Readers of National Pain Report and social media groups for chronic pain communities may recognize her name. Trini Yeager is a chronic pain patient about whom I wrote and on whose behalf I spoke in a broadcast segment of KOGO News San Diego in December, 2019. I joined anchor/commentator Marilyn Hyder in pointing out that thousands of people like Trini are being denied safe and effective pain treatment due to the arbitrary and unscientific misdirection of public policy regulating prescription opioids.
Trini’s pain began with spontaneous development of lower back pain, rather than an accident. A doctor did lower back surgery, and then referred her to another physician after pain persisted. An epidural spinal injection was administered in an effort to block her pain. Although the injection procedure is widely used and highly lucrative for some healthcare providers, it is not FDA-approved. For Trini, it made her pain far worse by generating scar tissue on nerves branching from her spine. She describes the pain as “pouring hot oil down my spine.” The diagnosis was “adhesive arachnoiditis”.
For several years, Trini was treated by a primary care provider and by Dr Forest Tennant, one of the foremost experts on chronic pain in America. She had a limited but real quality of life and function, with enough pain control to be engaged with her family, and to occasionally leave her home for normal community activities. All of that changed when Dr Tennant was forced out of medical practice by trumped-up charges of a San Diego prosecutor.
Like others among Dr Tennant’s patients, Trini sought on-going care with other pain management specialists. And like others, she was repeatedly turned down by physicians afraid of being persecuted as Dr Tennant had been, if they continued her on high-dose opioid analgesic therapy. She reached out to radio broadcasters and to her California State Senator, Patricia Bates, advocating in her own behalf. The State Medical Board disclaimed responsibility for referring her for care. Senator Bates’ Chief of Staff and the office of Governor Newsom slow-rolled her with platitudes and avoidance, perhaps secretly hoping that she would just “go away.” In other words, that she would actually die.
As her previous prescriptions ran out, Trini grew desperate and suicidal. Late in December, she was admitted three times to a local emergency room, treated overnight for intense pain and then released without any referral for on-going specialist care. Trini’s primary care physician continued working on her behalf. To avoid inundating this brave physician with similarly desperate inquiries, I won’t offer a name.
However, the doctor’s work finally paid off. After referring Trini for palliative pain care four times and for hospice care three times, an eighth referral was accepted. A local hospice service visited and evaluated Trini at home. Her diagnosis of adhesive arachnoiditis was accepted as a recognized incurable and critical disorder, and her pain medications were restored within hours. Methadone was added to her treatment plan, to address her nerve pain. Methadone is recognized as effective in this role, apart from its applications in addiction management and harms reduction.
For the first time in weeks, Trini is today adequately medicated and able to sleep. Her insurance covers the cost of her hospice care in her parents’ home. Her immediate crisis has been addressed.
But she is one of many thousands who face similar circumstances all across America. Federal and State public policy on prescription opioids needs to be rapidly and profoundly redirected. The notion that our opioid crisis was created by physicians “over-prescribing” opioids to people like Trini is a mythology, if not an outright lie. The US CDC knows from its own published data that over-prescribing did not make this crisis, yet they refuse to get off their collective posteriors and fix the mess they made.
Unbiased medical professionals and knowledgeable patient advocates could rewrite the 2016 CDC guidelines for prescribing opioids in a month. We don’t need the two-year cycle of argument and back-door wrangling proposed last December by the CDC Center for Injury Prevention and Control.
The nation may require Federal and State legislation to turn this crisis around in the face of such intransigence. But if so, here is a model that might be adapted to the purpose: http://face-facts.org/lawhern/congress-clean-up-this-mess/ .