A new definition of pain is out for comment from the International Association for the Study of Pain, an influential global alliance of researchers.

When I heard about it, my hair stood on end. Some people think a new definition could lead to new therapies. But as a 23-year veteran of serious pain from a progressive disorder, I dread losing the old therapy: opioids.

Prescription opioids have lost favor since the national opioid crisis, when a growing number of people fell victim to an increasingly unrelated supply of these drugs. Prescribed drugs, illicit drugs — the distinction between the two, and their respective contributions to overdoses, hasn’t been widely grasped. And so there’s much ado about opioid replacements such as ineffective drugs, “mindfulness,” chiropractic, cognitive behavior therapy, “coping and acceptance,” acupuncture, virtual reality, and more. The problem is that none of these has been proven or even properly tested. New drugs likely to work on severe pain aren’t anywhere near the pipeline. And most of us already know what we’d pick for a broken bone or a kidney stone.

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As someone who lives with a lot of pain, I care deeply about pain treatment. In the last two years, I’ve lost care twice, without warning, because of the thoughtless, often self-interested policy that’s fueling the fad to get everyone off pills. My longtime primary care doctor in Halifax, Nova Scotia, threatened by her regulator, suddenly stopped prescribing opioids. Next, the Nova Scotia Health Authority abruptly closed my pain specialist’s practice.

As a writer, I care as deeply about words. Here’s the old definition of pain that the International Association for the Study of Pain (IASP) laid out in 1994: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

It ain’t broke. Why fix it?

Here’s the proposed new definition: An aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury.

Look what the cat dragged in. Something only resembling damage might cause pain. Despite disclaimers in the notes attached to the new definition, here’s the slippery slope: Pain might result from a verifiable injury, or it might not. It might be an illusion, an inconvenient mental trick. If it’s all in your head, pain obviously won’t need a Percocet.

And there’s more — or in this case, less. Treatment, which was declared a must in the notes accompanying the old definition, goes unmentioned in the notes accompanying the new one.

The IASP is accepting comments on the new definition until midnight on Sept. 11.

One thing I notice about the opioid crisis is this: the more talk, the less pain care. Will a new definition help, or will it harm?

How did we get here? The IASP always seemed to be a good guy in the conversation about pain relief — by whatever methods it takes. Since 2010, the organization has been associated with what was long considered one of the world’s best pain clinics, at McGill University in Montréal. The clinic’s former director is past president of IASP. He’s written thoughtfully about untreated pain, even mourning Spain’s Philip II, a 16th-century Catholic who died in needless agony from cancer while refusing all help but God’s.

Back in 2010, IASP issued its “Declaration of Montréal,” after the city in which it was crafted during the group’s 13th world congress. It’s strong stuff. “Recognizing,” it says, “the intrinsic dignity of all persons and that withholding of pain treatment is profoundly wrong, leading to unnecessary suffering which is harmful; we declare that the following human rights must be recognized throughout the world:

  • The right of all people to have access to pain management without discrimination
  • The right of people in pain to acknowledgment of their pain and to be informed about how it can be assessed and managed
  • The right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained health care professionals.”

Who could argue with that?

Almost everyone, it turns out: governments, prescribers, insurers, news media, the public. It’s wonderful that professionals who really know pain once declared these rights for people like me — for all of us, actually, since at some point we’ll all have pain. But who’s listening now? The deprescribing whirlwind has battered many like me beyond repair. However carefully chosen the words of the declaration, they’re not binding in the least.

Dr. Yoram Shir, the current director of the McGill clinic, has said that pain patients on opioids “hate” the drugs. Prescription pills feed overdoses. Doctors should be dissuaded from prescribing them and patients from taking them.

IASP has changed, too, and some of the changes unnerve me. For instance, Christine Chambers, a psychologist, is championing a new IASP initiative called the North American Pain School. Health Canada ponied up $1.6 million for her work to “bridge the gap between current treatments and evidence-based solutions.” At the annual conference of Canada’s pain specialists last year, Chambers brought in her colleague Dr. Jane Ballantyne, the enduring president of the opioid-averse lobbying group Physicians for Responsible Opioid Prescribing, as the conference keynote speaker — and then declined to comment to the media on her choice.

PROP’s executive director, Dr. Andrew Kolodny, has called medical opioids “heroin pills.” Ballantyne famously recommends “coping and acceptance” over drugs for intractable pain, and has been a paid consultant to states suing drug manufacturers, whom they blame for overdoses.

Ballantyne also helped craft IASP’s 2018 Position Statement on Opioids. It advises caution “when prescribing opioids for chronic pain, focusing instead on strategies that integrate behavioral and physical treatments,” because, we’re told, opioids are good only for acute pain, cancer pain, and end-of-life care. When used “indiscriminately” (meaning for chronic pain, according to the statement), we’re also told that the use of opioids has led to “high rates of prescription opioid abuse, unacceptable death rates, and enormous societal burdens.”

Recent research, and much of IASP’s own work, says otherwise. Take, for example, the largest study to date, of 2.2 million North Carolinians, which pegs the risk of dying due to medical use of opioids at just 0.022%.

What, exactly, is pain? It’s not something I need spelled out. But as the IASP rejiggered its answer to that question, did these colleagues weigh in? Another PROP director, Dr. Mark Sullivan, sits on the definition task force, where opinion lists the ship by favoring “nonnarcotic methods” and “risk containment for opioid misuse, abuse and addiction associated with medical prescribing.”

The IASP and its task force comprise many points of view. But even if the rewrite were less trendy, I’d question the need for it.

In our new no-opioids culture, pronouncements like the IASP’s lead to more resources going to “innovations” and “emerging research” that disparage and displace proven therapies, leaving nothing for people living with pain.

What matters is what’s done, not what’s said. George Orwell wasn’t the first to observe that what’s said can be designed to obscure what’s done. Funding attaches to words. Will more parsing mean more mindfulness and acupuncture for victims of head-on car crashes? And more advantage for opioid detractors, whose opinions spell opportunity in the form of research grants, publishing records, jobs, media prominence, speaking engagements, paid testimony and other consulting for law firms, as well as promoting alternative analgesics and addiction drugs for pharmaceutical companies?

Let’s look at who is behind new declarations and definitions, and who isn’t — understanding the players helps us understand the argument. Let’s watch the data, not the news, and check facts and sources. The IASP’s rewrite is on the way to kicking medical opioids to the curb. Maybe we will do that someday, and maybe that will be fine.

But until then, I’ll stick with opioids … if I can.

Dawn Rae Downton writes on health policy from Halifax, Nova Scotia.

  • To Dr. Lawhern: I am not affiliated with PROP and strongly disagree with them in many ways. I have no knowledge of laws in other states, I have enough trouble keeping up with my own.
    I do believe however that opioids should be a last choice when choosing treatment, that the massive increase in opioid prescribing for non- cancer pain beginning in the 90s fueled by promotion from the pharmaceutical industry was a primary cause of the opioid epidemic, that regulations guidelines and laws enacted in TN were reasonable and necessary and that pain patients in TN have access to excellent care.

    Opioids given to people for long periods (over 90 days) without assessing risk have a high incidence of addiction. This is well documented. There are many risk tools, but I believe the best is the ACE score. Acute pain treatment, less than 3 days, has little risk of addiction.

    I have been in this business a long time , I watched as my adult daughters were caught up in this epidemic, I watched as multiple pill mills opened in TN, and I have watched as the numbers of opioid deaths climbed long before illicit fentanyl was available. There is no doubt that opioids are dangerous drugs that require careful prescribing by well trained clinicians.

    Addiction is a complex social and medical problem. It is a brain disease but social and economic conditions play a large part and careful control of licit opioids will only play a small part in remediation. Excellent treatment options must be made accessible to all those needing.

    • Dr Lister, based on my own 22 years of reading medical literature, and tens of thousands of contacts with patients and care givers, I believe you are both professionally and emotionally invested in a mythology. You simply refuse to entertain any significant challenge to your biases.

      As stated by Dr Nora Volkow, director of NIDA, “Unlike tolerance and physical dependence, addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with pre-existing vulnerabilities… Older medical texts and several versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) either overemphasized the role of tolerance and physical dependence in the definition of addiction or equated these processes (DSM-III and DSM-IV). However, more recent studies have shown that the molecular mechanisms underlying addiction are distinct from those responsible for tolerance and physical dependence, in that they evolve much more slowly, last much longer, and disrupt multiple brain processes…”

      Recently published analysis of data published by CDC and of hundreds of thousands of medical insurance records followed for an average of 2.5 years, confirms the observation of Dr Volkow and her coauthor. The risk of a diagnosis of substance use disorder in post surgical patients treated for pain 13 weeks or longer is indeed higher than for those who are treated for only a few days. But risk is nowhere near 10% as you have asserted (without quoting an original reference)

      I have also had the advantage of exchanging correspondence with Dr Dasgupta concerning the appropriate interpretations of the massive epidemiological study that he and his colleagues performed in North Carolina. One of the more important understandings that emerges from that study is that while mortality risk does rise with dose and duration, there is no distinct “knee” in the mortality curve, or “threshold” of elevated risk. Only a few thousand of the hundreds of thousands of records processed for the study reflected dose rates above 200 MMED. In that small population, it is not at all clear how much of the elevated mortality is due to opioid exposure as such versus the overall increased severity of medical conditions which prompted higher levels of prescribing. We just don’t know that answer, and we certainly can’t generalize public policy to restrict opioids to ALL patients — which is what is now happening — based on risk of bad outcomes in just a few patients.

      Your central point seems to be that prolonged exposure to medical opioids at significant doses is a reliable cause of addiction and mortality in perhaps as many as 10% of all patients who are treated for longer than a few days. That’s simply not true, and the experience of millions of Medicare and Medicaid patients proves it isn’t true. You also assert that reliable alternatives to opioids exist — implying but not stating that these alternatives can replace opioids for perhaps the majority of patients. That is also not true. NSAIDs, anti-convulsive meds, and anti-depressant meds do help significant numbers of people and should indeed be tried early in a program of pain management. But for literally millions of people, these alternatives do not provide adequate pain management. Likewise, the non-pharmacological alternatives like acupuncture or rational cognitive therapy have no record of effectiveness — or even trials — as replacements for opioids. To assert as some investigators have, (not you personally) that someone can meditate their way of the worst of the pain caused by CRPS or EDS or psoriatric arthritis is simply ludicrous.

      The central realities of pain practice today are that opioids are now and will likely remain for many years, a central and indispensable element of pain management for millions of patients. There are no useful alternatives for these people. And their risk of mortality from overdose is more related to the mandated under-treatment of their pain than to any actual risk from medically managed exposure to opioids. Mortality risk in high dose patients is comparable to risk associated with modern blood thinners used to protect stroke victims from atrial fibrillation — on the order of 1/2% annually.

      You are correct that mortality and addiction risks in acute pain are lower than in treatment of chronic pain. But that distinction is not reflected in the current witch hunt being conducted by State medical boards and drug enforcement authorities. Doctors are being driven out of practice every day by high-prescriber letters (despite AMA repudiation of the practice) and prominent announcements of doctor investigations or prosecutions. The pendulum has swung from naive ignorance of the real but small risks of opioids to an even more naive over-magnification of perceived risk. US regulatory policy is a drunk under the lamp post — seeking to deny medically managed opioids without assessing the consequences to those who need them, while failing to understand that America’s opioid crisis is caused by illegal street drugs, not medical opioids. That policy position is not ethically sustainable.

    • Dr Lister,

      Thank you for finally admitting that you “have no knowledge of laws in other states…”.

      As I posted some days ago, you write in generalities — but do so based only on your views of TN law. You forget that TN is only one state out of 50, plus territories plus the District of Columbia. And so it’s not accurate to extrapolate from TN.

      CPP’s in the rest of the country are suffering terribly and you simply dont’ care. You view us as mere, impersonal “collateral damage”.

      But I doubt you view your daughters as mere collateral damage. Well, I am someone’s daughter. So is LRH. And the rest of us. All sons, daughters, fathers, mothers, …. loved ones.

      And I am not an addict and I dont’ use illegal drugs. I do need legal safe opioids in higher doses than the CDC Guidelines recommend — Guidelines which, as Dr Lawhern wrote, became the foundation for the laws of many states. And even in other states, there’s still the DEA and so the CDC Guidelines have a LOT of impact.

      Also the more you write about TN, the more I doubt it’s a haven for CPP’s, since many thousands of us do need long term opioids in doses higher than the CDC MME’s.

      Again, what about people like me who need the higher doses long term? If we lived in TN, what would happen to us?

      We’ve already been thru lots of other treatments that didnt’ help. Our PM’s, who know our bodies and our histories, have concluded that opioids are our only option. Not your injections. Not anything else.

      What would happen to us in TN?

      I do want to know b/c as I mentioned, I am thinking of leaving FL due to the increase in the number and severity of hurricanes which is bad enough for healthy people, but in my frail state, I can’t go thru having my home heavily damaged and having to move out for months, again. Not to mention the problems with evacuating and sheltering in a school gym.

  • Our US Army refers to collateral damage when they accidentally bomb a school full of children, but I’m sorry if the term seems cold. There is no limit on the MME prescribed by a pain specialist in a licensed pain clinic as long as the medical decision making is reasonable. The chronic pain guidelines are just that, guidelines ! I support PCPs with a consult agreeing with their treatment if the MME exceeds 120, but my agreement with chronic opioids is always reflected in my office notes sent to the PCP. Specific procedures combined with my patient population makes high doses rare. In some cases we refer patients to more comprehensive pain centers that can provide services unavailable locally. We always work closely with orthopedic and neuro surgeons.

    • Dr Lister, you seem ignorant of a central reality: over 30 US States have implemented restrictions on opioid dose or duration, citing the CDC guidelines as the basis of their mandated legal restrictions. And NONE of those States have retracted their limitations even after the CDC fessed up and “clarified” last April that the guidelines were being “mis-applied”. State drug enforcement authorities and medical boards are still mounting draconian persecutions of doctors, grounded on the same misinformation. Patients are dying, and increasing numbers of practices are hanging out signs on their front doors that state unequivocally that they will not prescribe opioids.

      All of this is occurring despite the outright repudiation of the central logic and MMED metrics proposed in the guidelines, last November by the AMA, and the strong public protest lodged in April 2019 by AAFP and five other professional organizations of front-line physicians.

      In light of your adamant refusal to examine the evidence in front of your very eyes, I must ask a pointed question: are you personally affiliated with Physicians for Responsible Opioid Prescribing (PROP)? That organization is responsible for much of the hype and policy misdirection reflected in the sorry record outlined above. They are also arguably responsible for the departure of hundreds of physicians from pain management practice, and the desertion of hundreds of thousands of patients now being denied safe and effective opioid therapy.

      Good evening.

    • Dr Lister –

      I’m aware that the term “collateral damage” is used by the military. But it’s an icy cold term, not reflective of babies dying.

      And the military using it for their reasons due to its purpose in life, is no reason why you, a doctor whose profession is caring for people as people, as individuals who are suffering, should use it.

      Perhaps you will reconsider using that term in the future to describe human suffering. I hope so.

      As to the limits on MME’s, my question stands — if PCP’s are limited, and if TN has so few pain clinics, and you are one of them but you prescribe almost no opioids, then what happens to patients like me, who need higher MME’s and for whom no other treatment has worked?

      You refer to your contracts with PCP’s but it’s not clear — are PCP’s under contract with PM’s allowed to prescribe higher doses as long as the PM’s allow it?

      But if that’s so, since you basically dont’ prescribe higher doses, then I guess someone like me would have to relocate.

      Again, I am trying to understand, and trying to ask you very direct questions, but I don’t feel that I get a lot of direct answers.

      Perhaps it’s just your writing style. That you imply things that laypeople don’t have the knowledge to understand?

  • Thank you, but you haven’t answered my questions, such as what do TN patients do who need long term higher doses of opioids than TN Guidelines allow for, etc.

    Also, the term “collateral damage” that you continue to use makes what’s been happening CPP’s and our docs so impersonal. Like our cars got banged up.

    Patients are in AGONY. Committing SUICIDE. Being forced to become CRIMINALS against their will, and RISK THEIR LIVES on illegal drugs against their will, knowing that those drugs are the killer drugs.

    Doctors have had to hire lawyers to defend themselves against frivolous charges and threats of asset confiscation, if not actual, irrevocable asset confiscation.

    LOTS AND LOTS AND LOTS of people.
    We are more than collateral damage — just like your daughters.
    Each one of us is an individual with a story of physical pain, lost friends and family, lost careers, lost dreams.

  • Dr Lister, you wrote that: “The doctors who treated my daughters are gone. We have over 130 pain clinics licensed in TN. We encourage primary care to write chronic opioids if the MME is low. And we encourage alternative therapies when effective. Our state is a model for other states.”

    How are the docs “gone”? Sued successfully too often for malpractice? In prison? Or just retired at their normal retirement age? If they were so incompetent and criminal as to have caused what happened to your daughters, which is how you seem to view most doctors, then there must have been many other victims and these docs must have been punished somehow . I am trying to understand what happened to them given your stated view that the vast majority of docs are bad and so the strict regs are truly needed.

    I’m not trying to be hurtful. Truly. I am just trying to understand.

    And from what I’ve read, I believe that the CDC Guidelines were intended to apply to PCP’s and not to PM’s, —- even though PM’s have been bound by them, and as I’ve written, my PM showed them to me when he imposed my forced taper.

    So, given that rationale (that the guidelines were intended for PCP’s) it makes sense for TN to restrict the MME allowed for PCP’s to prescribe, but then what about CPP’s who need a higher dose?

    You’ve said that you dont’ prescribe and that you work with PCP’s who do, but I dont’ recall you saying that the PCP’s are restricted in the dosage they can prescribe.

    And I’m sure we ALL agree that alternative therapies should be tried when feasible (and bearing in mind that often they are not feasible b/c not covered by insurance or simply due to the patient’s personal history). But what happens when the alternative therapy(s) does not work or is not feasible?

    Which is my case, and the case for — well, all of us on opioids as the last resort. Nothing else worked; no non-drug treatment and no non-opioid drug treatment.

    If we lived in TN, then, what about us under your TN model guidelines? People like us who need Rx’s with higher than Guideline MME and for whom all else has failed?

    I am truly trying to understand, but it doestn’ make any sense to me.

    When you first wrote about how great TN is for CPP’s, I actually thought that maybe I’d move there. But I dont’ think so any more. At least not right now.

    When I move, it has to be to a state where I can be treated with the opioid dose that my doctor determines I medically need, w/o any govt interference.

    And b/c I don’t drive further than a half hour from home due to my pain — to ensure I can do my appt/errand and still get home in one piece, my PM needs to be near me and not 100 miles away. And that half hour I mentioned is stretching it. Right now, I dont’ have to drive more than 15 minutes for any of my many docs, and that’s a huge big deal to me, given how wiped out and pain-spiked I am as it is when I get home.

    • Cindy I doubt Tennessee has 130 pain clinics left. Seems there are nearly daily closures.

      I can’t take OTC meds for pain, as they aggravate other health issues. Especially Gastro ones. I’m what I call a Complex Patient as I have more than 1 health issue. Gastro, Cardio, Endo, Neurological and Degenerative spinal Stenosis with a Calcified Lumbar. And a Stage 3 Kidney issue. BTW all my Specialist are a 2 hr round trip + wait time.. Our ER’s are so horrid you would not want to take your dog to..the closest 1 is in a Drug/crime infested neighborhood. They smoke MMJ in front of the hospital in SCRUBS. MMJ is illegal here.

      I’ve tried all the so called Snake Oil treatments. Had what was to be a simple Thump surgery nearly 3 yrs ago. Ended up with 2 screws in the base of my thumb, and the fact that I have Neuropathy in my Wrists from the Spinal Degeneration, the hard Cast CRUSHED the wrist nerves creating a Mallet’s Index finger, what that did was leave me with NO fine motor skills in my Dominant R. hand and constant pain. I’ve spent nearly 3 yrs Rehabbing my hand. That 13 weeks Medicare Allowed wasn’t enough to begin to rehab it.

      Take up a hobby? My hobby is Quilting which requires Fine Motor skills. It took 2 weeks of PAIN before I reached the stage where Tylenol might work if I were allowed to use it. I’m not allowed any OTC meds. Just ask the Cardio, Endo, Gastro, Neurologist what they will let you take and the answer is NOTHING. Use Ice. No one has invented a Ice Pack for the Mouth. I’ve had my FDA MEDICATION CAUSED DAMAGE TO my last 10 lower teeth pulled, bone spurs removed then the Jaw re-sculptured all on 2 days of 7.5 Mg of NORCO. So resorted to Ice Cream which in my world is a NO-NO to ease the pain. I’ve had no lower teeth for 9 months. When all was done, the denture didn’t fit, and I reacted to the chemicals and dye for the gums. Had to have them re-lined, and they still don’t adhere. Since my husband has worn dentures for years I had him show me how much adhesive to apply. BTW it’s red too.

      When I was allowed that lowly 5 mg NOCO 4 times a day I could sleep, walk, clean house, do laundry. Now I am basically home bound as I can barely walk from the recliner to the bathroom with out the Pain medication. I am a over protective mother, I kept count of my pills, kept them in a combination lock box because I have grand children. Never once in 5 yrs lost a pill, sold a pill or asked for an Increase. Now I’m home bound, and have to use a electric cart to do groceries, which are becoming more and more box meals like Hamburger Helper. My Endo is NOT happy with that.

  • Dr Lister, as I said in my post, representatives of Physicians for Responsible Opioid Prescribing (PROP) have said that addiction can develop in one day’s acute use. I didn’t say it. Yet you seem to be suggesting I did. I write this now merely to clarify the record.

  • Dr Lister,

    In reply to your post saying:

    “You are still equating acute and chronic pain. The 49.3 million can still be effectively treated with short term opioids while recognizing the risk of the 300,000 receiving longer term opioids who may become addicted. The CDC guidelines are not aimed at acute pain care. Addiction is highly unlikely with short term opioids”

    The problem is that the fear of govt prosecution due to the opioid hysteria has spread to the point where patients are not receiving even short term opioids after surgery. And I have to think that the stress on the body due to untreated pain would have ill effects.

    Same for terminal cancer and other hospice patients. Denied opioids. Why? If they are dying, then why not make them more comfortable?

    We treat dogs and cats better than this.

    My mother, the most stoic woman ever, spent her last weeks in a hospital in agony, begging to die, b/c the docs refused to adequately treat her pain. This was not post-surgery. She kept getting rushed to the hospital in agony for unknown reasons and they finally admitted her. She remained there until she was sent home on hospice, where thankfully she had morphine.

    She was 87 and they couldn’t figure out why she was screaming and crying in pain for such a long time. After lots of theories, they finally figured out that hernia mesh had embedded itself into her small intestine and she was having massive organ failure.

    In spite of her excruciating pain and my father’s repeated requests, the hospital docs wouldn’t give her another pain pill too soon. It had to stay on their schedule.

    Honestly, who cares if an invalid, stroke victim, always-in-lots-of-pain-from- multiple-causes, living in an ALF, 87 year old woman, becomes addicted to anything? We didnt’ — her family. If she became addicted, big deal. Certainly least bad approach.

    I wasnt’ there in person. I live far away and due to my pain, can’t travel w/o enormous difficulty. Also, I was told to stay away, so I wouldn’t be another burden to my father. But if I had been there, I would have been screaming at them to medicate her much more aggressively than he and my sister.

    What I finally did do from across the country was call my parents’ elder care lawyer and asked if we had grounds for her to get a court order to medicate my mom. She said no, but put me onto a Geriatric Care Manager in private practice, who I hired and who did go to the hospital to help my father fight his fight. But by then it was too late; they were sending my mother home to die.

    If she didnt’ have morphine, which is the case now for many hospice patients in agony due to the opioid hysteria, I dont’ know what we would have done. If she was awake, she’d be crying and begging to die. We couldn’t let her suffer like that for who knows how long. I guess we would have given her bottles of benedryl and kept her out of it to the best of our ability. I don’t know. But I do know that loving families can’t just sit by and do nothing.

    So, Dr Lister, what about these situations? I went on about my mom’s terminal illness, but I’ve read about patients receiving nothing after surgery except some tylenol. Is that what you’d want for yourself or your loved ones? Or your pet?

    • I’m sorry for your situation and wish I could help.. There has definitely been “collateral damage” and in TN we have seen some of this even though our chronic pain guidelines are more carefully considered and more liberal than the ones from the CDC. I suggest you lobby your state legislature to look at the TN guidelines and laws. They are reasonable, compassionate yet still encourage careful monitoring of the risks and benefits of these potent drugs. BTW The best assessment for risk of addiction is the ACE score.

  • Dr Lister –

    NO ONE is defending pill mill docs. NO ONE. They are criminals who deserve to be prosecuted.

    But you write like the vast majority of docs are pill mill docs and/or incompetent — which is why such strict regulation is warranted, no matter what the impact on innocent docs just trying to help patients, and on patients suffering endless agonizing pain.

    Is that what you really believe?

    I assume that the doc who first treated your daughters has been successfully sued for malpractice, and barred from practicing medicine? And the pill mill docs too ?

    • The doctors who treated my daughters are gone. We have over 130 pain clinics licensed in TN. We encourage primary care to write chronic opioids if the MME is low. And we encourage alternative therapies when effective. Our state is a model for other states.

  • LRH; A well written example of what we mean when we say we have had our QUALITY OF LIFE taken away. It’s all the little things that everyone takes for granted.

    Like you, my nightmare began with failed surgeries. Surgeon ruins you for life, with no consequences. The consequences for us are immeasurable.

    I have 4 kids. 3 are aware and understand the situation. The other thinks I’m an addict. She has the same conversation with her dad each time we visit and he tries to set her straight. The difference between this kid & the other 3? This one has doctors as close friends. She also lives 1/2 across the country, hasn’t lived in our town for 20 years, was in college prior to that & has no idea of anything medical going on with me.
    She’s the last person I’d discuss that with, sadly.

    When we face judgement from our own family, well, there are no words.

    • Julie,
      I’m so sorry about your daughter. Like I wrote to LRH, maybe if you show her the posts of CPP’s on NPReport etc, she’ll wake up.

      My disabling pain problem started with a surgery too. But, some time after it I had an epiphany and realized that it was not unusual for me. I found a theme of bad reactions and never healing going back to my childhood.
      My very rare bad reactions to my wisdom teeth removal and gum surgery, among other things. And that either I never heal, or heal incredibly slowly (decades) from minor injuries, as well as from medical procedures. I also have the rarest of rare reactions to lots of meds.

      So, I can’t blame the surgeon. Any surgery has risks; any procedure has risks; no matter how perfectly performed.
      With my “princess and the pea” body, which strangely reacts to Vicadin as if they are tic tacs, I just wish I wouldn’t be in constant fear of again losing the meds I need to stay alive.
      We each know our own bodies; we each know what we’ve tried and what has failed. Which is why we’re on opioids.

  • Thank you Dr Lawhern.

    I had been wondering about that to myself for some days, and then another person posted that question, and I responded to her that I’d been thinking the same thing, and then opined that you or Dawn Rae might have some insight.

    In no way am I casting any blame on Dr Lister for what happened to his daughters. Each family is different, and while I was always a non-rebellious prudish type of teen and young adult that my parents never had to worry about and they knew it, I know that more teen girls than not are just the opposite and hide things from their parents. And that parents are busy people and human, and humans are fallible by nature.

    I think we’re just looking for reasons to explain his views, which seem to exist in spite of all the evidence to the contrary and all the personal tales of suffering patients.

    I guess that, whatever the backstory is to his daughters’ stories, it’s certainly pushing him in a direction to try to ensure that it never happens again, no matter what the consequence to others, and even if the balance of competing interests doesn’t reasonably, objectively, come down in that direction.

    And it does seem to me that he intertwines legal and illegal opioids.

    I’ve stated that I know my body, my pain, my bizarre reactions to procedures and meds and even to PT, and that I dont’ care about any studies or stats — that I simply know what I need based on my own personal experience.

    I guess he’s just doing the same.

    But the difference is that I’m a patient with no influence or impact on anyone else, and he’s a doctor with a lot of influence and direct impact on the lives of others.

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