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.

  • Actually the question of licit vs illicit drugs ARE central to this issue of what caused the early inception of the opioid crisis. There is no argument as to what is continuing it: illicit fentanyl from Chinese labs sourced through Mexico. Patients already addicted will seek the drug of choice from whatever source. But data shows conclusively that the initial wave of addiction/OD deaths were related almost exclusively to prescription medications improperly prescribed.

    However, posting on social media and getting a response from 100 patients is hardly a scientific study and carries no validity unless you determine the qualifications of the provider involved, whether it was a licensed TN facility, whether the owner of the facility shut it down because of continued fraud investigation by the DEA/FBI etc. I don’t, and never have, in this discussion indicated that the regulation presently in place is perfect. My initial comment simply made clear that regulations and guidelines put in place (in TN) were necessary, developed by pain professionals and academics (UT, Vanderbilt) and reasonable.

    I am glad that you finally agreed with me regarding appropriate work up and monitoring since that has been our clear focus here in TN. I will gladly let you deal with the rest of the country since all of my time is spent treating chronic pain in TN and helping improve the medical practice across the state. We have a very good system of licensed pain clinics in TN , staffed by APPs and supervised by pain specialists. Recent closures due to allegations of fraud, improper billing and highly improper prescribing (for sex or money)are out of our hands and have little to do with state regulations.

    I hope your daughter and wife are responding well to whatever therapy they are receiving. My wife continues to have interventions procedures from Dr Choo and is doing very well. That is good because we are raising 5 grandchildren from two daughters, one of whom is deceased the other fully disabled from illegally diverted prescription opioids.

    Working together is the best way to resolve this problem. I am neither a member of PROP nor a proponent of OTC opioids. I believe in reasonable regulation that helps patients get the treatment they deserve. You cannot understand the situation in Appalachia unless you have visited the communities where millions of pills were prescribed without good medical judgment, and I can’t understand the situation in California, but good guidelines, well developed and applied appropriately are universal.

  • Cindy, when the city you use to live in becomes the crime Capital of the State, you learn you have to get out as Seniors are prime targets. I can get to the Primary, dentist and eye doc on my own. Hubby takes me to the rest. We are lucky they are all off one main road. We call it Doctor’s Row. Dozens of all types of doctors. From all different hospitals. It’s in a slightly safer part of town. I no longer shop at malls, or big chain stores, they don’t provide electric carts. Niche stores don’t carry what a 71 yr old is interested in. It’s as if this generation has forgotten us. Even Church has. Praise Hymns not Songs. Got told not to get up and use the bathroom during service. Where do you want me to PUKE or have a incident of Diarrhea then on that nice bench or the nice rug? We sat in the back row for that reason. The noise is overwhelming to people who wear hearing aids. No one is patient with us either. People have become so RUDE. One day they will be in our shoes.

  • Cindy: Nor is it reasonable for you to extrapolate to the thousands addicted and dying from inappropriate opioid prescribing. The state of Florida fueled this crisis as much as any other state. I am truly sorry for your pain, and I hope your doctor is a good one.

  • Please point out my contradictory statements. I don’t believe you can. An individual response to treatment is not evidence of efficacy or risk.

  • Dr Lawhern, is this the pot calling the kettle black? You seem to be immersed in your own mythology, or is there an ulterior motive? Have you disclosed all conflicts of interest?

    Its interesting that you quote Dr. Volkow, an extremely well respected physician who gave us the idea that addiction is a brain disease. Certainly addiction is not a predictable result of opioid prescribing, that is exactly what makes management of chronic opioids difficult. And what “small percentage ” does Dr Volkow quote? The articles of Flemin,MF et al indicate a SUD risk of 4-8% in a primary care population (1000 patients), but up to 24% in patients with 4 risk factors. In some counties in TN and KY 100% of the patients would have 4 risk factors! I suggest you visit some communities in Appalachia and see what devastating consequences can occur with irresponsible opioid prescribing. Even Dr Volkow’s own NIDA website discusses the risk of addiction with prescription opioids.

    You seem to continue to make a distinction between licit and illicit opioids as the cause of the opioid crisis? What is the difference? Fentanyl is both, heroin is metabolized to morphine. How do you define medically prescribed opioids for chronic pain? Does it require a history and physical, reasonable diagnosis, assessment of risk factors and discussion of risk? Or is it “I’ve got pain…” OK give me $100 or sex”.

    You seem to be overly concerned about MME. Certainly the CDC guidelines overemphasize this. But that said high MME does carry it’s own set of risk: diversion for income, hypogonadism and cardiac disturbance with methadone, a common drug associated with high MME. Also the risk of accidental OD increases with high MME and co-morbid conditions such as sleep apnea. Chronic opioid patients are at higher risk because tolerance to analgesia develops faster than tolerance to other side effects such as respiratory depression.

    You have asserted in previous posts that the opioid crisis is the result of illicit opioids. Records for the Knox County medical examiner’s office in TN reflect differently. Prior to 1996 opioid OD deaths in Knox county were few. The drugs of choice in addiction were crack cocaine and methamphetamine. Soon after 1996 opioid deaths began to increase dramatically, long before fentanyl or significant heroin increased on the streets. Opioid deaths were almost always associated with prescribed benzodiazepines, long before illicit benzos arrived.

    Last, you seem to continue to assert that I want to deny chronic pain patients access to opioids. Nothing could be further from the truth. Nothing upsets me more than not being able to control pain completely with procedures and non-opioids, and I recognize that opioids are still the bulwark of chronic pain management. That simply does not mean, however, that opioids should be prescribed with little attention to good medical care by greedy or poorly functioning doctors. Doctors and other medical professionals are licensed by the state for a reason, to protect the public interest. While guidelines are mutable, laws are usually not. I suggest you spend you time working on reasonable revision to the guidelines rather than asserting there is no need for them.

    I remember a patient many years ago from LA. She came to me with huge bottles full of Oxycodone, treated for chronic pelvic pain with high dose opioids and “vaginal electric stimulation”. She was down to Tramadol b.i.d. after an appropriate gyn consult and gradual weaning. Chronic opioid treatment is NOT safe unless there is a real pain physician on the Rx side.

    • Dr Lister, I have no financial or professional conflicts of interest. My spouse and step-daughter are chronic pain patients. I have been an unpaid volunteer moderator and website administrator for online chronic pain communities for over 22 years. I’m easy to find in the Net. My qualifications have been carefully stated and qualified at several points in this commentary thread.

      The distinction I make between licit and illicit opioids is central to this public policy issue. Almost none of the fentanyl that is killing addicts across the country is sourced from prescription pharmaceuticals. It is created in Mexican and Chinese labs, and there are several close analogs in circulation.

      Our opioid “epidemic” really isn’t sourced in prescription drugs. Illicit drug distribution networks have adapted to changing markets and targeted vulnerable populations. Continuing unemployment and underemployment and the hollowing out of communities following the financial collapse of 2008 have accelerated a long standing trend in this complex socioeconomic reality. It is not going too far to suggest that increasing rates of addiction are in part a response to hopelessness and economic stagnation over the last 40 years.

      OF COURSE prescription should only be made after careful workup by a trained healthcare provider and trial of non-opioid therapies. The WHO ladder of pain treatment has established that framework for nearly 40 years. and OF COURSE patients need education in self-management and access to ancillary therapies. Nobody is arguing against those observations.

      Arguably “trained healthcare providers” also include Nurse Practitioners and Physician Assistants if they have completed a program of training and been licensed to prescribe controlled substances. Periodic monitoring of patients is also needed. And evaluation of co-morbid conditions and treatment of depression and anxiety are a key to reducing morbidity rates.

      However, access to such care is increasingly restricted by draconian and unjustified persecution of healthcare providers who prescribe opioids. Hundreds have left practice, and thousands are discharging patients or refusing them the only therapies which reliably work.

      Yesterday I posted a question in social media asking for comment by Tennessee residents who have been force-tapered or discharged by physicians afraid of being sanctioned. In the first six hours, I got over 30 responses, and they are still coming in. Some of the patient narratives are heart-rending. The idea that over 100 pain management centers are adequately addressing the needs of chronic pain patients in TN simply doesn’t survive the sniff test.

  • To Cindy: PCPs are not legally limited in TN but the guidelines recommend pain specialists be consulted over 120 MME. There are over 130 pain clinics in TN , that is not a “few”.

    • Dr Lister –

      TN is a big state. Whether or not 130 is a “few” depends on how far people have to drive to get to one that they like — where they can get what they need. And I don’t mean pill mills. I mean legit clinics and PCP’s.

      I don’t know how far people have to drive for service. I dont’ TN. But one TN resident posted here that she has to drive quite far. The number 130 is relative — sounds huge for Rhode Island but tiny for CA….

      I had asked you what would happen to me, a higher-than-guideline MME patient, if I lived in TN.

      You replied: PCPs are not legally limited in TN but the guidelines recommend pain specialists be consulted over 120 MME.”.

      I’m still trying to understand.

      What exactly does “be consulted” mean?

      Let’s assume that the PCP has all my records and can see from my history and from meeting with me that nothing works except opioids, and that I’m not an addict, and the PCP agrees that I should get my higher dose.

      So, my PCP, who would consult with a PM, and then I’d get my needed dose?

      Is that what would happen? OR, would the PM say no, in spite of the PCP’s opinion, and would the PM’s “no” mean that the PCP’s hands are tied, even against the PCP’s wishes?

      What exactly is a consult? Does the PM have veto power? Can the PCP go to another PM?

      If the PM said no, then would I go for an exam to the PM?

      It sounds like if you were the consulting PM, you’d say no.

      Leaving people like me, who can’t drive far, in agony.

    • Cindy: Scores of PCPs prescribe in TN. Like I said earlier, most of my referring physicians fall in that category, the rest are orthopedic, neurosurgery, rheumatology or neurology. Most of the 130 pain clinics are in populated areas, and some patients do drive far, some because they have been discharged from their previous clinic for aberrant behavior. Most clinics have 2 to 8 advanced practicioners. “Be consulted” is a pain specialist consult 1 time each year. The questions you ask are hypothetical and unlikely to happen since PCPs rarely choose or need to prescribe at that level. The driving distance to a pain clinic is usually 25 miles or less

  • To Dr Lawhern: Since you seem to assert authority over me in spite of the fact that you are not a health care provider, here are my credentials. I have 42 years experience in treating patients with chronic pain. I was one of the first physicians in TN and in the nation to be certified in pain medicine by the American Board of Anesthesiology (1993). I have treated thousands of patients for chronic pain, many of them health professionals, and continue to do so. I am a member of the TN chronic pain guidelines committee, the ASIPP, the TN Pain Society and the Metropolitan Drug Coalition of Knox County. I work daily with pain physicians all over the state and law enforcement.

    I decided in 2000 to stop prescribing chronic opioids for one reason: I believe it is a conflict of interest for an invasive pain physician to also prescribe. Patients who are dependent on a physician for their meds will agree to any procedure. This feeling is not shared by most of my colleagues.

    I find it interesting that you keep deferring from the basic subject: chronic opioids can be addicting and there has been marked overprescribing by poorly trained or greedy practicioners to individuals with high risk for addiction.

    Its interesting that the studies you have quoted do not support your position. The NC study is simply not applicable to chronic pain and the review regarding death rate really has no new information regarding addiction rates.

    In supporting the CDC and Tennessee guidelines, I support them as guidelines not as law. You seem to infer that I somehow don’t approve of legitimate reasonable opioid use for chronic pain. Many of my patients use opioids as well as injections for their pain. I do believe that the CDC and Tennessee guidelines (more liberal) are correct for the family physician. Do you actually truly believe that an average PCP should be prescribing ultra high doses of opioids or should this be left to a pain specialist? Do you believe a complete history and physical exam is indicated prior to opioid use? What about screening for risk factors/illicit drugs? What about reasonable diagnostic testing? What about trials of non opioid medications and procedures?

    Your statements regarding the increase in addiction rates in the young population are certainly true, however you don’t seem to recognize that this almost certainly stems from irresponsible prescribing or drug diversion at a time when prescribed MME were much higher and there were many pill mills. We can probably agree that the massive increase in OD death rate has been from illicit fentanyl, much of it disguised as prescription opioids.

    Your assertion that there is no cause and effect relationship between opioid prescribing and addiction is simply absurd. The vast majority of opioid addicts began using either legally or illegally obtained prescriptions opioids. The majority of fentanyl confiscated by DEA, FBI, TBI is disguised as one of these products. All addicts know them well but unfortunately can’t tell the difference between a true or fake pill.

    We can agree that all pain patients deserve appropriate medical care. If opioids are the appropriate treatment, a diagnosis is reasonable and alternatives have been tried then so be it. In TN we have encouraged PCPs to prescribe appropriate opioid therapy but because these patients can be challenging to manage, many choose not to do so. We have over 130 pain clinics with certified pain specialists as medical director to manage patients who are on high MME or who cannot get their PCP to do it. I have no problem with the AMA resolution, but no doctor in TN has been disciplined solely for high MME. The vast majority have been disciplined for overt actions: selling pills for money or sex, writing prescriptions for no legitimate purposes or without a medical record, prescribing to family etc. NO doctor in TN has been disciplined solely for high MME.

    You have been unable to bring one reference that reasonably indicates that the addiction rate is lower that the rate I suggested after 90 dsys of use.

    Hopefully we can at least agree that all patients deserve quality pain treatment by whatever works, including opioids, but they deserve at the same time recognition and assessment of the risk of opioids, a careful physical exam, an appropriate diagnosis and treatment by a qualified pain specialist when warranted.

  • Reply to Gail Honadle

    Gail, that’s another horror story.

    I also have multiple conditions and spend my whole life at doctors offices. Right now, between cancelling appts due to my pain and due to a new sinus problem which causes unbearable facial pain and headaches, I’m so far behind on seeing doctors I need to see.

    And yes, treating one condition can’t be done due to another condition.

    I recall your name from posting on NPR.

    I dont’ know how you can continue to live in a place so far from docs — esp docs you need to see very often.

    I cancel appts and cant’ go out even though my furthest one is only 15 minutes away, and most of my docs dont’ keep me waiting long.

    I wont’ drive more than a half hour from home out of concern that after my appt or errand, I wont’ be able to drive back home safely b/c the pain will be too spiked.

    When I’m a passenger in a car, I keep my feet up on the dashboard. I always have to keep my feet up. Can’t sit up like a normal person for any length of time. Another reason that flying is so unbearable for me.

    And pre-pain, my diet was all earthy crunchy organic brown rice and wild salmon and tofu; almost no sugar and no processed foods. Now, like you, I live on processed foods. I buy organic frozen dinners but they’re still processed. And I eat lots of sugar. I can’t stand up to cook, and then there’s the cleaning. Loading and unloading the dishwasher each is a major task, and then there’s the items that need to be hand washed.

    I have finally switched to frozen veggies instead of buying fresh with big ambition and then throwing them out, rotten.
    The ease of using them has helped my diet a lot. No washing, no cutting. If I plan ahead, I defrost some in a bowl. If I dont’ plan ahead, I nuke them.

    I make scrambled eggs more than anything else, and add defrosted frozen veggies to them. That’s one of my few healthy meals.

    I think that if I could take more opioids, I’d feel better and function better. Better diet, more exercise — things that would help my overall health and other health issues.

    But, that doesnt’ seem likely any time soon.

  • Dr Lawhern

    What is a high prescriber letter?

    And can untreated pain kill people or otherwise harm them physically? I’ve read/ heard that it can kill brain cells. Is that true?

    • Cindy: Several US State Prosecutors or Medical Boards have been mailing out notifications to the practitioners who prescribe the most opioids in their respective jurisdictions. The letters assert that the practitioner is prescribing far more opioids than most others in their State, and the authors of the letter are putting the prescriber on notice that they are being watched. Insurance companies are sending similar letters to pharmacies and some pharmacy chains are sending such letters to doctors at local level. The transparently obvious message is “reduce prescribing or we’ll investigate you and ruin your practice”. In its Board Report 22 of June 2019, AMA repudiated such letters on principle, as comprising an effort to blacklist doctors and their high-dose patients without due legal process. So far, the practice continues.

      There is a nuance here that we should be careful to acknowledge. Without doubt, some doctors have operated pill mills and dispensed volumes of prescription opioids that seem disproportionately large for the demographics of the regions they served. It’s well known that such pill mills operated in Florida for years, serving clients who traveled across State lines to obtain prescription opioids for resale. What is less well known and certainly more controversial, is that these pill mills operated for years with the full knowledge of DEA, which had all of the data they needed to investigate fraudulent prescribing — but instead did nothing. And Florida wasn’t the only place where this pattern developed.

      The Washington Post and CBS 60 Minutes did a series last year revealing the unwillingness of senior officials to aggressively pursue McKesson Corp and several other drug distribution companies who were involved in the supplying of such pill mills. These distributors were allowed to get off with a negotiated light tap on the wrist (~$26 million dollar fine, if I recall correctly from one company with over a Billion dollars in sales revenue per year), under the logic that if DoJ and DEA went after serious money, the companies would tie them up legally for years for doubtful result. Some of the frustrated field investigators who tried to get prosecutors to act implied pretty strongly that the prosecutors had been bought off with promises of lucrative lobbyist jobs after they leave government.

      My impression — and this is NOT a deep analysis — is that pill mills have been actively pursued on a local and State level since about 2010. Certainly fewer of them are still operating. But DEA and State Medical Boards go right on investigating individual physicians for “diversion”, ruining their medical practices by prominent public announcements and coercing employees to testify to physician misbehavior. Most of these quasi-legal actions rely on bad record keeping to convict providers of inappropriate prescribing. But I’ve talked to multiple physicians whom I am convinced did nothing actually wrong except for trying to treat their patients’ agony. For every case that gets investigated and announced, multiple practitioners leave pain management. And DEA disclaims any responsibility, blaming the doctors for being thieves.

      Somewhere in the middle of all this mess, we need to go back and find some ethical principles. A few doctors do knowingly prescribe inappropriately to “patients” who resell prescriptions for non-medical use. But the numbers aren’t high. We need a process in place that privately evaluates individual doctor practices and seeks non-judicial correction of mistakes or carelessness. There is simply no excuse for putting armed SWAT teams in doctor offices, intimidating patients or physicians with drawn weapons — and I’ve seen multiple reports of such damned foolishness.

  • Julie, I’m sorry to hear of your issues with your daughter. Like yours, mine is well educated, works extremely hard in her field, but is one of the stubbornest people I’ve ever met. Yet, she is successful and happy and that’s all I can ask.

    Cindy, I too was on the Medical Marijuana Program and hadn’t found a single strain to help with the pain. However, there are some that helped me with nausea, sleep and helped with my anxiety. In March of 2019, my doctors would no longer prescribe the Diazepam for me that was a successful treatment over the past five years for my severe anxiety, muscle spasms and CPRS in my legs and arms. To get my PCP to be able to prescribe it, with the okay from my PM doctor, she has to receive a letter from him, take it to her director, who in turn makes the final decision if she could prescribe it for me. It’s just not worth it. As for using MMJ for pain, some THC with a high concentration of CBD from the plant is what helps most with pain. I have many friends it does work for but they don’t have the pain causing damage like I do from head to toe and yes, that includes my Fibro. I’ve spent over $5K so far looking for the strain to help my pain to no avail. But, Se’ La Vi’.

    I’m so sorry to hear about your mother. I agree whole heartedly that her pain should have been immediately taken care of. Same thing happened to my mother, but that was in 1963. When she was diagnosed with Acute Leukemia she only had 3 months to live. Her last two weeks were in a hospital in Philadelphia. My grandmother recorded her experiences with my mother during those last two weeks. They weren’t addressing her pain then either. She past away March 1963. I was 20 months old.

    I just lost my father 2 1/2 months ago. He committed suicide because he was in pain and he told no one he was sick. It wasn’t until I was going through his things that I found out. He lived out of state and I only saw him once in two years, until the day he passed. He came up to see me for my birthday but died that morning and I never saw him alive again. He didn’t OD. He was on medication to keep his heart pumping. He stopped taking them and didn’t bring them with him when he came up north. I found them all in his medicine cabinet. He left a note for his partner saying goodbye. He didn’t tell her he was sick either. He left me no note, so I’m still in a state of shock.

    Dr. Lister, so far you have contradicted yourself too many times to count. I’m not going to point them all out, but I’m sure the readers here have noticed it as well.

    Your long term of prescribed opioid regiment assessment couldn’t be further from the truth. I’m sure everyone in this thread who has been on long term opioid care can attest that none of us are addicted which is why we are reading these articles in the first place. We are looking for validation of our cause which is Long Term Opioid treatment is not the first line of addiction! We are proof to that!

    I believe that no matter how anyone looks at this crisis, there is no way to prove that any pharmaceutical company is to blame. In part, yes it is the crooked doctors’ greed for under the table distribution of prescriptions of opioids and I’ll bet that the statistics you quoted in the state of TN that most of the OD patients who you say had prescriptions, I wouldn’t be surprised if a lot of them were written by these Pill Mills and other doctors looking to make money no matter who hurts from it. And, one state does not make up for the other 49.

    Where I live, which is in a very highly desired area of the country, has its own epidemic with Heroin. Not because of socioeconomic poverty, but because these teenagers have too much money given to them from their parents. I’ve always argued that parents are too quick to buy their children whatever they want. I did not raise my children that way because I came from a poor background and had to work for everything I wanted (and at times what I needed) and that’s how my children were raised. They had to have a job the day they turned 16. They had to buy everything they wanted or they didn’t get unless it was a birthday or Christmas. From the day my kids were born, I had put 1/2 of all $$ gifts into a savings account so they would buy their own cars when they turned 17. That was something that was not the norm for this suburban part of the country. I could give you statistics on how many kids totaled their first cars within the first few months of having their licenses. My kids never did. And, many of those kids in those accidents, had a lot of alcohol and/or drugs in their systems.

    Am I tooting my own horn about how I raised my kids to be good, upstanding citizens? Absolutely not. My son is mentally ill, and unfortunately, back under my roof at the age of 30. He has an addictive personality. He never drank or did drugs to handle his demons. His is gaming.

    My adopted brother fell into both factors. Both of his birth parents were alcoholics. He was 12 years old when his alcohol and drug journey began. He took all of my stepmother’s valium and OD’d at 14. Thank god he lived. My father never drank a drop, yet always had a slew of alcohol for guests. It wasn’t until the day my brother passed away 11 years ago that, while looking through his baby pictures I noticed that he had all the signs for Fetal Alcohol Syndrome. That’s when the puzzle pieces came together. He had many demons. My father, his siblings, their father before them, and his father before him all had addictive personalities. They were gamblers. My point, genetics do play a huge role in addiction.

    A chronic pain patient’s brain does not go in that direction. I forget to take my pain meds on good days because I’m enjoying that time getting things done that I cannot do on bad days. I take my meds as scheduled, which really doesn’t matter over the past 9 months since my tapering, I have very few and far in-between good days. So, if a good day comes I take full advantage of it.

    Well, I’ve exhausted all I can say on this board, so I’m going to say goodbye now. I wish everyone a successful journey and that this nightmare to the chronic pain community ends sooner than later.

    • Your not being addicted does not validate your statement. IF you had read my previous posts, the figure is around 10% after 90 days. Most chronic opioid patients are not addicted. However good medical practice can prevent most of that iatrogenic addiction.

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