also have a tear in my right rotator cuff. I also have a narrowing of the spine or in the neck area spinal stenosis. I keep hearing that 8% of people get addicted well compared to the 92% that go through pain management and don’t have these issues that number is pretty okay there’s going to be losses in war. It’s unfortunate that that’s the way it is but I think 92% of the people should be cared for instead of saying the 8% who become addicts is going to outnumber the other 92%. To me that is a crying shame that have this many people suffer. What I would like to see are the studies that show what happens to people with chronic pain that are not being treated for their chronic pain to see how much their life expectancy is reduced. Stress is the biggest killer so how many people that are not being treated for their pain develop the one thing that comes with stress more than anything else is cancer. How many people develop cancer because of their chronic pain not being treated. To me it goes back to its a business okay one thing that lets me know that it’s a business is Ultram Tramadol I think it’s an expensive ibuprofen it’s now in the same category is Norco used to be in Vicodin used to be they bumped the Vicodin and Norco up because it gives you more jail time higher fines. I’m sorry if something doesn’t work for you and then why are you forced to take it. Or why should we feel like we’re guinea pigs when I have chronic pain and you want to give me something like Gabapentin and with having ADHD Gabapentin can have an adverse effect to somebody in my condition like a very very angered outbursts basically. Which happened to me during a reaction I received and then I went back to pain management and they wrote a prescription for gabitril same family most likely going to get the same result was told to take it same result. Either I could be at home and a migraine hits if I am lucky to have a Norco or around maybe from a visit to the dentist cuz that seems to be the only people that can write anymore who claim to have the ability to write pain medication I can take a Norco and prevent me from going to the emergency room or if I don’t have it I can go to the ER and then they want to look at me like I’m some type of drug Ativan or this that and instead of a doctor speaking to you like someone who’s there to help they take the initiative to sound like a police officer question in you to your motives why do you need this while we don’t write this we don’t do this. Are great, our great country the United States of America has forgotten that drugs have allowed us to become the power we are without methamphetamines during World War II we do not win that war we had our soldiers we had our fighter pilots all on meth to stay up for days and days and days is okay for that. I would truly like to know the numbers if there is a study that shows how many people commit suicide because their pain management is not helping. Would that number exceed the amount they say overdose from taking pain medication. As someone who is in the process of starting a Christian transition home to help those coming from rehab to give them a safe place to have a fresh start or homeless people or people getting out of prison and with my previous experience running another transition house for two years I’m kind of in the now of what’s going on I kind of know what is happening. I believe a big part of the problem is we don’t have enough doctors that are standing strong and standing firm to the oath they took to protect the patient to help the patient. Protecting the patient who is having chronic pain by removing the medication that helps is not protecting, you or harming this patient. My opinion is when did doctors stop becoming doctors and not be able to do what they’re supposed to be doing and helping those and the guys in the suits and ties who are elected officials when did they become the ones that wrote the medical law. If your major is in business philosophy what in the heck do you know about okay the medications and the way they work the way they metabolize. of the situations that go with opiates running a Christian transition home people that are coming out of rehab or jail and help try to help these individuals rebuild their lives okay I see a big correlation when there’s a big hit on pain medication and a big influx of heroin hitting the streets. Is that a coincidence? No way. As soon as it’s found out that they’re going to be closing pain clinics or cracking down on pain pills there’s people calling down in Miami and other ports and ask him to bring in the heroin and they flood the streets with Heroin. I have a problem with a government that would allow such things to happen because it happens all the time. Another scary thing is if you go to a doctor and you have all your MRIs and scans and this and that showing what’s going on and what’s been happening to your physical body and he says I can help you okay what did they used to tell us to do when you do when you didn’t agree with the doctor get a second opinion but today if you get a second opinion you’re called a drug seeker and that is travesty. To me what the DEA the lawmakers Etc excited the people behind the curtain what they’re doing is Criminal.
Sorry for the bad composition of my article I spoke to Google and Google typed everything for me so I know there’s errors and my apologies but I didn’t have the time to go through every single thing.
I’m new here. I started taking pain medications in the spring of 2012. Before this time, I struggled with chronic pain and fatigue for years! I’m put into a category every day. I have no insurance due to not working. I was an educator for a short time.I’m proud of that time. I’m devastated and lonely from being ostracized and not being able to work. I believe pain brings depression. I don’t do well with depression meds, which, by the way, is what the doctor’s want to give patients for pain, that and anticonvulsants. I don’t understand how free clinics can hand out depression and brain chemical meds , but no pain medications. These medications have enormous side effects and cause health problems later in life; however, they’ll give them out like candy! It’s just nonsense to me. I suffer a lot. Many people judge me! I’ve been refused disability. And, I’m told to go to the ER for exasperated pain. Try going to an ER with no insurance for pain
They treat people with less empathy than they have for an animal! I’ve been trying Kratom for pain
I get it in the mail and capsule it. I get the cheapest that I can find. I have no idea really of what I am putting in my body. I’m that desperate! I do see a practitioner and receive loratab 5s for pain. I don’t get enough relief, but I’m told that my body will ‘ max – out’ if I take a higher dose. I have no money for tests or procedures to get out of pain. I go through all of this while it feels like no one cares! I’ve considered suicide often. When will it ever end? I suffer from fibromyalgia, degenerative disc, active AS spondylitis, migraines, terrible IBS, shingles and anxiety. I feel like often, humans are inhumane. I read the posts of others. God bless you all!!
I agree. For the past 9 years i have been suffering foraminal, spinal stenosis, severe arthritis left and right, herniated and bulging discs from c2 thru C5 back pain shoulder pain etc. I dont know how it happened i woke up one morning with an arm i couldnt move and a numb thumb. To this day my thumb and first 2 fingers remain numb. The pain is unbearable and im not a drug user but i think a dr should give me something that actually works for pain. Im ready to commit suicide.
I sadly understand the suffering of Intractable Pain and finally had a medtronic pain pump put in and it has changed my life. I am here to say the suffering is real, after an attempted suicide, and being refused at a pain clinic with rods protruding from my spine from a failed fusion due to osteoporosis, I recieved little humanity or humane treatment from doctors or nurses at a pain clinic I went to. They love to use the word hyperalgesia saying the drugs cause your pain but in my situation morphine didn’t work well. It is hard to feel that anyone cares except family who listen to the news and see that opiods are bad and you have to live with it. Well I am sorry that is to much to ask, laying in bed dying and no one caring or understanding the level of suffering I was going through. I couldn’t even get out of bed to brush my teeth let alone take care of other basic needs. I fought, got a social worker and a good therapist involved and finally found a caring pain clinic that saved my life. So far I am better and thank god there is hope for you too. We need to stick together and organize and create a voice that demands attention to this inhumane treatment of those who suffer. You do not suffer alone. We as pain sufferers feel your pain and weep for your loss. My we find strength to continue and bend the right ears to hear us.
I suffer from something called Degenerative Tissue disease and arthritis. One day as I was getting ready for work I lost all feeling in my leg. As of today I’m subjected to steriod injection to help with pain; but only leaves me in more pain. I’d been out of the workfield for almost 5 yrs due to ongoing lower back pain. This year I was finally at a place where my pain was under control. I had a awesome doctor but she took another job out of state and that when the nightmare started. I meet the new doctor and the first words out of her mouth was that she checks with the local pharmacist to see if I’m getting meds from other docs. I knew then I was headed for a fight. She cut my script in half leaving me to take more than SHE recommended. But I did my research and found that as long as it was communicated to her I could do just that. Long story short with the pain contracts that are in place you are forced to take a UA and at that point the meds where not in my system. I never went outside my clinic, I followed all the rules; yet I’m the dealing with the red tape.
On the mark as always Red!
Have there been any positive updates for severe chronic pain patients & the cruel treatments by medical community. The need to change the rules for severe chronic pain patients lives so there not forced into a life of forced into a life of agony from a life of a happy healthy functioning to bed bound life of all and only pain only forced by ignorance of DEA & AMA to only surviving not living.
I’m looking for any positive work to help patients who have been treated for many yrs for dilapating pain & were very secussfully treated with opiates to have a functioning life only by treatment by PM Dr & followed all rules set by treating dr.Are there records to prove how these patients lives were impacted positively with No negitivr effects on record. What states have records to prove that all the good out weighs Any negitive(constipation,minor effects) ??
Please email any work s in Any states that prove how lives of these patients were turned from negitave to positive from dr prescribed opiates . Short or long term use?