There was plenty to blame: the car wreck that broke his back. The job pouring concrete that shattered his spine a second time. The way he tore up his insides with cigarettes, booze, cocaine, and opioids.

It all amounted to this: Carl White was in pain. All the time. And nothing helped — not the multiple surgeries, nor the self-medication, not the wife and daughter who supported him and relied on him.

Then White enrolled in a pain management clinic that taught him some of his physical torment was in his head — and he could train his brain to control it. It’s a philosophy that dates back decades, to the 1970s or even earlier. It fell out of vogue when new generations of potent pain pills came on the market; they were cheaper, worked faster, felt more modern.

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But the opioid epidemic has soured many patients and doctors on the quick fix. And interest is again surging in a treatment method called biopsychosocial pain management, which trains patients to manage chronic pain with tools ranging from physical therapy to biofeedback to meditation. It helped Carl White, a 43-year-old social worker from Leroy, Minn.

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The catch? It can take weeks and cost tens of thousands of dollars — and thus remains out of reach for most patients with chronic pain.

“We’ve been banging our heads on the wall, and banging our fists on the door, trying to get insurers to pay for this,” said Dr. Bob Twillman, executive director for the Academy of Integrative Pain Management. “For the most part, they will not.”

When pain is not just physical

Chronic pain affects nearly 50 million Americans, according to the American Pain Foundation. The largest drivers include migraines, arthritis, and nerve damage — but in many cases, emotional trauma also contributes to the sense of misery.

“We have a lot of people in this country who are unhappy, isolated, and hurting,” said Jeannie Sperry, a psychologist who co-chairs the division of addictions, transplant, and pain at Mayo Clinic. “Depression hurts. Anxiety hurts. It’s rare for people to have chronic pain without one of these co-morbidities.”

Indeed, chronic pain has a substantial psychological element: Being in pain often leads to self-imposed isolation. That loss of a social network then leads to anxiety, depression, and a tendency to catastrophize the pain — so that it’s all a patient can think about.

So even if the initial cause of the pain is treated medically — with opioids, surgery, steroid injections, or physical therapy — it’s unlikely to go away entirely. That may be why just 58 percent of patients who routinely take prescription painkillers say the drugs are effective in managing their chronic pain, according to the American Academy of Pain Medicine.

“In the past, pain was viewed just as a physical issue,” said Robert Gatchel, a pain management researcher and professor at University of Texas, Arlington. “The thought was, if you cut something out, the pain will go away — but lo and behold, it doesn’t in many cases, and sometimes [the pain] gets worse.”

“In the past, pain was viewed just as a physical issue. The thought was, if you cut something out, the pain will go away — but lo and behold, it doesn’t in many cases …”

Robert Gatchel, University of Texas at Arlington

Acute pain is generated in the peripheral nervous system, which conducts danger signals to the brain. From there, the brain determines whether it’ll experience the pain signals or ignore them, Sperry said. “In the case of chronic pain, that system has gone awry,” Sperry said. “Without training your brain to turn down the alarm system, the alarm keeps going off all the time.”

So although the pain may have originated in the foot, patients end up with headaches, chronic nausea, chronic fatigue, and back pain — developing a host of other symptoms as the brain short-circuits.

“Focusing solely on a pain generator in the body,” like a herniated disc or nerve damage, “utterly and completely misses the chronic, complex, changing nature of chronic pain” as it’s processed and experienced in the brain over time, said Dr. Tracy Jackson, an associate professor of anesthesiology and a pain specialist at Vanderbilt University.

Carl White
Hardware removed from Carl White’s body after his last surgery. Sarah Stacke for STAT

Bracing for ‘New Age-y nonsense’

The second time White broke his back, he decided to shift gears: He left the cement pouring business and got first his high school diploma, and then a college degree. He began working at Mayo Clinic as a neurosurgery coordinator — but still relied on alcohol and painkillers to get through the day.

It’s tough to estimate how many people with chronic pain develop a dependence on medications, but in 2014, about 2.5 million adults had opioid addictions — and many of those addictions started with a prescription for potent pain pills.

White soon found that unless he distracted himself with intense physical labor, he focused obsessively on the pain, and his thoughts spiraled into darkness. “If it’s a 1-to-10 pain scale, a chronic pain patient will say, ‘Mine’s at a 12 or 13,’” White said. “A 1-to-10 scale isn’t even sufficient. When I was at my worst, all I know is that my pain was on my mind 24/7.”

“A 1-to-10 scale isn’t even sufficient. When I was at my worst, all I know is that my pain was on my mind 24/7.”

Carl White, social worker

By then, White had run out of medical options. No one would operate on him, and the pills were making him feel worse, not better. Finally, in 2009, Mayo referred him to its pain management clinic.

White went in with a great deal of skepticism. He recalls sitting in the back of the meeting room, arms crossed, waiting for the pain rehabilitation specialists to tell him some “New Age-y nonsense.”

Instead, in that short, intensive program, White learned tools that worked for him — some of them very simple instructions, like how to lift heavy objects with his legs instead of his back. The program also helped him process some traumas from his childhood, White said, such as when he was orphaned at age 10 when he found his abusive, alcoholic father dead.

The psychological component also helped White learn to be kinder to himself — easing a great deal of self-imposed pressure to overexert himself.

These days, White’s baseline pain stays at a 4 — meaning, it’s always there, but it’s manageable. On the bad days, he considers small things, like getting out of bed in the morning, to be victories. “Instead of lying in bed, I gotta get my butt out of bed — otherwise it becomes a tomb, and the ‘stinkin’ thinkin’’ comes back,” White said.

He’s now working at the Minnesota Adult and Teen Challenge, a faith-based addiction therapy program in Rochester. And he’s working on launching a pain management program for his clients.

Carl White
White and a client practice diaphragmatic breathing and passive muscle relaxation as a way to manage pain. Sarah Stacke for STAT

Plumbing psychology to deal with pain

There used to be hundreds of integrated pain management centers all across the country. But in the ’90s, the insurance market shifted; more patients joined managed care plans that limited them to a narrow network of doctors. Then in 1996, the powerful opioid OxyContin hit the market. It quickly became the tool of choice for controlling pain.

Soon, there were just four major integrated pain management centers left: Mayo Clinic, Johns Hopkins University, Cleveland Clinic, and Stanford University.

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The Mayo Clinic’s outpatient pain program runs for three weeks, and keeps patients busy from 8 a.m. and 5 p.m.

They do physical and occupational therapy — learning, for instance, how to go shopping or do yard work in ways that won’t aggregate their pain. And the program includes four to five hours of lessons each day on how to understand pain. Patients learn to relax, breathe slowly, and meditate to mitigate some of the anxiety-related pain flare-ups. Entire sessions are dedicated to understanding the psychological underpinnings of their own pain.

“By the time people get here, they have a lot of functional disability,” said Sperry, who helps run the program. “They’re fearful, because they’re getting such strong signals in the brain — so we offer a very structured increase in activity, where we’re retraining the brain to soothe the central nervous system to not process these signals as danger.”

The program is not cheap. It costs $37,000 to $42,000 for three weeks. Gatchel, who is affiliated with several pain management programs in Texas, said that price is an “exception to the norm,” and less intense versions of the treatment can run between $4,000 and $10,000.

“We have a lot of people in this country who are unhappy, isolated, and hurting. Depression hurts. Anxiety hurts.”

Jeannie Sperry, Mayo Clinic

Studies suggest the programs can be quite effective. The Brooks Rehabilitation pain program in Jacksonville, Fla., reports that six months after intensive treatment, 9 out of 10 patients reported improvements in quality of life and 3 out of 4 felt decreased levels of pain. The center reported that just 6 percent of patients who were weaned off of opioids during the program resumed taking them afterwards.

Another study, published in the journal Pain, followed 339 patients who completed a three-week program at the Mayo Clinic Pain Rehabilitation Center. Some 70 percent responded to questionnaires six months after their treatment, and reported significant improvements in pain severity, depression, social functioning, and other metrics. The gains held both for patients who had been taking opioids before entering the center and for those who had not.

A renewed interest in alternative treatments

Such results, and anecdotal reports from patients like White, have spurred renewed interest in biopsychosocial pain management.

Insurance coverage is still a battle: Many plans will pay for medical treatments such as surgeries, pills, and steroid injections that can run $2,000 apiece. They’re not as keen to cover therapy, massage, and meditation. “It’s much more efficient for insurers to pay for a pill in a 15-minute office visit,” Twillman said, “instead of a pill, plus a psychologist, plus a chiropractor, plus acupuncture, plus yoga and massage.”

Slowly though, that’s changing, in large part because of the opioid crisis.

The Food and Drug Administration just changed its provider education guidelines to urge doctors to learn about alternative strategies for managing pain.

Some insurers are open to new approaches, too. Oregon’s Medicaid system, for instance, recently began covering more physical therapy and chiropractor visits for people with back pain, so as to help them avoid painkillers and surgery. Cigna, too, has increased its coverage for back pain physical therapy.

Veterans Affairs, meanwhile, is taking steps to reach out early to chronic pain patients, often through their primary care physicians, to coax them into increasing physical activity, sitting through cognitive behavior therapy, and meditating.

Sperry has appealed to Congress to accelerate the shift with more funding — not just for chronic pain and addiction treatment, but also for medical education. She conducts a workshop at Mayo Clinic to teach medical students how to say no to patients who ask for opioid refills — and how to help them instead train their brains to manage their chronic pain.

“We need a cultural shift,” Sperry said. “There’s an implication that there’s a pill for everything — and that’s not accurate. It’s very dangerous.”

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  • Part of what’s going on seems to be, once again, the medical community “branding” something and exclusively providing it, along with its high fees. The basis of freeing onesself from the habit of adding layers of suffering to an experience are simple and almost automatic with very basic meditation techniques taught for free in buddhist temples and some yoga studios. Or just read instructions from accredited lamas and gurus who are highly trained and experienced. It is natural and ordinary. Animals do it.

    It needn’t cost tens of thousands of dollars at all.

    It’s a matter of basic self-understanding -that you are not your pain. Not the kind of understading that arises from endless scienticic studies or attending drawn out lectures and analysis. Experiential understanding – establishing a moderate training routine of undoing the layers we add, that cause additional pain. Basic insight meditation techniques, such as “Calm Abiding”, not even targeted to “pain management” will accomplish this, and more. We’ve been tricked into thinking it is a secret or that special gatekeepers can sell you the key. Just another ill effect if a consuming/capital based culture. By sharing perspectives from East and West, we can improve our sutuation.

  • This is what AMAZES me about this whole MESS,, the shrinks have made for their piece of the pie,,,They know nothing about my medical conditions,,NOTHING,,, yet,,because it has past the 90 day point,,it is labelled chronic,pain,,and this person has the inhumane ideology,,it is for ALLLL chronic pain people,,,”control it w/your mind,” ,,yea rite buddy,,control pancreatitis w.your mind,,,control lung scarring w/your mind,,,,control heart scarring w/your mind,,control a thoracic damage to the cord,and every single muscle attached to that back bone,,,w/your mind,,,I get censored,,for a so called ,”personal attack,” about the true source of this torture and genocide,,,yet article and authors like this one can attack me personally by publicly putting out a article ,that will deny me access to effective ,medical care to lessen severe chronic pain w/ a broad statement for all mankind,,,”’control physical pain w/your mind,”,,,,,,,,,and I get censored for personal attack,,,what the hell do u think this article PERSONALLY is going to do to all those who need MEDICINE to effectively lessen their physical pain??!!!,maybe its time,,to stop/slow down the death’s from denial of access to effective medicines thee ATTACK ,,,witch hunt on chronic pain patirent who have tried everything,,who have forcible been made to see a shrink or no medicine,,,where the hell is freedom in that ,”forcible,”?????/no-where,,Articles like these,,are literally causeing the denial of effective medical care to 10000’s…..and people,,chronic pain people,,who’s physical pain was controlled effectively w/medicines are now having their medicine forcible denied access to because of articles like this….MAYBE IT TIME,, people like this guy recgonize,,its the age of internet,,,and w/all this opiatephobia,,some doctor somewhere is going to see your article,,,quote it,,and stop someones medicine,THATS NOT PERSONAL,,,,that person will have to choose death to stop their physical pain,,,maybe we should start charging shrinks like how they have wrongly gone after medical doctors for prescribing MEDICINE,,,,??!!!!!FOR THE DEATH OF PATIENT,,AFTER ALL,,U CLAIMED HIS/HER PAIN SHOULD BE CONTROL ONLY with the mind,,and u have a very prominent university behind your article,,,right???eye for eye???take responsibility for your article,,u are a member of Stanford right??just thinken out loud here,,,,,maryw

  • Removing the barriers, hurdles, biases, bigotry, closed minds, and access to:
    Rethinking muscle-derive pain is the muscle tissues as wounds, scars and injury, football, rest, restoration, and rehabilitation:

    Daily self-care stretching, range of motion, Zumba and yoga.
    Mindfulness, meditation, access to social services.
    Osteopathic services
    Chiropractic care and services
    various aspects of services hands-on deep myofascial release and massage modalities.
    Medical Acupuncture.
    myofascial acupuncture.
    Chinese, energetic, German acupuncture.
    Variations on intramuscular needling such as dry needling, Gunn-IMS, Craig pens,
    Travell Simon’s protocols with spray and stretch and the myofascial release with manipulation and hypodermic wet and dry needling.

    Oh by the way:
    Surgery, knives, saws, rods etc will not touch or benefit intramuscular microscopic wounds and scars thus is contraindicated.
    Health and Human Services has deemed surgery the key definitive accepted therapeutic option and will cover the replacement of all 6 of your joints. Removing joints will not benefit the intramuscular pathology of pain yet they’re all covered.

    All the above options are not covered benefits based on Health and Human Services policies and procedures. Health and Human Services has deemed acupuncture the use of needling as worthless, valueless, experimental and investigational.

    You guessed it – there has been a lot of shenanigans going on the AMA board rooms for about 100 years.

    • Mr.Rodrigues,,,until ANY doctor,shrink,pt,,,,allows me,,to inflict thee exact same kind of physical pain I endure EVERYDAY,, and can literaly show me,,,they can endure thee exact same physical pain I have for a duration of my choosing,and ACTUALLY SHOW ME THEMSELVE,,HOW THEY WILL CONTROL IT W/THEIR MIND,YOUR p.t,,,,,,,,,,UNTIL THEN,,,,,,YOUR WORDS MEAN NOTHING,,UNLESS U YOURSELF CAN ENDURE EXACTLY THE SAME KIND OF PHYSICAL PAIN WE HAVE,,,,,FOR THE DURATION WE HAVE,,,,WITH NO MEDICINE,,DENIAL OF ACCESS TO EFFECTIVE MEDICAL CARE THE ACTUALLY LESSENS PHYSICAL PAIN ,,IS STILL TORTURE,,,FOR A REASON,,,,,, maryw

  • The opiate crisis and the sickening clinical outcomes in the standards of care can be traced back to (4) four profound yet unfortunate medical science discoveries. These new innovations allowed a physician to expedite the diagnostic and therapeutic process increasing the number of patients seen per day thus increasing income, power, prestige, influence, and market share.
    1. The invention of aspirin which allows a medical Doctor to treat pain with a pill.
    2. The invention of the x-ray which allows a Doctor to look deeper into the human body to discover disease. The x-ray evidence then ushered in the idea of design, the idea of being able to cure pain with a single surgical event.
    3. In 1940 the first hip replacement was performed successfully for hip pain. In the 1960s surgery was expanded to replacing knee joints, back surgery and brain surgery for the treatment of physical pain.
    4. The AMA then became the authors of universal socialized medicine and wrote and all of these new discoveries diagnostic techniques and surgical remedies.
    All 4 of those events and inventions allows a physician to analyze the data and establish a treatment action plans quickly; medication and or surgery to help the physical pain.

    Disaster:
    All four of those are all scientifically WRONG for the treatment of physical pain.

    Reality:
    It is humanly impossible to treat physical pain with medications or any surgical procedures because physical pain is first and primarily located in soft, connective, myofascial and muscle tissues. Physical pain will ultimately respond to physical therapy.
    It is humanly impossible to treat muscle derive pain with medications or surgical procedures because the pathology of physical pain is intramuscular microscopic wounds and scars which generate pain signals and muscle dysfunction.
    It is humanly possible to eradicate intramuscular wounds and scars pathology of physical pain with old-school, hands-on valid massage, stretching, unwinding, pulling, kneading and most importantly needling.

    Once you return muscles back into the diagnostic process, you will be able to deconstruct pain into 3 3 types of pain and their perfectly matched prescriptions I’m calling RX1, RX2, and RX3.
    RX1: Injury painful problems + Manual Physical Therapy = Resolution.
    RX2: Medical painful problems + Medications (ie Diabetes, Thyroid, True RA) = Resolution.
    RX3: Surgical painful problems + Surgical intervention ( i.e., remove dead infected tissues and cancers) = Resolution.

    Over the past 60 years, the American medical healthcare business establishment has pushed surgery and medicines as first choices. These business minded individuals then one about removing all aspects of the muscle system, functions, pathologies, diseases and all of the vast a way of muscle care therapeutic restorative options.

    Here is a snippet of all of the large arrays and of spectrums of clinical presentations of the singular intramuscular tissue scars pathology – in various individuals stages circumstances:

  • Carl White’s story is very inspiring. I am so happy for him that he found something that works for him without having to take pain medication. I look for strengths like his in myself every minute, hour, day, & year. I pray for such a epiphany to come into my life and all others suffering from physical or mental pain. I have never asked for additional pain medication from any pain management doctor for my chronic pain. I have tried to embrace my pain as part of the new me but after 11 years I still have not conquered this. I know the old healthy strong me is dead & I must accept this new over weight blob of pain my life has for me now but being an athlete until my injury at 51 yrs. of age and then have it taken away is definitely a bitter pill to swallow. I was prepared to be a strong healthy person as I aged. I worked hard for that so naturally I have a lot of mental issues to deal with from that perspective. My chronic pain is always a level 7 or more. I have pain attacks so severe I refer to them as ER pain but it would not do any good to have someone take me to the ER. At best they could give me a shot for some relief but it would not fix my problem. I do not have anyone to help me so I must be able to drive & do everything for myself. In order to do this I must have my pain medication. Otherwise, I am unable to do anything but lie in bed & moan, cry, & move as little as possible when my body is not wreathing. That is no way to live. I find I constantly must battle my own health issues in regards to what I take for what & what I can do without. I have voluntarily detoxed myself 2 times over the 11 years so I can make sure to get back in touch with the pain my body is truly dealing with. It is a horrible experience. I do not think because there are people abusing their medications that those of us who truly need them to help us get up each day & have some sort of productive day should have to be punished or treated like criminals. I do not think the doctors that are trying to help people like myself should have any retribution for doing so. I am sorry they must deal with those who scam them but they should not be held responsible for that. It is out of their control. That is another human beings decision & all the doctors can do is the best they can. I know many people who take pain medication are not only suffering physical abuse from their own bodies but also the mental abuse of their minds trying to get up each day & get dressed. It is a Ferris wheel I do not wish for anyone. It is my feeling that drugs should be legal & protected doses by the pharmaceutical companies to be safely prescribed. I do not think it is safe for anyone to have to purchase pain medication (street drugs) from individuals. It is dangerous. To legalize drugs would help curtail crime & death rates. This is a plus for us all around. It is correct that no one can imagine what someone with chronic pain is dealing with unless you could walk in their shoes. As we are all different in our physical & mental makeup so is our brains & the signals sent out regarding our pain. I keep praying for some medical group to try brain surgery on me. If it does not help me maybe it would help others in the future. The brain is the key to all our pain & all our happiness. I feel like a warrior with scars to prove it that must go to battle everyday. I try. May those of us plagued by chronic pain fight forward each day with our battles. God be with us all on our painful and/or happy journey we must face each day.

    • This is a tricky subject to talk about as chronic pain is a loop, closely intertwined with depression and anxiety. Either one can trigger the other. For me, after trying every possible medication and physical therapy approach, I resorted to ECT. I was able to do this as I have a diagnoses of treatment resistant depression. But my own thoughts were simply that I wanted to stop the deeply ingrained pain alarm that was going on in my brain. ECT is not for everyone. It has had its own side effects and I have had to deal with loss of memory and relearning how to organize my thoughts and stay ‘on my game’ in my career. But it did bring me to a place where pain did not consume me, and new neural pathways were formed as I carefully trained myself to think differently, act differently, and listen to the cues my body sends without immediately fearing a relapse into a severe and crippling pain flare. And it moved me from being someone who felt I was trapped in an endless cycle of pain, isolation, depression (and PTSD from past traumas). I wish I had done it earlier on in life rather than the constant scrambling to manage medications, avoid dependency or deal with side effects by using yet more medication…. it stopped the spiral. I still have pain, I still have spells of depression that scare me, but it gave me my life and my optimism back, and I’m grateful for that.

    • Not True!

      “Veterans Affairs, meanwhile, is taking steps to reach out early to chronic pain patients, often through their primary care physicians, to coax them into increasing physical activity, sitting through cognitive behavior therapy, and meditating.”

      I have been through all this training over the years. I have always taken my pain meds as prescribed, I do not drink and have never taken ONE pill other than prescribed. It took a long long time for me to even agree with my doctor to take pain meds, because I feared all the addiction horror stories. After 2 years of chronic pain and trying to control it agreed. My doctor of approximately 15 years retired and I was moved to another.

      I took my meds as prescribed, submitted to urine and blood tests to satisfy the VA that I was not using any other opioids it seemed every visit.

      The new doctor knowing Nothing about me because she did not have time to read my massive 2 volume records asked me to re-resign the agreement that I would not sell, give or misuse my pain meds. i tried to read the entire document but she proclaimed it was the same as I had signed the year before with my doctor. “Don’t worry, she said, it’s the same thing you signed previously. I will give you a copy. Yet, 30 seconds after I signed the agreement she flipped the computer off and said the government wants us to stop all pain medications so I’m stopping yours.

      I called to speak to patient care and after waiting two days for a call, he called me back and said we need to detox you. I asked what the heck he was talking about? I do not all in early for prescriptions, I do not take more than prescribed, and I do not claim someone stole them because I live an isolated life in part because of chronic pain. I tried to appeal to her and she said you may kill yourself but you will not die from pain. The amazing thing was that she order X-rays that were not based on my pain, they were of an area I specifically indicated I had no pain in, just to pad her books and justify taking my pain medications away.

      Had I an addiction, I would have been another statistic or story of people so addicted that they lost their homes, cars, savings and family. I have chose to isolate myself after my parents deaths because I did not wish to be a burden to others, and family because of the way they treated my parents. Through my pain I cared for my mother 6 months and never once touched her meds. I return 2 cases and 6 viles of morphine and handily to hospice,unopened.

      For the past year I have tried meditating, relaxed breathing, getting up is a chore in itself and some days I just can’t do it. I have gone through bottles of Tylenol with even the max allowable per day has not helped (aspirin and anything related causes breathing problems). I have no family or friends so this leaves me for days, weeks and some months on end lacking things I need.

      The last time I drove was a year ago, because the pain was so great that I feared having an accident or hurting someone else.

      I understand that there may be people, even some veterans like myself, who may get prescriptions for pain and sell or abuse, but why make us all suffer.

      It is very sad that the doctors, in particular the VA and the government lump everyone into one basket. Let’s take away everyone’s meds, instead of case by case. The last opioid pain med I had was May 2016.

      The point to this is I am in constant chronic pain as listed in my medical records. My pain is way off the chart of 10, but I refuse to self medicate with street drugs or alcohol.

      My heart Is saddened each time I read or hear a veteran or anyone in chronic pain daily decides enough is enough that they kill themselves. And it sickens me when it’s reported that we had mental illness and that is what caused the suicide. And although I commend the person on his success, I do not believe that it works for everyone. That helps the doctors, politicians and government sleep better at night. My doctor in particular, no matter my medical complaint she would always say “that’s not important, you don’t need to see the allergist, dermatologist or dentist, your not going to die from your pain.” Never an exam of the pained areas! As if looking into my ears, nose and mouth, an drug testing me in hopes of catching something in my urine or blood besides my prescribed meds is the fix all.

      My only fear is that if I keep trying to control my pain with Tylenol I will have another incident like 2005…my liver, kidneys started to shut down.

      As long as they make their quota for patients they could care less.

    • Kelly, I am thankful for the thoughts you shared from the prospective of one who needs a managed amount of pain medication to get up in the morning & function. Chronic pain ended a 33 yr nursing career for me due to a severe back injury as a psychiatric RN. I was determined to follow all medical treatments, physical therapies, surgery, refusing opioids medications for months. I would look on the internet for nursing jobs onthe internet that I might be able to perform, even fill out applications, and then realize there was no way I could be a good employee when I was having a terrible time doing the basics of life to care for myself. I finally agreed to take Darvecet, and when that was taken off the market, I was put on low dose hydrocodone. I have never asked for dose increases, and have always followed the dosing protocol provided by my reputable pain management doctor. I went 13 years without working, and on disability, worker’s Comp income. I struggled just to manage my home & take care of myself. Cleaning and grocery shopping an absolute struggle, even with the hydrocodone. I had been physically active before my injury, mostly water therapy. I had to change from swimming laps to walking laps, because swimming was painful with hyperextension of my back. Over the 13 years some healing did take place in my back & left leg. Two years ago I got a job as a parking cashier, which has connected me with people again. Some days the pain level is very doable, and some days it feels like my bones are scraping on the left back & down my left leg. I still have bone fragments floating in my spinal cord area. The big word for me is “function”. At least enough time has elapsed since my injury, so that with the low dose of hydrocodone I can function, minimally compared to others without chronic pain. But I am thankful every day that I can minimally function and have a simple
      job. I don’t want to live off social security or the government dole. I cannot function without opioids. I worked with patients with substance abuse for 15 years, which is why I suffered and refused opioids for some time after my injury. I am now thankful for the level of rest and functionality they give me. I have never wanted to take a handful of pills to make me feel good. All I have
      ever wanted is relief from pain so I can function! With all that being said, all people with chronic pain are not the same! Not everyone will overdose & die on them. Many of us, like myself & Kelly, have taken these meds properly for years and they have at least increased our ability to function! It’s great that law makers & others are concerned about the growing opioid epidemic. They need to be concerned, about doctors who abuse prescription writing and those who receive these meds from them & illegally. But DO NOT MAKE THIS A ONE SIZE FITS ALL FIX. Start fixing the problem where it starts, cracking down on the illegal treatment providers, the ones who call & beg known addicts to buy illegally over the phone. Provide good treatment for those who have gotten sucked into the terrible addictive process. But do not assume that every person taking opioids prescribed by legitimate pain management health professionals is headed for the morgue from an overdose!

  • I don’t think mind-related therapies need to be costly. I have seen some effective internet-based interventions. Also, I think various psychological skills (such as mindfulness skills) can be taught to a whole group (instead of individually).

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