An Epidemic of Under Treated Chronic Pain

An Epidemic of Under Treated Chronic Pain

I was relieved to read the headline “A Mea Culpa on CDC Opioid Guideline” in a recent edition of Pain Medicine News. Mea Culpa means a formal acknowledgement of fault or error, and gives me hope that the pendulum on opioids may be moving closer back to center. The 2016 CDC guidelines really cemented the medical hysteria around opioids (see timeline for further exploration) and rapid adoption of their strict opioid dosage ceilings and duration limits has resulted in widespread undertreatment of chronic pain. Even though studies show that patients taking opioids for chronic pain have a low risk of developing addiction, the presumption of “Opioids=Bad” seems to be everywhere now.

The Mea Culpa article describes how the authors of CDC guidelines themselves have recently acknowledged problems with their adoption, noting that some of the “policies and practices purportedly derived from the guidelines have in fact been inconsistent with, and often go beyond, its recommendations.”

And they are absolutely right that their recommendations have been taken to extreme levels. In Oregon, our state Medicaid plan is proposing mandatory opioid tapers for all chronic pain patients, which advocates (myself included) have been fighting against for over a year.

Other medical providers are speaking out as well. Even the current president of the American Medical Association, Dr. Barbara McAneny is fed up: “[Patients have] suffered… because of the crackdown on opioids. The pendulum swung too far when pain was designated a vital sign, and now we are in danger of swinging it back so far that patients are being harmed. We need to use our expertise in patient care to change the dialogue back to appropriate pain control.”

In response, the CDC convened a multidisciplinary expert panel to review the guidelines and their published report identified that regulators and policymakers have applied the guidelines “without flexibility and sometimes without full awareness of what the guidelines contain.”

The panel’s report also highlights other problems with implementation of the CDC Opioid Guidelines:

  • Improper application of dosage ceilings and prescription duration guidance
  • Failure to appreciate the importance of patient involvement in decisions to taper or discontinue opioids
  • Barriers to diagnosis and treatment of opioid use disorder
  • Impeded access to recommended comprehensive multimodal pain care

Clearly, we need to find a middle ground, one that enables access to opioids for chronic pain management while limiting abuse and addiction. The biggest challenge is the lack of access to effective alternative non-opioid treatments. So, until we have other choices in our pain toolbox, opioids must remain an option, while continuing efforts to minimize their risk of addiction and abuse.

Subscribe to our blog via email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Authored by: Ginevra Liptan, MD

Ginevra Liptan, MD, developed fibromyalgia while in medical school. She is a graduate of Tufts University School of Medicine and board-certified in internal medicine. Dr. Liptan is the founder and medical director of The Frida Center for Fibromyalgia and the author of The Fibro Manual: A Complete Fibromyalgia Treatment Guide for You...And Your Doctor and The Fibro Food Formula: A Real-Life Approach to Fibromyalgia Relief.

41
Leave a Reply

2000
41 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
37 Comment authors
  Subscribe  
newest oldest
Notify of
Terry

I appreciate all the work advocates of chronic pain patients have done but even if the CDC changed their guidelines to consider the needs of chronic pain patients, pain management doctors aren’t going to just reinstate opioid prescriptions for us, they’re much too paranoid, the DEA made sure of that. Think about it, if you were a doctor would you take a chance and start prescribing opioids again? I would be waaaay too afraid of losing my license, even if the guidelines were revised. So I’m not too hopeful about getting my life back. Thanks for all the hard work, it’s much appreciated. God bless.

Ruby

Stacie Wagner and Dave 2: I think Linda “gets it.” You two sure have managed to fill in an awful lot of imaginary blanks in the roughly 1.25 sentences she included about her medications. Obviously, she did what was necessary for this to not continue. Throwing around phrases used by those who are against us, such as red flags, need not be done here, and cruel, bully-like words of reprimand after her injury in spite of clearly stating her boundaries and merely seeking some relief as we all are at this point are more than uncalled for. Since many of us are at our breaking point to begin with, I surely hope that this type of reception Linda received by trying to share her experience amongst others in similar situations who should be kind and caring was not hers. Shame on y’all.

Katherine M Moriel

Thank you for hope instead of seeing suicide as our only hope for relief 1 in 5 people I have spoke to are looking towards suicide in the next 12months if things dont change soon and I’m one of them

Eric

Regardless of what the CDC has to say now, it is far too late for me as I was force tapered to 1/4th the dosage I had been stable & functional on for over a decade. My current pain management doctor will not increase my dosage (which is below the 90 MME threshold the CDC had set) in spite of what the CDC says know. Part of the argument goes “Well since you’ve already been force tapered there is no reason to return you to the levels that were effective.” So until there is actual change, I couldn’t care less about how the CDC is trying to cover their own butt on this.

Stacie Wagner

Response to Linda: I disagree that you were over prescribed opioids, you choose to continue to not inform your doctor that you had too many opioids. Take some personal responsibility for your conditions. IDK where people get off blaming ‘others’ for everything. So maybe these few rules can help you, 1) If you are taking an opioid it can be addictive and dangerous. 2) You need to be aware of how you feel on your medication. 3) You are the only one that knows how you feel. 4) If you are feeling high off of your medications tell your doctor. 5) Most medications have either interactions or possibly of addiction so do not misuse them. 6) Always be aware of the fact that addiction is a possibility. So if you mishandle, overtake or run-out of medication early or anything else it’s a red flag! 7) Communication is key to a successful relationship with your doctor. 8) If your doctor does not hear you, find a different doctor or something. So there are some easy rules to help with a more successful relationship with medical doctors and other problems. Please apply these in your treatment and please feel free to add other common sense rules to this list.

Thomas Shutt

As long as DEA overreach and harassment of good faith medical doctors,this is just idle words. My pain doc. when I even stated the MME for naive opiate pts”who cares what the CDC says” is unlikely to have any change of heart towards prescribing meds. I have been lowered to a 10th of my original doseges when I was referred to him after a forced retirement of my original doc. For 20 years I was treated sufficiently, still with pain and bad days but nothing like the agony I am experiencing now. The alarming rate of pain pt. suicides should have been a barometer , but has been ignored. For my fellow pts. who lay awake all night and day with debilitating pain there does not seem to be any swing of the pendulum to reverse this travesty. Only the 24/7 pain pulsing, throbbing , stabbing, shooting,through frayed nerve endings with sufficient medications held at Bay. I was at first on board with the forced taper,buying into the crisis hysteria,until realizing how beneficial the meds were to any resemblance of life quality. Even half of my former theraputic level of medication would be helpful compared to the living hell I and others are dealing with… ……

Dr.Liptan, thank you sincerely for standing up for intractable pain people. I for one have lost all trust in Physicians. If it wouldn’t cost the government money they would probably set up a clinic and call it the doctor Jack Kevorkian Center and have all the intractable pain people line up outside the doors. But they don’t do this because they don’t want to get a bad rap and so they want to show that they’re helping addicts and that they’re not causing any undue harm to anyone. The states have adopted the guidelines, shouldn’t be called guidelines should just be called negan’s Bat Lucille.

Cynthia

We have got to stop patiently , and impatiently, waiting…this [edit] has to be stopped….I pray for direction and organization,,,,please , someone, help us.

Researcher on PM

Kris Aaron
Do you really think the reporting of 4 deaths if there are 4 different opioids in one deceased person is accidental?
Illegal fentanyl contains a number of illicit drugs, & fentanyl &heroin oftentimes contain amphetamines, killing the user quite quickly.
Where does fentanyl & heroin really come from anyway?
All roads lead back to Rome.
And all roads lead back to…..

Researcher on PM

If the CDC says regulators & policymakers have made laws without even knowing what’s in the Guideline’s, why in the world do you think the CDC Guideline’s are the problem?
They have no power to pull Dr.’s license’s & close pharmacy’s.
Why does this site repeatedly refuse to focus on the problem?
Keeping CPP’s in the dark.
Possibly because the last real advocate’s plane crashed on the way to Washington while actually changing laws? Better safe than sorry. Peace&love❤✌

Dave 2

“Linda” you were not over-prescribed, you took too much. You failed to see your limits. You failed to see you could not be adjusted violently. You failed first and last. I have no sympathy for such cases of extreme neediness that one puts ones life in a strangers hands to the point where they completely stop thinking for and educating themselves for a relative stranger, whether they be called Doctor or President. Failure to be self-aware is what causes many deaths and overdoses.

Michele Hebert

Finally some hope! I’ve been couch bound for 3yrs feeling like a POW in my own apartment. I’ve had numerous pain issues since I was a child and many I saught treatment through drastic lifestyle changes. I’ve reached a point where I am in stage 4 RA but I still manage it by my lifestyle. At this point though, osteoporosis set in and I’ve needed joint replacements. Both hips 6 years back and 1 hip gives me tons of grief. Now waiting on reverse shoulder surgeries on both arms. The hold up with both surgeries is I have an infection all over my body, in my mouth as well. I have been fighting this going from specialist to specialist begging for test. I’ve gone from PCP to PCP looking for one that will listen treat my entire body because its blatantly obvious its systemic. The Drs all split off only focusing on their speciality. It also appears to them that I’m Dr shopping and that’s exactly what I’m doing. I’ve given up hope with getting help for pain so I never ask that question that terrifies me. “Can you help me with this overwhelming pain Dr”? I’ve been shamed and made to feel so horrible about seeking some relief so I’m not suicidal again. They are always way ahead of me when they see my list of diseases. “Don’t expect to get any opiates from this office” etc…says Dr after Dr.. The pain is overwhelming and like all of us, it effects me emotionally, mentally and socially as well. I’ve tried so hard to get help with this pain and all in vain. I don’t know how I’m even still alive cause there’s only one way out. I suppose because it would devastate my parents and other loved ones. I realize the trauma and the rippling affect it would leave in my passing. I returned to college and finished my Masters degree over 20yrs ago. I was once a gainfully employed Clinical Therapist living a life filled with purpose. When we lift others we simotanously lift ourselves….but no more. A small dose of pain meds would change everything about my life but here I lay.

Thank you Dr. Liptan. We ‘desperately’ need more doctors like you to start standing up and speaking up for our community in support of us as well as themselves and their surviving practices! Best of all to you.

ElizabethR

I certainly hope you’re right. I’m 82+ and probably do not have a lot of years remaining. I’d be SO appreciative if I could live whatever time I have left in less pain–not “0” pain, just less. I’m a compliant patient on a physician-monitored low dose of a mild opiate pain med. My pain is undertreated as the underlying medical conditions have worsened with age, but I recognize that I am much more fortunate than many. So far, I have not been cut off or involuntarily tapered. I live in fear every month when I request a refill, but maybe our voices are beginning to be heard.

Stacie Wagner

It’s a pendulum that will not swing far enough back soon enough to help too many of us. Because we are in chronic pain and have a lower visibility people just do not see the destruction the ‘ lack of opioid ‘ epidemic has left in it’s wake. That destruction is vast and unrepairable in many cases. Thanks for your help and information. You are appreciated.

vicki latham

I had been on high-dose opioids for almost 15 yrs due to intractible pain caused by CRPS and joint/back pain due to Ehlers-Danlos Syndrome. That dosage allowed me to function by reducing my pain by over 50%. A month after the new doctor took over my PM practice, he forcibly reduced my medications by 75% all at once in march this year. He said this was a requirement by the state med board due to the CDC guideline. I asked him would he increase my dosage back to the original amount or at least to a level where I could function if the CDC updated or revoked those guidelines. His immediate and concise response was “No!” He stated he didnt believe my pain warranted that dosage and he didnt see any reason for an increase. I was in so much pain after the forced reduction that the PM nurse practitioner increased my dosage back up a small amount but she is limited by the state med board suggested limits.

Im glad they changed some of the wording and indicated they felt the application of their guidelines was inappropriate but I think it was too little, too late. Regardless of whether or not they knew this would happen, there has been too many changes in state guidelines and laws. The federal and state govts wont retract what has been implemented. There is way too much momentum in the direction they want to go… complete govt control over pain management.

Kris Aaron

The biggest problem is that lawmakers and law enforcement — and the government — are being given incorrectly compiled statistics and confusing prescription opioids with illegal fentanyl!
SAMHSA (Substance Abuse and Mental Health Services Administration) is responsible for compiling opioid death statistics based on reports from emergency medical facilities throughout the US. But those reports don’t distinguish between opioids prescribed to the deceased and those prescribed to someone else but consumed by the deceased. Most overdoses result from combinations of multiple illegal opioids, prescription opioids that may or may not have been prescribed to the deceased AND alcohol, which significantly amplifies the effects of depressants.
If the deceased is of legal drinking age, alcohol intoxication levels are NOT reported by SAMHSA! We have no way of knowing how drunk the deceased was when they took the opioids or how much the alcohol contributed to their death. Plus, there is no way of knowing whether the fentanyl found in their bodies was manufactured legally and prescribed in the US or illegally imported from Chinese manufacturers.
And it gets worse: Each narcotic found in the bodies of the deceased is frequently interpreted as a separate “death” — which means one person who overdoses on three, four or five different opioids and dies may then reported as three, four or five separate deaths!
So pain patients are being denied the opiates they desperately need because of faulty government statistical estimates, incorrect reporting by the government and the media, and failure to include alcohol consumption as part of the problem.
Source: https://www.acsh.org/news/2018/11/05/who-telling-truth-about-prescription-opioid-deaths-dea-cdc-neither-13569
Source: http://www.pharmaciststeve.com/?p=24202
Source: https://www.cato.org/policy-report/septemberoctober-2017/myth-opioid-prescription-crisis

Rosalind Rivera

Personally, i am so disgusted that I’ve lost all hope of ever getting the proper and much needed pain relief that my rapidly dying body and mind so desperately need!

Thomas Kidd

Yes the mess those uncaring doctors created has caused much suffering and death. It that little to late for many people. They have done like in the Prohibition created many unwilling criminals of no fault of their own. So has this evil caused the same thing among the sick and dying. There is no excuse for what they have done.

Linda

I was on an one-track workable treatment program, having gotten pain medications reduced as I had to get away from a Dr. who had been severely over prescribing. With medications reduced, along with regular pain injections and my physical therapy exercise done nightly as I was able, I could be at least positive, somewhat productive as I have numerous medical issues to begin with. I was even encouraged by my physicians and able to relocate to a southern state as an added benefit as warmer climate would only add in positive way to my health.
However, it is now 2 years and I am without any medically necessary pain medication, injections or any other medically necessary service. I was forced to seek chiropractic help for even some slightest pain relief. Horrible to say, he totally ignored my medical records, my verbally informing him of my conditions, no carry or anything. Aggressively jolted my shoulders, and hip has caused a number of serious injuries on top of everything else. Traumatic complete tearing of rotator cuff both sides , injured clavicle & sternum, torn ligaments, tendons, plus more, further injury to hip, now can’t walk 10 steps without crippling severe pain, tearing through right knee due to compensation for damage to left side.
Severe, crippling chronic pain and I am refused any pain relief medications.
There was a problem yes, for years with “some” doctors over prescribing, not all. This whole opioid crisis was nothing more than a big push for their multimillionaires, billion dollar money making plot.
They couldn’t care less about anyone but their own pockets. Now so many people have had major medical setbacks, and some, like me even more injuries and pain problems.

David 2

The DOJ/AG wants the money for holding up pharm mfg. Opiates can’t appear to be good for anything and their ‘PR campaign’ (guns to heads) has been totally effective. They are the only ones who can do this. CDC, media, Kolodny, etc were simply satellite investors.

Michael

We must get kaiser permanente on board as well. Thier stance has been the structest of all. Whether they are part of PROP or not. Responsible prescribing does not mean NO prescribing nor does it mean taking a patient that has been on 540 mgmme for criping pain dow to 50 mgmme. At fporst it was thier lies blaming the CDC. Now they blame the state med board of CA. I FIGHT every time i see them. They are not open for discussion. THEY MUST FOLLOW THE FED RULES AND THERE ARE NON. THEY DO THIS JUST TO SAVE MPONEY PERIOD!

Lisa Hess

I’m looking forward to reading the article about the CDC you mentioned. Dr. Liptan, the only point that is too vague in your article is the statement…”The biggest challenge is the lack of access to effective alternative non-opioid treatments” most of us have had access to and have tried every non-opioid alternative treatment, including but not limited to, Acupuncture, trigger point injections, repeated epidurals, nerve ablations, nerve and facet blocks, spinal cord stimulators and surgery to no avail. For many of us all the aforementioned have been tried several times before opting to try opioids only to find out that opioids do work. The one thing we all have in common is the lack of government support to get us back our opioid medications that worked so well for us for years. The misnomer that long term opioid use is harmful is the mindset we need to change. Some of us have been taking successful palliative care with opioids for decades without a single yearn for a high as these so-called experts like to think.

Donna Collins

Thank you so much for the input it really puts it into prospective, I wish I could could get my Dr to read it

Max Beichert

So, then, is it better if the Feds do get involved in this area, and legislate the matter nationally, or better to fight the states individually, that have already adopt the CDC Guidline(s) as settled state law? As my optometrist always asks: “Is this better, or is THIS better?”

Connie

“While limiting abuse and addiction” Someone please explain to me how restrictions on needed medication for relief of pain, chronic or otherwise, does anything against abuse and addiction and particularly overdoses caused by them when the problem is not, and has not been, prescription medication? So an addict gets safe drugs why is that a problem? Overdose is rising while prescriptions have dropped because of ILLEGAL DRUGS and ILLICIT FENTANYL ANALOGS! Prior to the early 1900s opiates were in almost every home and used as needed. Those people held jobs, supported families and went to church on Sunday. When government stepped in to regulate their use, mostly as another means of controlling immigrants from China, India and other places where the use of opiates was commonplace, and realized how lucrative that control was, is when addiction became a problem!! If there was any real concern for the safety of the public the FDA would take most every modern drugs, such as lyrica, nsaids, and so many other DANGEROUS DRUGS, off the market immediately!! This whole narrative just makes me sick!!

Samantha

Thanks, on behalf of all CPP patients! I would ask tho, that all medical professionals expand their scope to include the DEA. Government is notorious, not only for in-fighting and partisanship but for not sharing information between it’s different factions, particularly those that are MEANT to co-exist and work in concert to represent and protect ALL American citizens.

Patricia Williams

I wish I could see ” the pendulum swinging back to the middle” and some hope for a more balanced and reasonable attitude towards the use of opiates…but this is America, and I fear the current hysteria has years, maybe decades, to run yet. If you have a severely painful illness or a terminal diagnosis and any $$$ to your name, I’d consider treatment or even moving abroad. I’m certainly saving my $$$ for a hip replacement overseas…I’m a sissy and a hip replacement with Tylenol and a stick to bite on isn’t the type of health care I want to pay for…in fact, I don’t even want it if Medicare pays for most of it

sharon l schmidt

This makes me so angry! It’s to late the damage has been done. Doctors have lost the practices for nothing more that treating pain patients. People have lost the doctors and acess to pain relief and all they did wrong was have chronic pain. I have had to go to the streets to get adequate pain relief. I have tried everything I finally find pain relief in pain medications and it’s yanked away and I am made to feel I did something wrong. Now they come out and say they didn’t mean to hurt chronic pain patient well it to little and to late we are hurt. Doctors will be afraid to write prescriptions for years to come thanks for nothing.

Rebecca Hollingsworth

I have never read Pain Medicine News before today and I must say I haven’t missed out by not reading it. Same old song and dance, CDC guidelines were supposed to be directed at primary care providers and not pain specialists , blah, blah, blah. Pendulum swung too far, yata, yata. For pain patients who are suffering and paying the price rof this injustice, it’s nothing new. Nor does it help our current situation. It’s all just talk. Nothing is being done, nothing is being accomplished by these articles. I don’t see any doctors trading their lab coats for a super hero cape defending the rights of chronic pain patients. Its just not going to happen, PERIOD.

The only chance cpp’s have is if the CDC guidelines, taken as gospel and law, are repealed and the DEA does the job that it was created to do, get a handle on illegal drugs coming in to this country, (for which it has failed miserably).
So no one is better off than before this article was published. We are all still suffering our “every day ” and wonder how that has changed so much since these guidelines have been enforced.

We cant let ourselves be dragged down into this pit of neverending pain. We must remain hopeful and vigilant while we fight for our rights to be “normal “. To be treated as valuable human beings and to receive the best care for our suffering that works…that dirty word, opioids.
I hope today is better than yesterday and that we all survive til tomorrow.

Harley

God bless you dr.4 standing up and supporting the chronic pain community I have had Interstitial cystitis for almost 30 years chronic burning and pain 24/7 in my bladder and pelvic region I was removed from my medications over a year ago and my health has deteriorated I’m 66 now and I pray to God everyday that someone will separate the invisible illness patients with conditions that have no cure and not put all of us in one big fish bowl not all people AKA patients are drug-seeking addicts yet we are treated that way now it is frightening after working since I was 15 years old and now over 50 years later senior citizens and chronic pain patients are being treated as if we have done something wrong! so thank you for believing and for treating us with empathy… you are a hero in my book I am a grandmother and a mother and I have missed out on so many family functions because of my pain so thank you for having compassion for us that suffer needlessly God bless you doctor…

Lori T.

Well it is about time the pendulum MIGHT start to begin to swing the other way. This is a great post and gives those who are starting to give up a reason to hold on. I will be watching this development very closely to see if this is too good to be true. I suspect many doctors and other “powers that be” will be very wary of any sudden changes to the status quo on opioids. Until we can see some real common sense reversals on the idiotic proposals floated and/or swiftly and ignorantly swept into law, I’m not holding my breath. But I will take all the good news I can take on this so called war on opioids. Let’s hope this won’t be the last of the mea culpa we hear on this issue. So much damage has been done. So many people left in sheer agony. This trauma will take a long time to heal once things hopefully are made right again. I hope the legislature learns their lesson on this one, hopefully never to repeat again.

Randy

Well said. I’ve been saying this exactly the same. I live in WV a opoid free zone. Not a place to get your opoids for pain relief. One of the first states to pass the new restrictive law involving the prescribing opoids for chronic pain patients. I was forced to taper off Feb 2018. I was then refered to a pain clinic over 50 miles from where I live one way. Said pain specialist refuses to treat with opoids and primarily treats pain with spinal injections and other modalities. 14 months later I’m barely ambulatory suffering from other medical conditions making my pain worse. A day late and a dollar short CDC.

Anon

Thanks Dr. Liptan. My husband and I, both physicians, see a lot more than this happening. We see refusal to work up pain, before it’s even known whether the pain represents malignancy, with disregard for consequences, and refusal to treat malignant and post op pain, even near the time of death. Please help us get the word out. When you become a full time patient, no one listens. Because you still practice, perhaps someone will listen to you if you share our story and others’. My father received nothing post op for an amputation and I was told as he screamed that he had phantom limb pain. When he went into hospice, confused from dementia and extremely anxious, he got one dose of anti-anxiety medication; he received one dose of pain medication for an infected stump, osteomyelitis on remaining foot, infected decubitii, etc. My mother died with terminal cancer and rheumatoid arthritis, and inadequate pain control. I have Ehlers Danlos with frequent dislocations, autonomic neuropathy, erythromelalgia, and narcolepsy among other issues. I’ve made it through compartment syndrome with nothing for pain, and I routinely wear a full ice cap for my migraines, which I’m told many chemo patients can’t tolerate, so the notion of all EDS patients having hyperalgesia is a joke. My husband with psoriatic arthritis and Sjogren’s that has failed all treatments made it through immediate post op from complicated 3 level cervical fusion with cord compression and severe outlet obstruction with nothing for pain. We can’t get his ENT to follow his parotid tumors, one recurrent, anymore with MRIs because of the stigma of having painful conditions. No one is interested in the 3cm and growing thyroid mass that hasn’t been FNA’d. He’s holding in a large, uncomfortable umbilical hernia with a belt. Many other issues, just like everyone else. I don’t recognize our country or medical system. We are thankful for the care we get; we should be able to depend on more.

Absolutely nothing will change for those in pain until a leash & a muzzle is put on the DEA. Until that happens, everything else is just talk. They could OK raising the amount of dosage of opiods allowed, but until DEA is muzzled nothing at all will change. The fear of DEA will continue to keep access to the much needed opiods from getting to us. Nobody misunderstood the guidelines but DEA & kolodney found that it meant a money making opportunity for them.

Kathy Rosenberg

Addendum. On looking back the title does say “guidelines” here but the rest of my questions stand.
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm

Kathy Rosenberg

When I read the CDC information from March 2016 I don’t see the word “guidelines”. But most posts on the subject call them guidelines. The information was for primary care physicians who were uncomfortable in some way prescribing higher dose opioids and opiates to their regular patients. The CDC said they should get help from or refer to pain specialists. The pain specialists were not told what to do in this information.
Where does the word “guideline” come when referring to this subject? Is there another descriptive word that would be more accurate?
As I understand it much of the problem has been the application of this information to both primary care and pain specialty when it was only meant to be for primary care.
Another problem is acting as though these are actual guidelines when they were just written as discussion.
Does anyone have definitive information on this?

Reece

Until a class action suit is filed and won, nothing is going to change. That is clear.

Gail Honadle

First of all use the correct terms, that you learned in Medical School. Intractable Pain is a Subset of Chronic Pain. Difference is the Intractable Pain can only be treated by Narcotic Pain Medications. Chronic Pain has other treatments. Intractable will last a person’s life time. Narcotic Pain Meds are then CONFUSED WITH ILLICIT STREET DRUGS. HEROIN, COCAINE, CRACK, METH, OR DESIGNER CLUB DRUGS LIKE GHOST, PINKY, OR MANY OTHERS. Those are OPIOIDS usually imported from Mexico and China. Many mixed with Illicit imported Fentanyl and Ketamine a horse drug.

If you as a Physician don’t use the correct words why would you think that the Press or Politicians would? They are looking for Big Bucks from Pharma and Pharmacy chains to fill their empty coffers. Despite new again Misguided, Misapplied Guidelines from the CDC, few of the 50 States are following that advice. Tylenol has become the Post OP drug of choice. Or Ibuprofen which as a Physician you should know all OTC’s but Tylenol causes bleeding.

Over 100,000 people yearly die or are injured by OTC pain medications. Tylenol is a 10 day use drug. The Latest advice for a woman in labor is a Epidural with Toradol. Which is a blood thinner and a GI destructive drug. If not administered right can case Adhesion’s of the Spine, which causes Intractable Pain.

We patients know more than you do because self defense of drug sensitivity has forced us to learn these facts. Stop miss using words and Lying.

Jeanne

What I want to know is; Why hasn’t anyone brought up the fact that it will take at least 10 years for any research to find alternate safe, effective pain medicine? Soon the meantime the approximately 100 million people with pain will be suffering with inadequate treatment. It’s insane. It is not health care. It’s as stupid as; why not just start a euthanasia program!

Bram Judy Cast

Thank bnb you. I for one have more quality of life on opioids. I’m responsible and careful. This whole thing got ridiculous. My kind of pain is not a candidate for shots etc.