Accepting Pain More Important than Reducing Pain Intensity Because Opioids Are Harmful, Docs Write in NEJM Commentary

Accepting Pain More Important than Reducing Pain Intensity Because Opioids Are Harmful, Docs Write in NEJM Commentary

People suffering in chronic pain need to learn to accept it because “achieving a balance between the benefits and potential harms of opioids has become a matter of national importance,” wrote two influential doctors who advocate for changing opioid prescribing practices in a commentary for the esteemed New England Journal of Medicine.

Jane Ballantyne, M.D., and Mark Sullivan, M.D., authors of the commentary, wrote,

“Is a reduction in pain intensity the right goal for the treatment of chronic pain? We have watched as opioids have been used with increasing frequency and in escalating doses in an attempt to drive down pain scores — all the while increasing rates of toxic drug effects, exposing vulnerable populations to risk, and failing to relieve the burden of chronic pain at the population level. For many patients, especially those who have become dependent on opioids, maintaining low pain scores requires continuous or escalating doses of opioids at the expense of worsening function and quality of life. And for many other people, especially adolescents and young adults, increased access to opioids has led to abuse, addiction, and death.”

Dr. Ballantyne is President of Physicians for Responsible Opioid Prescribing (PROP), an organization that advocates for state and federal policies that promote cautious prescribing habits, proper enforcement of laws that prohibit marketing of drugs for conditions where risks of use outweigh benefits.

Dr. Sullivan is the Executive Director of Collaborative Opioid Prescribing Education (COPE), an organization that educates healthcare providers on how to safely treat and manage the care of people with chronic pain in order to improve patients’ lives and end the prescription opioid epidemic.

The authors framed the topic of opioids this way:

“For three decades, there has been hope that more liberal use of opioids would help reduce the number of Americans with unrelieved chronic pain. Instead, it produced what has been termed an epidemic of prescription-opioid abuse, overdoses, and deaths — and no demonstrable reduction in the burden of chronic pain.”

The reference cited for the above statement, The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health 2015;36:559-574, was authored by Ballantyne’s colleague, PROP Executive Director, Andrew Kolodny.

Reduce pain intensity, or suck it up?

“We propose that pain intensity is not the best measure of the success of chronic-pain treatment. When pain is chronic, its intensity isn’t a simple measure of something that can be easily fixed. Suffering may be related as much to the meaning of pain as to its intensity,” they wrote.

“Patients who report the greatest intensity of chronic pain are often overwhelmed, are burdened by coexisting substance use or other mental health conditions,” they added.

Instead of opioids, the doctors say that an interdisciplinary and multimodal treatment coupled with coping and acceptance strategies are critical.  In addition, they conclude that a “willingness to accept pain and engagement in life activities despite pain, may reduce suffering and disability without necessarily reducing pain intensity.”

Comments on the New England Journal of Medicine’s website related to the article included:

Intensity of pain is relevant mostly when pain limits the actions and abilities of the patient to live a life with any minute level of fulfillment. Humane treatment should be a goal in any medical plan, one dealing with pain should start there” – Kimberly Miller

Chronic pain is an injury to central nervous system functions that profoundly impacts a cascade of measurable biological functions and associated adaptive behaviors which are rarely accounted for by the addiction or the interventional pain models and often discounted when reported, leading to increased disability. It does a disservice to patients to infer that chronic pain serves to maintain emotion and reward seeking behaviors or that the degree of experienced sensation is somehow illegitimate.” – Terri Lewis, Ph.D. (who is also a contributor to National Pain Report).

Many patients are not much interested in learning behavioral strategies which may help them function better with chronic pain, nor changing their expectation of complete relief. They wish a simple pill to swallow or a procedure to be performed on them, and many do not want to stop doing things making their pain worse. While basic research continues, with a goal to finding improved treatments for chronic pain, we have a difficult task before us changing the population’s attitudes towards what is possible and practical for our patients in pain.” – Leo Martin, MD

Thank you for your interesting article pointing out that the suffering associated with chronic pain is related to its meaning and not only to pain intensity and therefore treating it only pharmacologically with opioids does not work. … Without a philosophical/spiritual context no strategy will significantly ease the burden of chronic pain, no matter how biopsychosocial it is.” – Alberto Montoya, MD

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Connie

Articles like this just happen you are educated professionals with their heads so far up Thier rectum they can’t see the reality of the “normal chronic pain” patient. NO WHERE and at NO TIME have I ever heard someone in chronic dehabilataing pain expect miricles. And have never seen one unwilling to try anything within reason to get relief. Much like an immature teen age boy, farming under the blankets and “fluffinf” the smell with hideous laughter,.. these doctors merely only see Thier own selfish motives. These days a doctor won’t fill out a simple for without charging a very nominal fee. Wonder how much they got paid to write this.
Saddly, I pray Karma throws them under the bus.
ALL MEDICATIONS have side effects!!!!! And “mental illness” is a pathetic excuse to pawn off genuine pain that can clearly been seen on Xbox rays and digital images. That can be seen in the faces of pain.
Take someone’s ability to function, work, or even be self sufficient and tell the to just suck up the pain that prevents you from walking, and dance. Although, this pain has no end. Much like a prison of torture and ridacule.
I agree there are responsible ways to use pain meds. And handing an rx out of gumball machines probably isn’t in anyone’s best interest. But take more than the 3.5 minutes with your patient that “retail medicine” allows you. And figure out what is the best treatment for the patient. Not your office managers bonus. Or your tropical vacation.

LouisVA

Woops, evidently links do not work. The article is called “Intensity of Chronic Pain — The Wrong Metric?” and it was published on Dec 3.

LouisVA

@ dave rosen

Thank you for your kind words, Dave. I am just one of a million pain patients. What I find so ludicrous is that opioid therapy has given me a higher quality of life for five years with no dose increases during that 5 year period. I do not disagree that addiction and misuse is a problem but attempting to solve the problem on the backs of the disabled is unbelievable. If you have not done so already, please read:

which is an article here on NPR that was written by my wife Kristen Ogden. She really has put things into perspective. Thanks again!

Doc Anonymous

Today is December 4. Comments for the NEJM article by Ballantyne and Sullivan were open until December 2, 2015. As of this posting the last comment found on the NEJM website was posted on November 29, 2015. There are people who are pain sufferers who have sent comments to the esteemed NEJM after the last comment they have posted but BEFORE the deadline at the close of the day December 2, 2015.

Where are the unposted comments that have been sent to the NEJM? Are they discarding the pain patient comments? Is that not a form of contamination of evidence? Is that not a classic example of how the “lack of evidence” about chronic pain has become such a problem?

Just wondering.

dave rosen

LOUIE VA
GOD BLESS YOU I HOPE SOMEONE STOPS THESE TWO. I AM ASHAMED OF THE NEJM. I HEARD THOUGH DOCTORS ACTUALLY PAY TO HAVE THEIR ARTICLES PRINTED, LIKE AN AD.
IT LIKE A ENTERTAINER PAYS.25K TO HAVE A STAR PUT ON THE HOLLYWOOD WALK OF FAME. LIKE I SAID. THE NEJM ONLY PUT 22 COMMENTS ON THEIR PAGE YET I READ OF AT LEAST 200 PEOPLE WROTE COMMENTS SLAMMING THE AUTHORS. where are they. oh ..
the authors probably said not to accept any more.comments. Those to should be brpught.up on charges of something…….

dave rosen

BL
THESE SO CALLED AUTHORS HAVE 1 AGENDA, TO TAKE ALL OPOIDSS OFF OF THE FORMULARY OF EVERY INSURANCE COMPANY. I HAVE DONE HOURS OF RESEARCH ON THEM
THEY ARE ONLY ABOUT THE ALMIGHTY BUCK. THEY TRY TO COME OFF AS CO.PASSIONATE BUT THEIR GOAL FOR NOW IS TO MAKE SURE NOBODY FETS MORE THE 100MG MORPHENE EQ. FOR MOST TRUE CHRONIC PAIN PATIENTS LILE ME, THAT HAT TAKE 600 TO 800 MG MORPH EQ DAILY THAT IS A DEATH SENTENCE. .mY METABOLISM HAS BEEN TESTED SEVERAL TIMES. IT GOES THRU.ME OH.. AND MANY OTHERS. IF YOU WANT TO DRINK THE JUICE THEYRE GIVING GO FOR IT. BUT LOOK AT WHOS PAYING THEM AND WHY. NONE OF US WANT TO BE STUCK ON THESE MEDS FOR LIFE BUT THEY WORK FOR 99.9% OF THE PATIENTS THAT TAKE AS DIRECTED. THERE IS NOTHING IEAN NOTHING ELSE. WE HAVE OUR BALANCE . THE JUNKIED AND ADDICTS WANT HEROIN NOW ANYWAY. ITS CHEAPER EASIER TO GET AND VERY PURE. UMFORTUMATELY MANY REAL PATIENTS TURNED TO HEROIN BECAUSE OF THE WORK OF THESE AUTHORS. I WOULDNT DOUBT IT IF THE CARTELLS PAY THEM TOO

Misty Morse

It’s really interesting when “DRS” write these types of blogs . It’s usually drs who know NOTHING about what we go through as chronic pain patient’s. Unless you have been through what we suffer from it is not wise to “try” to spout your so called knowledge. The only way I have been able to function at all is BECAUSE of my opioids. I’m sorry but we are not addicts. We are going through pain levels none of you can possibly comprehend. Alternative therapy is great if we could get our pain levels under control enough to try to do it. I love how the medical society wants to throw us into physical therapy and do injections but the truth is some people who have tried everything such as I are not able to cope without opioids. What would be a great help is if you went back to school and learned about chronic pain and how to dispense the meds we need without under prescribing or prescribing for your comfort levels not ours. Some people’s pain levels don’t ever get lower like mine. Mine have been sitting at 8, 9 and 10 for 4 yrs now. My medication is the only way I can get out of bed in the morning. So pahleez don’t sit there and talk to us about opioids being evil and not good for us. When we have manged pain treatment we don’t get addicted. Yes there’s dependence but it’s not the same as addiction. So give it up already.

I excepted my pain, I dared my pain, I tried every modality medical science has to offer. Bio Feedback : I became an expert and I still use self relaxation today. I can lower my blood pressure with just 3 cleansing breaths. The problem is – I can’t spend 24 hours a day trying to relax.

Is there any medication OTC or RX that won’t cause any harm with long term use ? Is there a procedure where death isn’t a possibility ?

I spoke to my pain Dr. today about Dr. Ballantine’s article in NEJOM – her response was ” she has no idea what she’s talking about

I hate the Opiates I take but they help me get through the day and allow me to contribute to my family and my community. Yes they do have side effects but so do all the other drugs they would rather we take / like antidepressants.

It’s agenda driven with no regard for those that get hurt. The war on drugs is not patients in pain It’s El Choppo in Mexico they should be chasing down . Maybe we are the easier target that will look like a battle they fought and won. Maybe it’s all about money, I don’t know. I do know its not about patient safety or Heroin irradication.

Thank you,

John S

LouisVA

Apologies for misspelling your name, Dave Rosen!

LouisVA

@ Dave Rosin,

I know of many comments sent that have not been posted. I still have hopes that they will but am becoming doubtful. It is beginning to seem that pain patients are ‘persona non grata.’ I’m a pain patient that has done remarkably well on opioids yet I don’t matter. PLEASE SOMEONE LISTEN B4 MASS SUICIDES START!

dave rosen

WELL IT LOOKS AS THOUGH THE NEJM DIDNT CARE ABOUT PUBLISHING THE COMMENTS OF THOSE IN CHRONIC PAIN. THOSE THAT COUNT ON OPOID THERAPY TO SURVIVE. THEY SAID THEY WILL TAKE COMMENTS UMTIL12/2/2015, YET THE LAST COMMENT WAS FROM 11/29. THEY ACTUALLY PUBLISHED A ARTICLE FROM A DR IN ITALY AND NEW ZEALAND THAT AGREED WITH THE 2 QUACKS THAT WROTE IT.. ONLY A FEW OF US WERE HEARD. I KNOW FOR A FACT 1 WROTE 2 SEPERATE ARTICLES NEITHER WERE LISTED. I AM SURE THERE WERE MANY MANY MORE.
WAY TO BE BIAS. IF THERE IS A DOCTOR OUT THERE PLEASE WRITE AN ARTICLE TO THE EDITOR SP ONCE AGAIN ONLY 1 SIDE ISNT HEARD. WE NEED THE DOCTORS.OUT THERE TO CONTINUE TO SUPPORT US, WE DO APPRECIATE IT. YOUR SERVICES TO US ARE HEROIC. I PUT YOUR ACTIONS UP THERE WITH SHINDLERS LIST. thank you again!
i wish i could meet everyone of you.
HOW CAN WE HAVE A RALLY AT THE CDC?

Renee Wilson

The opinion in this article is just unacceptable to me. It sounds like the opinion of someone uneducated as well as one who has never experienced chronic pain of any type. It must be wonderful to live in a body that feels no pain. What is your secret? I really want to know so I could maybe uhh use it myself!

If people who suffer could “just deal with it” don’t you think we would? This outlandish opinion is just like spreading hate to me. It’s spreading the hate of people who are legitimately suffering in pain everyday.

I was hit by a drunk driver when I was very young. I was 20 years old and about to start my life. I don’t think there are any more bones that I could have broken. How many more bones do I need to break in my body before you tell me to my face to “just deal with it”. I’ve broken 2 vertebrae in my neck and broken my pelvis into 8 pieces requiring a complete reconstruction and later a total replacement. Not you or any doctor can convince me that there is no residual pain from this type of injury. I was better able to “deal with” the consequences of these kinds of injuries when I was younger. Now I am getting older and developed a lot of arthritis in these bones and joints. More severe that would naturally occur in ageing.

You have a lot of nerve.

Deborah

Theresa, I’m glad you are able to do without medications. Some of us have bodies that do not do well with constant intractable pain.

Your daughter chose to get high. She died. I am so very sorry for your loss.

I did NOT choose to have this pain and if not treated the stress on my CNS andadrenal system is going to kill me. I am a walking time bomb which I was NOT when I had pain relief and could relax and sleep and live without the constant stress and headaches among the other issues untreated pain has caused my body.

Deborah

Diane, I don’t have TN but I have horrifically painful conditions that are causing adrenal regulation issues because, DUH, my body is under stress 24/7. I lost my pain meds when the schedule of hydrocodone changed and have struggled with ever rising BP issues since.

I would like to copy your comment and put it on my FB page. Anonymously of course. Let me know if that would be ok with you.

As for me. I am pushing and pushing and now with no care as my doctor closed his practice and I have no insurance and no one wants to touch me even though I have EIGHT years of records, I am praying the charity care I applied for comes through. Until then I am trying my best to not have a stroke or heart attack without my BP meds. My family needs me. It’s inhumane.

Scott michaels

go to new england journal of medicine. set up acct and write comments about these 2. you only have ti December 2. so hurry!

Scott michaels

EVERYONE MUST FO TO NEW ENGLAND JOURNAL OF MEDICINE SITE. THE ARTICLE IS ACCEPTING COMMENTS UMTIL.DECEMBER 2.
LETS GIVE THEM A PIECE OUR OUR MINDS
THERE IS ANOTHER ARTICLE.THERE AS WELL THAT NEEDS.OUT ATTENTION

Cynthia

I have been riveted by this conversation…and I wish I had others with chronic pain to interact with…can anyone post websites or blogs where we can talk to each other? Would be greatly appreciated….

Carole D.

It’s unconscionable that the New England Journal of Medicine even published this tripe.

Perhaps doctors wouldn’t need to rely on studies on pain medications if they listened to & observed people with chronic intractable pain or surgery pain. It sure is evident when they are able to do things in life, that it works.

Living a life in constant pain is no life at all. Being bedridden is no life.

Why is it that veterinarians know that being in a comfortable state of being is extremely helpful for an animal to not only heal after surgery but to also have good quality days remaining in their life if they are afflicted with an on going pain condition? The answer is simple, because they have much more training in pain care & also have much more empathy & compassion.

These so called doctors have an agenda which will be horrifying if it comes to be. I feel sorry for any of their patients. I bet PROP, Kolondy, Ballantyne & Sullivan are having quite the chuckle that this tripe of theirs was even published. Shame on NEJM for allowing this opinion in their publication. I, as well as others, can only hope this gets a lot of other (well qualified) doctors to write rebuttals on this issue.

Kristine (Krissy)

Assume for a minute we are in a court room and we (the patients) are the prosecuting attorneys.

The doctors and others associated with PROP and including anyone associated with studies, groups, etc. that believe chronic pain and the suffering that goes with it, i.e. nausea, inability/disability and about 100 other things I could list, is livable, are the defendants.

We say, “I have a question for the defendants, your honor:”

“If your dog was (or you saw a dog) crying and laying on the pavement in obvious disabling pain, and serious distress, would you walk by and tell it to shut up? Do you know anyone who would leave an ailing animal without doing something to help?”

“OBJECTION, YOUR HONOR!”, cries the defending attorney. We are dealing with humans! People! Not dogs!”

(“Over ruled.”)

Us again: “End of questions, your honor.”

my hand never touched the submit button on the first one.

Dr. Ballentyne has no right to make a statement like that and that is the problem. Telling us to DEAL WITH IT is just not realistic or even humane. Where does power like that come from ?

I see my pain doctor this week and I’m going to ask him what he thinks about this new approach to treating severe chronic pain.

My son had 2 combat tours and when he hears someone talk about or make some snide comment he will just say ” Have you been in combat – No – then you haven’t earned the right to say one word about it. ” Come see me after you’ve been shot at for 9 months.

So Dr.Ballentyne, come see me after you’ve suffered from severe chronic pain for several years.

Thanks,

John S

“Patients who report the greatest intensity of chronic pain are often overwhelmed, are burdened by coexisting substance use or other mental health conditions,” they added.

Again, I must be the exception to that rule; no other drug use and no alcohol – NONE
People that know me often ask; why are you always so happy and positive.

People in pain often say – If that Dr. could just walk in my shoes for a day they would know how I feel – well no they wouldn’t. We could probably all suck it up for a single day, right ? It would be hell but we could do it.

After a Myelogram ( I’ve had about 18 ) I developed that headache they tell you about. It hit after about 2 or 3 hours after the procedure. The one time I would say – that’s a 10 on the pain scale. The fluid dripping out was putting pressure on my brain and simply turning my head caused me to vomit. The doctor had me on every drug none to man and it was enough to keep me from passing out, I wanted to die. Had the doctor told me to just deal with it I would have gladly welcomes death. After nearly 48 hours of this I was given a BLOOD PATCH – the pain was gone before I left the O R.

Dr. Ballentyne

Natasha

This is one of the most disgusting and upsetting articles I have ever read, I am now crying uncontrollably knowing that this even exists. I have suffered from severe, debilitating, daily migraines for over a decade, and chronic migraines since I was 4 years old. When I was little I would bang my head on the floor to somehow lessen the pain (I know it doesn’t make sense to those who never experienced this pain, but it was all I could do). I never even took a single opioid until a couple years ago for this severe pain condition, I wanted to try every other options out there, I’ve tried literally everything that exists except surgery. Now I have no other treatment possibilities and nothing to lessen my pain. I only leave my house for doctors appts, don’t have a life, lost most friends, can’t work, I even have to have my mom take care of me, I am 29 years old. I “pushed through” my pain all my life, worked hard, graduated college, all while suffering. One day 2 years ago the pain was causing me to collapse, vomit uncontrollably, and often pass out. I had to accept that I could no longer ignore the severity of my pain, quit my job, and start to take care of this condition better. I went to the ER for some relief last night and luckily got one of the few doctors out there that care, he wanted to try everything he could to help including steroids and opioids, he saw how bad my pain was. It’s just a horrible thought to know how many awful and uncaring doctors there are out there like these geniuses in the article, they’d rather blame to chronic pain patients than ever listen and treat them. I bet they are the type who cry when they stub their toes, I welcome that sort of pain because I know it will end. I can’t say the same for my debilitating migraines. There are no “cures” out there for me or others like me, but why should we continue to suffer more and watch our lives just pass by. I can’t remember what pain free is like anymore, but every once in a while, when my pain is just unbearable, I need opioids to fall back on. I really hope these doctors develop a very severe and debilitating pain condition asap, or even just have one of my level 10 migraines for 1 day, they clearly would have no clue how to “deal with it” and would be begging for treatment.

Scott michaels

i just read more about this so called dr ballentyne. she is being highly paid by multuple sources to do all of this negative publicity regarding opioids.
her mission is not altruistic as our advocate doctors are. maybe if someone gave her a million or 2 she would say how opioids are the godsends the are. her writings and opinions should not be published. she should be btought up on charges of malpractice and misrepresentation. her statistics have been altered biasly, she has several conflicts of intrest and needs to be stopped. if perdue, phyzer and any other pharmaceutical manufacturers need proof that their pain meds work and only do harm to those that are absusive. PLEAS CONTACT ANY OF US! WE WILL GLADLY WRITE ARTICLES, BE IN ADVERTISMENTS AND VOCALIZE HOW YOUR MEDICATIONS HAVE GIVEN YS BACK OUR LIVES. we need your help

Toni K

First of all: Addicts will use ANYTHING in order to get “high” and they are an infinitesimal percentage of people taking opioids. People in Chronic Pain who do NOT keep track of when they took their last dose may accidentally OD and are ALSO an infinitesimal percentage of people taking opioids. RESPONSIBLE people in Chronic Pain who follow directions and ONLY take their pain medication “as needed” and keep track of when they took their last dose do NOT get addicted and do NOT accidentally OD and these people are the MAJORITY of those taking opioids. People in Chronic Pain that turned to heroin, and this set of people is even MORE infinitesimal percentage-wise than addicts, did so because they are no longer being given the pain medication they need – not because of an addiction, but because they are in debilitating, unbearable Chronic Pain! Key words here are “DEBILITATING” and “UNBEARABLE”! So, Jane Ballantyne and Mark Sullivan, HOW is someone in SO much Chronic Pain supposed to “deal with it” and “suck it up” when, at the very least, 80% of their day (and night) they merely “exist” in BED because the pain is THAT debilitating and unbearable. That is NO “Quality of Life” whatsoever. 4 years ago when I was able to have the pain meds that worked FOR ME, I rarely used a cane, was not bedridden, and had a “LIFE” – an actual LIFE. Now, though, since not one single doctor, in the area I live, will give me the ONLY pain med that works for me (and I HAVE tried it all – even alternative medicines and PT), I am bedridden for at least 80% of my days and nights and if I absolutely MUST go somewhere, I have to use a rollator (a walker with wheels and a seat) and in the near future it will be a wheelchair that someone will have to push me in since doing it myself is an impossibility due to SO MUCH CHRONIC PAIN. Additionally, I have cancelled doctor appointments, backed out of family get-togethers, and I can no longer go out and do my photography because of my excruciating, intolerable, debilitating CHRONIC PAINS (yes that is plural on purpose). I have myriad types of high-level pains from various health issues. I HAVE NO LIFE ANYMORE – thanks to people like you two Jane Ballantyne and Mark Sullivan! There are MANY days that I create “med cocktails” to force me to sleep (knock me out) for 8 – 10 hours – or more – so I won’t feel all my pains as much! “Know-it-alls” like you two, Jane Ballantyne and Mark Sullivan, have PUSHED me to mix together whatever OTCs I can find to FORCE me to sleep. (I actually write down on a notepad what I have taken and leave it on my nightstand – just in case!) THAT is SO MUCH MORE dangerous than the 5mg of Oxycodone OR 5mg of Hydrocodone I USED to get… Read more »

LouisVA

Mary D’Auria Allen said:

““For many patients, especially those who have become dependent on opioids, maintaining low pain scores requires continuous or escalating doses of opioids at the expense of worsening function and quality of life.” What????????

WHAT IS RIGHT!!! Some people may require increases in dosage but my gut tells me that they were never adequately treated in the first place.! I am on the exact same dose now that I have been on for 5 years and no increases were needed, my qual of life has greatly improved, and my pain level is much lower!!!!!! Perhaps it is time for a WHAT??? from Kolodny and Ballantyne.

Scott michaels

this was was best article i have evere read since this subject of opioid abuse has become publicized. FINALLY! The idiots that claim to be doctors have been exposed as the morons they are. If you are a drug addict i am sorry, dont group the millions of us that live in terrible pain daily. our need for opioid medication is to take away some of our pain in order to be productive. yours is to get high. BIG DIFFERENCE. Since PROP says suck it up, I strongly urge any addict NOT TO GO TO PHOENIX HOUSE FOR TREATMENT. Since the Dr in charge of PH IS ALSO ON THE BOARD OF PROP THERE IS not only A Conflict of interest but any rehab clinic that is worthwhile works off a 12 step program and the words “suck it up” dont exist. they also have only a 3% + – success rate.
WE NEED OUR MEDICINE TO HAVE A QUALITY LIFE, THIS IS NOT THE 1840’S PIONEER DAYS. THE DOC DOESNT SAY BITE ON A. STICK WHEN IT HURTS.

Laurie

To BL: I have Zero Problem accepting that my life is different and life isn’t fair. I’ve had to give up the majority of dimensions of my life due to chronic daily migraine for 14 years. I will be the FIRST one to adjust, adapt and do my best with the cards I’m dealt.

TO ALL: That, however, is not the cure-all. Mind over matter doesn’t CURE a nerve/neurological disorder! I’m in pain every single day and have raised three kids this way. My meds are less and less effective. I am a reluctant Med taker. But my life isn’t functional.

Doctors are supposed to HELP people in PAIN. THIS APPROACH is bogus for chronic pain patients.

Diane

Time for me to let ‘er rip. This article is disgusting. I have a nerve damage disorder of the fifth cranial nerve called trigeminal neuralgia. I experience pain that would have the physicians behind this article drop to their knees whimpering in terror that their skulls are cracking open and would someone please rescue them? That is, if they could drool those words out of their clamped-shut mouths during the spasms while fending off a snarky nurse who thinks they are trying to scam up some hydrocodone just for the fun of it. Due to their privilege — they’re doctors after all — fellow MDs would swoop in to the rescue. The rest of us? Never mind. We’ll just go over here to this exam room and stuff some towels in our mouths and…um….er….oh, yeah. Adapt! We’ll adapt. Trigeminal neuralgia really does produce pain so horrific that at times it feels as if one side of one’s head is being smashed open. Is that the kind of chronic pain these scornful medical professionals are working with today? Do they need naps? Have some of their pain patients been a little impatient or moody? I’m so sorry. Until these so-called doctors experience that level of pain — every day of their lives for the rest of their lives — they are guilty of malpractice in pitching the sadistic idea that living with chronic pain should not involve the use of opioids as is currently offered to (far too few) pain patients. I view physicians like this to be lazy. I question their credentials. Did they hate their mothers? Did they have to put up with one hypochondriac in 1978, so now ALL pain patients are using far too many pills? People like me are fired from jobs and cannot pay our bills because we are on the floor shrieking through another attack. You didn’t know? Or do you think I’m faking it? We are denied disability benefits because someone at the Social Security Administration listens to a doctor who says we can go out and get a job. We are not hired because we show up to job interviews shaking and leaning on furniture because we just lost the vision in our eye again during a spasm that moves the corner of our mouth up and down. The guy interviewing us thinks we’re drunk. Our families think we’re just trying to gouge out more sympathy at holiday dinners. Who the hell do all of you think you are, pretending that chronic, horrible pain that disables people does not exist?? Any medication, whether opioid or other type, that allows a person to function, work, support themselves, cook a meal, iron a shirt — those tasks that the authors seem to think can be performed while suffering excruciating pain every day — needs to remain part of pain management. What I sense is that there are still physicians (and nurses, and paramedics, and cops, and bosses, and…) out there who think that there… Read more »

Theresa S

I have had chronic pain for over 25 years. I did find that stopping the treatment of the symptoms of my pain with opioid pain relievers improved my life. It took me out of the “fog” and actually ended the rebound pain that occurred while taking them. I found that some NSAIDS also had detrimental effects to my system, especially ibuprofen and my upper GI tract. Because I was so hooked into believing taking pills was the way to go, I was very “lazy” about doing the other things that would help my pain and have now been forced to find alternatives that, believe it or not, work. I have also gained a higher pain tolerance or perhaps my pain threshold has even changed. Who knows but as a 50 year old with RA, Fibromyalgia, Chronic Migraine and a near bone on bone left knee I know a little bit about pain and opioid pain relievers are not the way to go for long term relief. These Dr’s finding do not surprise me at all. May I also share that my middle child did steal my medication when she was a teen. She became a drug addict. She died at age 26 from a drug overdose. Wake up America. It is time to start feeling our pain to some degree again… It is far better that the pain of loosing a child.

greybeh

Don’t confuse a “tough love” approach (“just live with it”) with the assertion that people need to adapt. We DO need to adapt to chronic pain. We will never be pain-free. However, chronic pain does affect our lives in very tangible and sometimes devastating ways.

It’s been a constant process of adapting and sometimes there has been very real decline. I’ve seen it in my mom who is now having MOBILITY issues due to osteoarthritis that is aggressively attacking her spinal cord.

She’d love to be able to do SOME housework. My father is struggling to try to work long hours AND keep up with the house. He also resents being the single bread-winner now that she’s disabled, and I’ve watched them fight… sometimes quite viciously. There’s a lot of hurt and resentment and emotional pain. I’ve worried that I’ll be seeing my parents getting a divorce in the future.

The problems related to chronic pain are SO wide-ranging. It goes so far beyond just what activities you can do in a day or just “sucking it up.”

“Tough love” is so insensitive to the realities of chronic pain… even to the impact they have on a family when one member of the family can no longer play the role that they used to play.

Lori Verton

As an example Intractable pain sufferer for 15 years I find the authors’ view condescending and impractable. Like so many other CP patients I have severe, irreparable spinal cord and mechanical stru tural abnormalities that just won’t seem to listen to all the cognitive acceptance, counselling and intention that I have a thrown at it. I cannot tolerate sitting, standing or walking and the mix of medications make it tolerable for me to lay in a reclining position all the time.
I too, in desperation scaled my opiates back to near NIL, then went into a psychotic break for weeks after months of intense, unrelenting pain which came flooding back, overwhelming my system with exhaustion. Opiates were reinstated and my nice, stable, 5 year dose was destabilized, resulting in dosages three times as high to wrestle the pain, and my mind, back. A nice new stable dose has once more been achieved, and I live in fear for the day where this important PART of my treatment is taken away by doctors with irresponsible, one size fits all solution.
It is important to know that people from every walk of life can be affected by Intractable Chronic Pain. It is ignorant to assume that we all are ignorant about our conditions to such an extent that we simply rely on opiates to get us through. So many of us have already tried their suggestions to remove opiates and required reinstatement.

trudy myers

I think telling a person who has severe chronic pain to “suck it up” is a rediculous statement-I am not overwhelmed and I dont suffer from mental disease. I have pain from several different sites on my body-it hurts very badly. Yes I have had opiods -and no I have not had escalating doses. The meds take enough off the pain I can manage. I have been without meds too and I ALMOST KILLED MYSELF JUST TO ESCAPE IT!! Thank god not all doctors believe this crap.

Richard Dobson, MD

This article belies what seems to be total oblivion to the people who suffer the unending torture of daily severe chronic disabling pain: Those whose pain level on a good day is 6/10 and on a bad day is 10/10. Patients in this category are automatically excluded from all medical studies but they constitute the people who will be most harmed by the approach recommended by Ballantyne and Sullivan. I saw about 300 people a month in this group of patients and almost all were chronic patients. I took very few patients in my last 10 years of practice. These chronic patients were NOT seeking pain relief but sought initially improved ability to participate in daily life…those things that are guaranteed by the Constitution and by the Americans with Disabilities Act. They reached a very stable balance that was maintained for years., balancing ACTIVITY, medication and pain level. For these patients, the hope of improved quality of life became at least a flicker of reality. Take away the medications, as happened when insurance refused to pay, and function invariably went down. But then, Ballantyne and Sullivan seem to be in oblivion when they refer to treatment of people with chronic disabling pain. They, via PROP and elsewhere, refer to the lack of studies. And on that note they are correct. But that is not the fault of the pain patient. It is the consequence of medical attitudes like those exhibited by Ballantyne and Sullivan and now the “esteemed” New England Journal. Treat them with words of hopeless “hope” and keep them hidden. In the meantime, the pain patient will go on suffering MORE than needed. No, opioids do not just lower a number; they do limit the torturous suffering of a unique and ignored group of people.

Teresa

The author obviously doesnt have chronic pain.
Live in intractable pain one day and we would be reading a whole different article.

Malinda Sutherland

I did the 90 day no pain meds deal, no over the counter and no rx pain meds of any kind. when the doctor told me I could start taking OTC meds again, the Tylenol raised my blood pressure I thought I was going to die. At that point, I was welcoming death. In the Physician’s oath, first do no harm. Really??? When does a governmental law enforcement agency have the right to tell my doctor what he can write? When did they go through medical school? I know way too many people who have ended their pain forever. So these doctors don’t want opioids to be taken, well I really hope they are prepared to pay for the increase in funerals.

greybeh

A few specific comments on the article: “Is a reduction in pain intensity the right goal for the treatment of chronic pain?” – If it leads to improvement in quality of life, then it’s worthwhile pursuing. The patient, especially someone who is new to chronic pain, would love to have a life without pain at all. Over time, I came to accept that I WAS going to have pain. A doctor discussed expectations with me. That was the best conversation I had with my healthcare provider. Not everyone HAS a healthcare provider who can articulate this! We will live in pain, but the goal was to improve my quality of life through improving my ability to work, to take care of myself, to try to maintain a modest social life. My focus was shifted from being “pain-free” to “living the best life I could WITH the pain.” This is an ADVANCED understanding of chronic pain that doesn’t happen overnight and may not happen without a doctor who can develop a relationship with his/her patients. SURE, if you want to dispense drugs and send someone out the door — on to the next patient… yeah, I see miserable patients all day and I can’t FIX them so why bother with them at all… then YES YOU ARE GOING TO HAVE LOUSY OUTCOMES. The current model of medicine does not do well with people who have chronic illnesses. My doctors work for big medical institutions who grudgingly increased the time allotted for patients to 15 minutes. Don’t blame the patients when you’re not establishing a partnership to address what is truly a complex issue (chronic pain). Don’t blame the patient because you’re not having the right discussions with them. Don’t assume they’ve been to medical school and that they should have realistic expectations… HAVE THE CONVERSATION with them! “We propose that pain intensity is not the best measure of the success of chronic-pain treatment. When pain is chronic, its intensity isn’t a simple measure of something that can be easily fixed. Suffering may be related as much to the meaning of pain as to its intensity,” Is the frustration stemming from the fact that the problem can’t be “easily fixed?” It doesn’t negate the fact that there’s a problem in the first place. Maybe doctors need more training in understanding that some problems are not fixable, and the best solution is to seek improved quality of life. I went to a podiatrist once who told me that he wasn’t going to prescribe orthotics for me because “I’m going to hurt anyways.” I asked him — if he had another patient who didn’t have the same additional health problems as me, would he prescribe shoe orthotics? He said he would… so I insisted that he do the same for me. This wonderful, non-invasive treatment helped me with my foot pain, my back pain… and it was nearly denied to me because “I would have hurt anyways.” Where’s the logic? Just because you can’t… Read more »

Mary D'Auria Allen

“For many patients, especially those who have become dependent on opioids, maintaining low pain scores requires continuous or escalating doses of opioids at the expense of worsening function and quality of life.” What???????? My pain is not under sufficient control for me to have ANY quality of life. Opioids are not toxic in that they offer the possibility of having quality of life. It’s not the patients fault that in order for pain medication/opioids to be effective, the dose needs to be adjusted. It’s not the patients fault that the medical profession has not come up with an alternative effective medication to reduce pain & give a chronic pain patient quality to their life. This article infuriates me. Due to the “war on drugs” or should I say “the war on opioid medication” people with legitimate medical problems are suffering because they cannot get the prescriptions they need. Good, qualified doctors are afraid to prescribe pain medication due to the illegal actions of some of their peers. How is any of this helping those who must lie in bed all day due to excruciating pain have any quality of life? If my pain was controlled I would be able to function. I could be a productive members of society. I could support myself & my children. Why has the “war on drugs” turned into a “war on opioid medication”? The consequence of this is that good people, who are not drug addicts, are finding it harder & harder to receive the treatment they deserve. Your answer to this is that chronic pain patients need to “get used to” living in excruciating pain for the rest of their lives? This is truly unfair & beyond cruel. An entire innocent population is suffering due to the illegal actions of other people who have nothing to due with them.

Malinda Sutherland

With all due respect, do either one of these doctors have chronic pain? Can opioids be dangerous, yes, if not taken correctly!!! This is going to take me a bit to type out because it is taking EVERYTHING not to curse out the doctors. The “balance” doctors and patients should be trying to reach is minimal pain and also not pushing yourself to do more because your pain level is manageable. The newer non-opioids meds have other side effects. I gained weight at an alarming pace on one medication which ended up triggering another condition. Also, the cost of these medications are WAY TOO HIGH.

Sorry for the pause, my brain went through all the curse words in the different languages that I know and some in english. You live my life for a month and then tell me ‘to suck it up’.
At this moment, I am having images of where you can stick that report and everything in between.

Fred

-Chronic pain sufferers should be provided opioids as needed, if nothing else helps…
-Chronic pain sufferers ALSO have an obligation to try, for 3 months straight, alternative pain therapies…every day; for 3 months…no quitting, no giving up…3 months…
-Millions of people are affected by opioid addiction…whether the addict or their family/friends…
-Opioid addiction must be minimized…
-Chronic pain sufferers must accept pain…it ain’t going away in any likelihood…so accept this fact, stay positive, no “stinkin-thinkin”…and live your life…otherwise, you will lose…
-It ain’t easy to accept…but there is someone worse off than you…start living!!!

Cynthia

I am so outraged by what I read in this post that I don’t even know where to begin. I am 68. I had perfect health until I was 60, when degenerative disk disease , as they like to call it, struck me down. For 4 yrs I continued working as an LMFT who had a thriving practice. I was also a runner for 32 years. To have these ignorant professionals speak this way is condescending and highly insulting, but even more, it should be illegal. It is a blaspheme for the medical profession, which has the key to the main tool for relieving pain, to state openly that they wish to withhold this key and let humans suffer. They are advocating inhumane policy and must be confronted before more people kill themselves. Obviously, these ignorant fools have never lived a day with what we are suffering through. I have never abused my medication and I assume there are many prescription-takers, like me, who have not either. I am sorry some people get “into trouble” with opioids, but that has nothing to do with how I manage my meds. I am distinct from them. We are two distinct groups. It’s time to get very organized, somehow, even though many of us are sidelined with pain.

BL

Chronic pain patients need to learn to adjust their life style. They can’t do things like they did before and they need to accept that. No, it isn’t fun and it isn’t fair, but life ins’t fair or always fun. The chronic pain patients that I know that don’t have problems with having their pain managed or getting their meds filled are the ones that realize this. Instead of always asking for an increase in their pain meds, they will adjust what they are doing first. They also adjust their non medication pain management. Then in a month or so if their pain level stays at the increased level they talk to their dr about an increase or change in meds. They also realize they will never be pain free.

I know this isn’t popular because no one likes not doing things they want to do and enjoy. Quality of life is no longer the top priority, unfortunately. If a person wants to, they can adjust. But, if all they do is complain and stop doing everything because of the pain and not try to adjust, more than likely they won’t have any quality of life. It doesn’t happen over night and people don’t like to do things that they don’t get instant results from. The silver linning is that when you have to give up doing certain tthings, you discover other things that you can do that you never paid attention before.

The days of doing all the things we did before the injury and/or illlness that resulted in chronic pain are over.

Rob Larson

With all due respect, these highly esteemed professionals sound like idiots about this subject. Sorry, but it’s true. I would invite them to live just one day in my body. Sometimes the pain gets so bad that you just don’t want to wake up…that is, if you’re able to sleep at all. This kind of insufferable ignorance and draconian thinking is keeping the treatment of chronic pain in the Dark Ages! Hopefully the next generation of doctors have some better answers than “just suffer.”

Michael Maltese

I do NOT apologize for my previous comment! I lost too many friends with Chronic Pancreatitis due to being labeled drug seeks which caused death by suicide and massive pain induced heart attacks!

Bobbie Hudson Penick

Seriously? I challenge these doctors to experience just one full day of intractable pain and then I will consider listening to them on how “relative” pain is in the real world!

LYNNE NORRIS

You should try living with constant, chronic pain first, before you tell US to suck it up! Thaat is just an asinine and heartless statement.

Kathleen Cooper

I have lived with chronic pain for 15 years. I have tried physical therapy, meditation, exercise etc. The only intervention that has consistently allowed me to function is norco. I have never become addicted. The majority of us using pain medication responsibly do not experience addiction. The emotional and mental toll chronic pain causes is extremely difficult. Often the only escape from unrelenting pain is sleep. This article is dangerous. It infers that chronic pain is a mindset and not a reality. And it infers that the majority of chronic pain sufferers misuse pain medication. I am fearful of my future should the option of pain medication be taken off the table.

LouisVA

Ms. Ballantyne and Mr Sullivan,
Why do you hate me? Why do you want me to suffer? Your assertions (at least in my own case) are WRONG! My quality of life is better on opioids than off. Also, my pain level has been lowered by opioids, as well. You will find others like myself if you would get your heads out of the sand and stop being so convinced you are right. Open you mind and look at me and do not be so sure that you know the best for me. IT’S OBVIOUS YOU DO NOT!!!!!!

Diane Hamerling

Please forgive me and you do not have to publish this comment, but I only have one thing to say… Just one question please. Do ANY of these esteemed professionals suffer from chronic pain which can only be relieved by some type of pain medication to allow them even a chance to be able to live a marginal lifestyle? Thank you.

missroxmiss

I sent the PROP people a message and needless to say I can not believe their take on things I would like to leave a version of what I sent them,for them I had to shorten it cause email wouldn’t hold whole message. The war on opioids is all good but what you are doing is waging war on people who need proper pain management.. people are killing themselves because of under treatment or no treatment at all for unrelenting pain. I had a level 3 cervical neck fusion surgery I was begging the recovery room nurse to kill me the pain was so bad and she told me there was nothing more she could do. Death would have given me peace I wanted death.. after surgery my family or I neither 1 saw the surgeon or anyone else to let us know how surgery went the surgeons assistant came to see me the next day and said they wanted me off fental pump I said fine it wasn’t helping me at all ..(got home and I had a hard vein where fental was suppose to go in) RN who took out IV port said out loud what the hell did they do ? when the Neuro who came to discharge me I had to ask him before I was discharged to look at my neck wound ,he was gonna just let me go no exam nothing i was in extreme pain.they gave me Torodal that caused my heart to race and sweat,I felt like I was gonna have a heart attack & die the pain had got so bad and I had a reaction to the shot so they gave me pills and the pain was better but still unbearable I stayed awake from the time I was released from surgery til I left the hospital 2 days later because of pain !!! The Neuro who did discharge me not the surgeon after looking at neck wound said to me (a perfect cut line ) had the nerve to say to me “that looks so beautiful Nobody will believe you are suffering so” his exact words I wanted out and because I kept calling about how much pain I was in( the hospital is a hour drive) after I went home ,I was given less pain meds then when I went in but the pain was worse than I went in , ,I called my family doctor and he was gone and doctor who was there wouldn’t see me said I had to see surgeon ..a vicious circle.. When my family doctor got back he saw me and I was in so much pain and depressed I was on edge and my family doc gave me stronger meds he said it happens all the time ,I told him that the nurses aides had put my collar on upside down and I wanted to kill myself. Family doc also informed surgeons office he would take over pain management Neck surgeon… Read more »

Patti

Urrgghh. Spoken like someone who’s never had to deal with unending, horrible pain. Do none of these guys ever stop to think why torture is so effective – and has been deemed inhumane?

After one of my surgeries in a very busy and understaffed hospital, someone forgot to plug in the morphine machine. I screamed for 24 hours as wave after wave of crushing pain rolled over my body. They had cut through my back, rolled me over, and cut open my belly. When my surgeon could finally be bothered to send someone to check on me, the PA he sent looked at the machine, held up the plug and said, “It’s not even plugged in,” with a chuckle, like she couldn’t wait to tell this funny story. As a result of these hours of untreated pain, nothing worked to get it under control, they tried to put a pacemaker in me because my heart couldn’t handle it, and I had to spend over a week in a physical rehab hospital learning how to live with my new reality. I was told that once your body goes through such an experience, it can’t always switch back to normal. Mine never has.

Now a group of doctors are promoting this idea that pain is something we should just live with because the drugs most effective in treating it can be dangerous? When much of the blame for my, and so many others, predicament can be laid right at the feet of the medical profession, forgive me for saying these docs are arrogant, ignorant, and dangerous. May they suffer in the same way I did. But then they wouldn’t, would they? Because no one would ignore a screaming doctor, or refuse their family visitation, lying and saying the patient was ‘resting comfortably.’ And that’s about 80% of the problem right there. These rules are being made by people who live in ivory towers and have no idea how differently the rest of us are treated.

Pain is real. People die. Making them spend their last years in unrelenting pain, which is where we’re headed, will be judged by history as the second coming of Dr. Mengele.