CDC Opioid Guidelines Released

CDC Opioid Guidelines Released

By Ed Coghlan

The Centers for Disease Control released its anticipated guideline for prescribing opioids for chronic pain. The guideline is aimed at primary care providers to, as the agency put it, “ensure the safest and most effective treatment for their patients.” Primary care doctors write about half of the opioid prescriptions.

While acknowledging that opioids are often prescribed to combat chronic pain,   the agency said the risks far outweigh the benefits for most patients with long-term pain, except for those receiving cancer treatment or end-of-life care.

“More than 40 Americans die each day from prescription opioid overdoses, we must act now,” said CDC Director Tom Frieden, M.D., M.P.H. “Overprescribing opioids—largely for chronic pain—is a key driver of America’s drug-overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.”

According to the CDC press release, “Chronic pain is a public health concern in the United States, and patients with chronic pain deserve safe and effective pain management.”

Among the 12 recommendations in the guideline, the CDC emphasized three principles are key to improving patient care:

  • Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care.
  • When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose.
  • Providers should always exercise caution when prescribing opioids and monitor all patients closely.

“Doctors want to help patients in pain and are worried about opioid misuse and addiction,” said Debra Houry, M.D., M.P.H., director of CDC’s National Center for Injury Prevention and Control. “This guideline will help equip them with the knowledge and guidance needed to talk with their patients about how to manage pain in the safest, most effective manner.”

These guidelines are voluntary at this point.

Here’s a link to the guidelines: (click here)

The CDC came under fire for how they developed these guidelines. Even Congress was wondering how the agency’s Core Expert Group (CEG)was formed. Critics felt that the process was done with appropriate transparency and the CEG was weighted with more addiction advocates and that the voice of the chronic pain patient was not adequately represented.

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Authored by: Ed Coghlan

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scott michaels

you have cr*p insurance and you go to a cr*p pain mgt clinic. Most are great. if you have done pt and prove it, they cant make you. you must try other things before they just hand out narcototics. if he has passes all urin tests, there should be no problem. PLEASE DONT CLASSIFY ALL PAIN MGT BECAUSE OF YOUR BAD EXPERIENCE. Also let your ins co know of the urin tests. If they wont pay him he wont take them. Or buy one at walmart and bring it in and take it in his office. he shouldnt argue. Tell him your broke. Tell him your husband is a good patient and only takes his medication as directed and show him xrays and mris showing surgery is the only thing that may help and that is too big of a maybe. Thats why he takes the medicine. nothing else works. IF THATS THE TRUTH

MIKE.K.

ALL PAIN MANAGMENT CLINICS ARE ARE LEGAL DRUG HOUSES…SPONGEING MEDICAID AND MEDICARE FOR ALL THEY CAN GET…MY HUSBAND WAS FORCE TO GO TO ONE…WE HAVE A 2K DEDUCTABLE WITH EMPLOER INSURANCE AND THESE IDIOTS ALREADY HAVE DONE 3 URINE TESTS IN 3 WEEKS AT 800 DOL A POP…AND NOW THEY SAID PT IS MANDITORY…WE HAVE A 2K DEDUCTABLE,,THEY WONT PAY FOR NOTHING AT ALL…THERE WAITING ROOM IS FILLED WITH MEDICAID PATIENTS JUMPING THRU THERE EXPENSIVE MANDITORY PROCEDURES…AFTER ALL THEY DONT MAKE ANY MONEY JUST WRITTING A NEEDED SCRIPT…THESE PLACES SHOULD BE OUT LAWED,,,IM SO DISGUSTED WITH IT ALL….

Krissy

Teresa, what wonderful news! I hope you will be comfortable with that doctor. Let us know. NPR is the site where you read this article – National Pain Report! Some of us use the abbreviation, but not to be confused with National Public Radio. Oh I am so happy you found a place for your medical help. So happy!

Teresa

Krissy.

I have no idea who/what NPR is? I am new to pain forums.

I have finally found a pain management place who will treat me. Having to start all over on dosages, but hell at least they treated me with matter of fact dignity instead of overt and not so overt distain. NP took 2 whole hours on my initial visit, just listening and discussing the true nature of just what all was going on with me. I left crying and smiling!

Deb

I was watching the news and now I’m really confused. They say the 3rd leading cause of death in the US is medical error. Why isn’t this a major concern of the CDC rather than making pain patients life a living hell. I was just really shocked by this news.

krissy

TERESA – Can you get what you are writing to NPR so we can see it. It might spark more response for all of us. Thank you.

Kimberly Rosenberger

you do not need to delete your post, it speaks volumes to what those of us in chronic pain will eventually be suffering from because of the CDC’s “stupid” guildlines. Very generalized applying to the population as a whole not the individual. Please pick yourself up a copy of the June 2016 Consumers Report reiterating what has already been stated by the CDC, all of us need to pull together and write a rebuttal to this article out to destroy many lives now facing pain and those to follow who will never know what it’s like to at least have a life outside suffering daily. I have been working up my rebuttal and plan to publish it to the magizine company as a different view titled. “A Patient’s Perspective” all opinions ranging from every step in life need to be included, granted I still functional and fading fast, all walks of life and varying degrees of impairment and quality of life need to be included. I’m advocating not just for myself but all those being burned by this recent release of guildlines I will also be sending this article to the WHO as well since I have read about their investigation who this recent release of detrimental guildlines as well

HJ

I did have to add one more thing, because there was something in the Dr.’s last post that bothered me and I couldn’t exactly put my finger on it until I’d finished the other post. I suspect there’s a name for this type of manipulation:

“It is because I care. I’ve dedicated my whole life towards this purpose. Keep in mind that for decades all I do, all day long, is treat patient’s pain, one after another. It is a vocation, a devotion to God. I am not the enemy. In fact, I am one of the few who really do care about you.”

I had a doctor insist that I was depressed, that I was “lucky to have him” because most patients would run away from depressed patients. He proceeded to rant about how lucky I was to have him as he offered me fewer and fewer treatment options. As I tried to go along with treatment, my chances of remaining employed were slipping away.

The therapist he recommended that I see, she had one conversation with him. She said he “liked to hear himself talk.” He talked over her and she could barely get a word in edgewise. She understood how I felt in the exam room with him.

I found a new doctor who expanded my treatment options again. My ability to concentrate at work improved. This doctor referred me for a sleep study. If you remember my story, it’s what I’d asked for from the very first doctor… about seven years before. I was diagnosed with sleep apnea.

We have a lot of value, Dr. We’re still human beings and deserving of having quality of life… no matter what your personal biases, no matter how burned out you are from seeing us “one after another.” I had one doctor who thought I should feel privileged to be in his care because other doctors would “run away.”

He wasn’t the doctor who made the difference, who gave me back quality of life. In fact, he was the one taking my treatment options away and adding to my difficulty trying to hold onto my job.

Teresa

Robert

I feel for you, I really do. If you cannot see the gut wrenching fear and despair in our lives as you are being told in plain English, I hold no hope for you. These posts are a sharing of that fear and despair in an attempt to enlighten our selves and maybe, just maybe, enlighten someone who matters. It is a cry of bewilderment, helplessness, hopelessness and anger. This just happened to be one of the first forums to post on the CDC’s asinine ‘suggestions’, therefor it is where our reactions burst forth first. Surely you can understand it. Besides, all the letters to CDC and for me personally, to the AMA and FDA, were ignored in favor of the DEA’s witch hunt. (Jesus, American alphabet soup.)
Why should they listen to us? We are only the very ones who are losing hope of ever having anywhere near a normal life do to their actions. (or lack of action in the case of the MANY dr.s, n.p.s, p.a.s who are the actual caretakers of chronic pain patients and who 100% disagree with the torturous new narcotic guidelines but were and are afraid to fight) That just makes me extremely angry. Evil flourishes when good men do nothing. Even WHO is investigating just why Americans are being left to suffer horrifically. WHO sure as hell did NOT suggest this kind of torture in their guidelines. Medical professionals will be judged harshly by all in the future and are being judged right now by the very ones they took an oath to protect. Christ save me for such protection.

My injury had me ‘retired’ 5 years afterward. It was very difficult to lose my nursing career. God taught me a harsh lesson. See, I felt like you do so He thumped me upside the head with reality. Let’s just say I learned about pain, humility, arrogance and compassion. It was a lesson I needed. It is one I pray you learn without the thumping from God.

I am now bedridden. I am 53 years old and BEDRIDDEN by premeditated malpractice. Sorry, but I am not deleting that, it is the truth.

Well here I go again getting drawn back into this blog. It is because I care. I’ve dedicated my whole life towards this purpose. Keep in mind that for decades all I do, all day long, is treat patient’s pain, one after another. It is a vocation, a devotion to God. I am not the enemy. In fact, I am one of the few who really do care about you. But again, this is a blog about CDC’s Opiate Guidelines; it isn’t about any one of you. What you say is being read by others and it does matter what you say because someone may be stupid enough to listen. No offense is intended here. I have never met a pain patient that knew how to treat pain but everyone one of them thinks they do. CDC represented you very well with a thorough literature review just to be able to tell you what we know and what will help others like you the best. Here are some facts: • Opiates are not given to treat pain. Well all live with pain. Aches and pains of the common cold, sore throat from tonsillitis, and let’s not forget my bunion “which is killing me”. • Opiates should be given only to prevent suffering. Suffering is an abomination and malpractice. No one should ever suffer from pain, regardless of its cause. • There is no such thing as pain that cannot be diagnosed or treated. Opiates only mask pain and should only be an adjunct to other treatment modalities. • Opiates are not benign medications. They are addictive which destroys lives. They add morbidity by creating physical dependence. They are one of America’s leading causes of death. They are one of the major reasons patients don’t get proper treatment and end up having chronic pain, like RSD. They lower the immune system and testosterone with all the attending sequela. Just to name a few. Summarizing: Opiates are one of the tools we should use in conjunction with anything else we can find. No excuses, everything should be tried and tolerated until you have no other choices. This will be your tool box to manage your own pain. CDC is simply saying the same thing by stating that at the minimum pain patients need early treatment with injections, non-opiate meds, behavioral therapy, and physical therapy to include myofascial relief, and then “rational” use of opiates. Personally I don’t care what you do to get relief as long as you get the minimum that CDC recommends. On top of that you need to find other things, life style changes, job changes, yoga, and swimming, massage with or without happy endings, Jacuzzi, drinks with funny umbrellas, smoke pot, make love, do whatever you can to minimize suffering so you don’t have to rely on opiates. You are not controlled by them but instead you control them. Your quality of life will be better. Your sense of self and spirituality will be stronger. It should be… Read more »

HJ

Dr. Kutzner,
I have cervical spondylosis and widespread osteoarthritis at age 36.

I’m on NSAIDs, but that alone wouldn’t allow me to continue working.

I’ve not been told that I’m a surgical candidate.

You talk about treating pathologies. I’ve had physical therapy – it only helps to a degree and then it’s no longer beneficial.

Without adequate pain relief, I would have trouble walking. My mother has very aggressive osteoarthritis and without her medications, she would lose all her mobility and be in a wheelchair, her muscles wasting.

The fault in your argument is that you fail to see the point at which denying pain medications causes deterioration. Would you sacrifice a patient’s ability to work? Would you sacrifice a patient’s mobility? QUALITY OF LIFE is important and it’s important to be compassionate.

I did some volunteer work at nursing homes for college. I observed that once patients lost their mobility, their health decline was dramatic.

Deb Moore

Dr. Robert Kutzner, Well I have to put my 2 cents in here. I have very severe fibromyalgia. You say let’s fix the problem instead of treating the pain. Well I sure wish someone would fix the problem. I really wish someone would figure out what the problem is. I want my life back instead of just treating the pain but until someone can figure out even what causes fibromyalgia there is nothing we can do but treat the pain. I have taken opiates for the pain since 1998. In addition to treating the pain I have tried more than I can even remember to eliminate my pain. I even moved to a different state when my son was 12 years old. Yes his dad divorced me because he didn’t want a wife that couldn’t function. My son was my world but I moved 1,000 miles away because I found a dr that gave me hope. Of course it didn’t work for me. The CDC says that opiates don’t work for fibromyalgia pain. Well since I have fibromyalgia and I’ve taken opiates for all these years I know that they do help with fibromyalgia pain. I can only find one study done on less than 20 people with fibromyalgia and that is what the medical community basis their statement that opiates don’t work on fibromyalgia pain. There was even an article written by a doctor that treats fibromyalgia here on the Nation Pain Report that said she could only find clinical trials done on less that 100 people with fibromyalgia and opiates. So please tell me Dr. Robert Kutzner, what about those that the only thing that can be done is treat the pain? I know there are others out there with what they think is worse pain than fibromyalgia pain and my answer to them is we all must deal with the hand that was given to us. Something I have learned in my long journey is to never ever ever judge someone elses pain. I have not been diagnosed with it but I also think I have chronic fatigue syndrome and I wonder if I don’t have CRPS (I think that is what it is). I completely stay away from ever doctor I can because I have been abused by too many doctors and I just really can’t let it happen anymore. So I get thru life the best I can and am undertreated by my current pain doctor and every time I have an apt. have panic attacks that this will be the month I lose what little relief I get. I lived 3 years without a pain doctor and I don’t think I can go thru that hell again. So Dr. Robert Kutzner, what is the answer for those of us there is no treatment for what we have. By the way, I can’t take the 3 drugs the FDA has approved for fibromyalgia. I tried them. In my opinion the only reason the drugs have… Read more »

krissy

Scott, would you be kind enough to email me for a quick question. Thanks so much.

Krissy
kandiapple.mac@gmail.com

scott michaels

THE SOLUTION IS SO SIMPLE. IF A PATIENT HAS BEEN ON OPIOID THERAPY FOR AT LEAST 1 YEAR WITHOUT ANY SIGNS OF ABUSE, DR SHOPPING OR MISUSE THEN THEY SHOULD VE GRANDFATHERED IN. 20 MILLION OF US BELIEVE THE OPIOID THERAPY IS MAKING OUR DAYS VETTER AND RELIEVING US OF A GOOD AMOUNT OF PAIN.
FOR NEW PATIENTS DO WHAT YOU WILL. BUT DO NOT PUNISH THOSE OF US THAT ARE LEGITIMATE PATIENTS THAT ALREADY WENT THRU ALL OF THE OTHER OPTIONS AVAILABLE TO US. SO THE GOVT ABD CDC CANT TEST THEIR DR MANGELA TYPE OF DOCTORING ON THE NEW PATIENTS. WE ARE LIVING PROOF LONG TERM OPIOID THERAPY WORKS OR WE WOULD HAVE FAILED DRUG TESTS, RAN OUT OF MEDICINE EARLY ALL THE TIME AND THE DEA DATA BASE WOULD HAVE TRIGGERED AN ALARM. WE ARE GOOD PEOPLE THAT DO THE RIGHT THING. BOT LIKE THE JERKS YOU SEE ON YOUTUBE GETTING HIGH, OR SEARCHING HEROIN BECAUSE OUR PRESCRIPTIONS DONY CUT IT. I QOULD GENERALLY CARE ABOUT NEW PATIENTS BUT NOW I MUST ONY CARE ABOUT US, THE PUNISHED ONES. Punished for living with extreme pain for many reasons. I HAVE HAD CANCER, IT WAS PAINLESS! MY STENOSIS AND FRACTURETD VERTEBRAE AND DEGENERATED DISCS ARE WHY I NEED HIGH DOSE PAIN MEDICATION

Robert Kutzne MD

This has turned into a forum to vent personal, al-be-it unfortunate, experiences with the health care system. Anyone who knows the science, the truth, knows that the CDC and doctors like me are trying to stop an ongoing problem that hurts pain patients in many ways.

If you care about changing the system, really care, then you MUST SUPPORT EFFORTS TO TREAT PATHOLOGIES NOT SYMPTOMS. If not, then you will inadvertently promote the ongoing misuse of medicine that leads to unnecessary morbidities and mortality. This means that more patients pain will become chronic, like yours, more will suffer, more will die. Opiates are simply tools that support treatments that are incomplete; opiates are not the only answer.

ALL OF YOU LISTEN, SIMPLY VENTING AND COMPLAINING ABOUT MORE ACCESS TO OPIATES PERPETUATES THE VERY PROBLEM YOU ARE A VICTIM OF. If you don’t get it, that’s not my problem. I’ve tried to help you see but enough for trying on this post. See past yourselves, become part of the solution, help others.

Krissy

Wow, John. What a telling story. I do hope you will share this more. I belong to about 35 pain groups on FB if you would like any help sharing.

From Effective Healthcare.gov
and the study done on Multidisciplinary treatment of pain.

Individuals experiencing chronic pain can also exhibit significant psychopathology that might have existed premorbidly but also may be reactive to pain and/or the lack of relief and exacerbated by iatrogenic or traumatic injuries…. The result of this concurrent psychopathology is that the patient’s pain might not be taken seriously enough. The patient might be dismissed as “crazy” and their pain as “in their head,” which might result in not being treated at all or not being treated medically, just psychiatrically. Alternatively, they might be treated overly aggressively medically in that their depression or somatization disorder might just amplify their pain or their suffering or illness behavior.73

In 1987 while I was being treated as an inpatient for chronic pain they used all of the multidisciplinary modalities mentioned in the study. After a few days my pain got worse shooting down my leg into my foot. I complained to the Dr. in charge and after a quick exam he told me it was All in my head. After about 2 weeks I was told to leave for not following the rules of the program / I refused to use the bench press in PT.

Within days I was at the Cleveland Clinic and the Dr found the cause of my pain / the disc had splintered and it was embedded in the nerve root. Surgery was done the next day.

My faith in this old but now called new form of treatment is gone. That was nearly 30 years ago and now they claim it’s the answer. There is no answer – what works for me is medication / my pain is acute, chronic and progressive. Dr’s can’t lump all patients into a single categorie and claim what will or will not work.

Thank you,

John S

But this isn’t about you, your experiences, or our shared disgust. IT IS AN ATTEMPT BY CDC TO PREVENT THE ONGOING MALPRACTICE THAT CREATES MORE PATIENTS LIKE YOU.

Dr. You need to explain to me just exactly what you mean by
MORE PATIENTS LIKE YOU

If you can / please

Thank you

John S

Then the CDC needs to do a better job of communicating your message to all pain patients.

The US government has never stepped into a situation and made it better. / John S. 2016

To all pain patients, LISTEN AND UNDERSTAND. I am a professional, you are not. You don’t know the how, what’s, and whys. Your pain is a symptom, not pathology. Please be mature enough to realize that your oppinions distort the truth and influence others. Take responsability that someone, not as “knowledgeable” asy you may take your unprofessional advice. Turn to evidence to form your oppinions and influence others. Look to science, it is your right to human knowledge. This is why you go to a physician in the first place. The experiences you have with the medical industry, from what you say, is enough to upset me and make me offer to speak for you before any judge against the care you have received. I mean it. It is sad and exploitive. An abomination! But this isn’t about you, your experiences, or our shared disgust. IT IS AN ATTEMPT BY CDC TO PREVENT THE ONGOING MALPRACTICE THAT CREATES MORE PATIENTS LIKE YOU. Pain needs to be addressed in an integrated multidisciplinary approach that includes early treatment (within a month or so is enough to indentify chronicity), interventional medicine, behavioral medicine, physical medicine, non-opiate pharmacy, and yes OPIATES where the above falls short. Opiates are your bail out, your ace-in-the-hole, to prevent suffering. They should very rarely be the only treatment. CDC simply says that if you’re only spending 5 minutes with a patient (which is impossible to do and say you’re treating pain) and dolling out opiates then ONLY DO THAT FOR A FEW WEEKS, maybe a month, and if the patient still needs opiates SEND THEM TO A REAL PAIN CLINIC. If they did this with you, with all patients developing chronic pain, then you wouldn’t have suffered so long. You would have received an accurate diagnosis, a prognosis, and an option of treatment plans you could choose from. This is the right way. It prevents chronicity, hopelessness, and suffering. Now you might say that you tried but there were no pain management resources, no clinics, to turn to. Unfortunately you may be correct but this is because of our current socioeconomic environment we live in and have promoted. Payments for medical care have diminished, greedy doctors compensated by never referring patients even if all they can provide is symptom relief with opiates. This, again, is what CDC is aiming to change. If patients got their opiates for their acute pain from their primary care doctor, their pain and suffering would be controlled and gone for most injuries or pathologies. But if the pain persists beyond anything reasonable (a few weeks, a month) then if their primary doctor referred the patient that would force the patient’s doctor to find legitimate pain centers and, in fact, promote their formation. We would get out of this current mess. If this patient had shingles and needed opiates to prevent suffering then, because it lasts up to 2 months, the patient would be referred. A pain center would literally stop the shingles and… Read more »

HJ – I can relate to every word you wrote.

After nearly 30 years of PAIN and too many to count ” Ok let’s try this ” that didn’t work nearly as well as the opiate medication I now take.

On one ocassion the Dr didn’t even come into the exam room to evaluate me. Instead he put me on 1200 mg Motrin 4 x day. I guess he didn’t read the part of my chart that said I had an ulcer from taking Motrin for 8 months.

One night while in the emergency room and after the doctor had evaluated me I overheard him tell the nurse to send me home with the medicine. The nurse said to the doctor but Dr. he didn’t ask for any pain medication he said he’d can’t sleep can we please give him something that will help him sleep. They sent me home with one sleeping pill and that was back in the late 1980s

After 12 low back operations I feel lim an expert and I know that without opiate pain medication I would have no life at all.

Thanks for a great post

John S

HJ

Dr. Robert Kutzner, You come across as high-and-mighty. You’re not going to reach patients that way. I’m dubious of your “concern.” Let me tell you where I was before “pills” (and I say this because I prefer not to get into specifics over an online forum). I barely functioned at work. I couldn’t concentrate. I wasn’t sleeping well at night. I couldn’t latch onto a train of thought. I feared I had early-onset Alzheimer’s because I would walk into a room and forget what I was there for. Not once… but five or six times in a row. My co-workers were noticing and my self-confidence took a huge hit. Normally a very well-spoken person, I couldn’t even connect my thoughts into coherent sentences. I felt like I was losing my sense of self because AS HARD AS I TRIED, I could not be the intelligent, thoughtful, well-spoken, educated person that I knew myself to be. I feared that I’d lose my livelihood. I feared that I’d have to move back in with my parents and rely on them to support me. Would you want that? Picture yourself there. Exercise your compassion. I went to the doctor for help and I was treated rudely. I didn’t ask for pain pills. I wanted to know what was wrong with me. I wanted a diagnosis. I got mocked for having a “little list.” (because I was having so many cognitive issues) I had an anti-depressant slip shoved at me with a sneer and the doctor shut the exam room door on my face after less than five minutes of talking. I had another doctor tell me “You’re lucky I’ll even see you. Most doctors see depressed patients and want to run the other way.” I had “doctor-induced depression” as I call it. I went to the doctor with full hopes that I’d find someone compassionate who would help me try to find out what was at the root of my health issues that were deeply interfering with my life. And I was treated awfully for no reason that I could fathom. Top it off with relentless pain and fatigue. LET ME BE CLEAR: I WAS HOPEFUL WHEN I WALKED INTO THAT DOCTOR’S OFFICE. I wanted help. I thought life would get better if I had a diagnosis and treatment plan. When I walked out of the doctor’s office, that hope had been robbed from me. You know what I’d asked the doctor for instead of pills? A sleep study. I told her I was TIRED. I was EXHAUSTED. She told me I was “just depressed.” The doctor made me want to kill myself. It was getting close to Christmastime and I decided I’d say good-bye to my family first. I’m not being dramatic. If you could no longer be a doctor and could no longer support yourself and were in daily, unrelenting pain and fatigue and your cognitive function was so horrific that you didn’t even know yourself anymore… If you thought you… Read more »

Teresa

Robert,

If you are not being adversarial, then why do keep insisting we are addicts in every post you make? You my friend need to become educated in compassion and the difference between quality of life and quantity of life. Your rabid insistence totally ignores the availability of pain treatment centers in the first place, much less the ability to pay for them. You also fail to consider every legitimate pain patient has tried all avenues of relief for years before making such a gut wrenching decision to ‘take a pill’. Stop drinking the Kool-Aid and learn the truth!

Teresa

There are MORE valid scientific studies supporting the use of opiates for quality of life with chronic pain than there are against. Failure to consider an aging population when comparing opiate use through the years is the height of incompetence. As is failure to consider more people survive worse injuries compared to even 20 years ago. Failing to null out population increases qualifies as idiotic. Not one state can report less overdoses from opiates since this crap started nation wide in Oct. 1014, not one. The statistics being thrown around like God’s own laws are skewed to present the result wanted. Those numbers are for all opiate over doses, including those from pills illegally obtained or mixed with another drug or alcohol. Until ONLY legitimate prescription opiate overdoses are considered, it is all BS.

KIM I live 200 miles one way from Alb.
I have never never wished my pain on anyone until this rabid witch hunt started against legit pain patients. I now wish it on the idiots trying to kill me by saving me from a hypothetical addiction or overdose. Every so called pain clinic in my state that I or my NP contacted only ‘recommends’ but refuses to prescribe narcotics. My NP works for Presbyterian and they refuse to allow prescriptions for narcotics. The clinic that just dropped me(the day after CDC statement came out) is the ONLY one for over 90 miles to even write a script. Even if they would still see me, they would NOT follow pain specialists recommendations(yes I was flat told that, to which I replied then why are you sending me to a pain clinic?).

As for a new primary care doc in another area, calling and asking if they will prescribe narcs is an exercise in futility. You cannot imagine how fast they slam the phone down and how humiliating it is to call in the first place.

I went through every possible solution for over 20 years before I gave in to needing opiates. My quality of life matters more than any damn possibility of addiction.

HJ, sorry man but you are the one failing to account for the content of CDC’s guidelines. I’m not trying to be adversarial here because I don’t even know you except for this blog. But, through it, I can discern that you are not a specialist medically trained in this field. You are wrong and it is interfering with your life. These guidelines are not just CDC’s but every article that has any scientific evidence written over decades now. I’m not being judgmental, this is not opinion and there is much too much at risk.

You refer to “pills” so I assume you are referring to opiates. You are correct that pills are not evil but what you fail to see is that addiction is. I am not referring to physical dependence here. FYI addiction is repeatedly doing something that you know hurts you. Obviously addiction has a component that reflects a lack of personal value and self worth. A spiritually depraved road with only a few off ramps; hospitalization, jail, destitution, or death. Not a road you want to find yourself on, basically not kool at all. So, no matter what excuse one uses to rationalize their addiction it comes down to nothing good. Because of this, every effort must be made prior to succumbing to simply treating the symptom, pain. Else, sorry to say, you’re giving up and are too lazy to try, it is hard but not that hard. God forbid if you really have no choice because you can’t change where you live, or what you do for a living, or you are one of the rare unfortunates that nothing else works. But unless you try, then there is no excuse. Find a way and stop excusing or blaming, after all it is a choice not a decree. Your choice, but I’d highly suggest not getting on the road of addiction in the first place.

I suspect you will be offended because you think you are right, but you are not. I’m trying to reach out to you, not only from knowledge but experience. I have nothing to gain except knowing that I tried and gave you the chance to get around yourself. Trust me here and if you don’t, oh well there are plenty of others caught in your world out of choice that may listen. This is the very reason CDC put out these guidelines.

Well koodos to you along with much respect and admiration. Doing all the modalities you are takes time and lifestyle change, to say the least. You are receiving CBT, Phys. Therapy, medication mgmt, and more. That is what CDC is trying to get to and it is supported by every bit of science over decades. Way to not take the easy road but the right one. The 3 hour/wk CBT multidisciplinary pain clinic you refer to seems reasonable but obviously not a fit for you. Lets not get rid of them as they will have patients able to attend and, like you, they will find a better, al-be-it more painful, life. I hardly know you but I do know all about what you have, and are, going through. I am proud of you and strongly suggest that you be proud of yourself also. Good work.

Krissy

Scott. Right on the money! Thanks for that post. You need to write an article with every point you made!!

HJ

Dr. Robert Kutzner,

I saw your latest response where you tell people to STOP IT.

I felt I should also say that not everyone lives in an urban area like I do. I grew up in a small town where there was no “multi-disciplinary center.”

There seems to be a lot that you fail to take into account.

Also, pills are not evil. I am NOT lazy because I take pain pills. My pills allow me to continue to work. I can’t exactly stop and take a hot bath in Epsom salts while at the office. I can’t exactly use a heating pad here or lie down and rest. I do my best to pace myself but when you’re in an office setting,it’s a completely different and more restrictive environment than your home.

Respectfully, please tone down the judgement and have a look at context and circumstances.

HJ

Dr. Robert Kutzner,
I had tried going to a pain clinic. They’re so inflexible. They wanted me to come to “fibromyalgia classes” three times a week for three hours a day.

I’m still fortunate enough to be able to work. Had I been forced to conform to their schedule, I would have lost my job in the process. This is wholly unfair. I clearly said that I wished to see a doctor on a one-to-one basis every month or so.

I now have a physiatrist (Dr. of Physical Medicine and Rehab). This is a wonderful specialty and I think we need more of this type of physician. I’ve gotten trigger point injections, orthotics, compounded creams, physical therapy, a TENS unit and medication monitoring. I’m only on tramadol and mobic, but I told her that I trust her and didn’t want to have to be referred out — that I was fearful that if my pain got worse, she would tell me to go elsewhere. She said that it’s dependent on my function… I was fearful that it would solely be dependent on the strength of the drug I needed. I’m doing very well and don’t need any medication changes since changing from flexeril to baclofen. There are days when I have a hint of feeling “normal” again — the pain is still there always, but I’m not “fighting” it and it fades into a daily hum and lets me do some extra activities around the house or office. It’s lovely and I will never take that for granted. I know many are not so lucky.

I just have to say that the pain clinics really ought to make themselves more accessible to folks who are still working. It’s never fair to say, “Take 3 hours off work 3 times a week or we won’t help you at all.”

Please be aware that this happens and this is the reason why I chose not to go this route… because I can’t, even if I wanted to. Not if I want to maintain my employment, which pays my copays.

All of you STOP IT. If you are a patient then go to a multidisciplinary pain clinic where they can help you. AVOID ANY “so called pain clinics” that tell others (like PCP’s) to do what they should be doing. REMEMBER that pain is a symptom with multiple etiologies and opiates only help to cover the symptom. A true multidisciplinary pain will find out what the causes of your pain are and treat them accordingly. Where our current medical science falls short THEN they should manage narcotics to prevent suffering. I’m trying to help all of you here. Opiates are not helping you, in fact they contribute to your medical problems. There is no easy fix like taking a pill.

scott michaels

I am really getting tired of people that have no real experience in opioid pain relief sharing their opinions. Without actually using the medication for long term your statements are VOID.
I ALONG WITH MILLIONS OF OTHERS TAKE OPIOIDS, high dose opioids at that. WE HAVE FOUND THEY DO WORK, AND WORK WELL! AFTER YEARS OF TRIAL AND ERROR THE ONLY THING THAT WORKED FOR ME WERE JUST THE OPIOIDS. WHEN I TOOK MUSCLE RELAXERS TOO, THEY MADE ME NON FUNCTIONAL. THE OPIOID ONLY THERAPY ALLOWS LE TO BRING MY PAIN FROM A BEDRIDDEN 10 TO A FUNCTIONAL 3.
3 MONTHS AGO BECAUSE OF PEOPLE LIKE YOU, MY DOCTOR TOLD ME I MUST REDUCE MY OPIOIDS AND TAKE MUSCLE RELAXERS AS A COMBINATION.
NOW MY MY PAIN IS 5 TO 6 AND IM AM LETHARGIC! THAT MAKES NO SENCE TO ME. THE DEA HAS OVER YHE PAST SEVERAL YEARS BUILT A DATA BASE of opioid users. You can not doctor shop.
As a legitimate patient it is very difficult to get our medication.
Drug addicts have walked away from pain pills years ago. THAT IS WHY HEROIN USE IS UP. ITS CHEAP AND PURE. WHO WOULD TRY TO GET A PRESCRIPTION WHEN THEY CAN JUST GET HEROIN IN ANY CITY USA. OH I KNOW PEOPLE THAT FOLLOW THE LAW AND TAKE THEIR MEDS AS DIRECTED.. Tgose are the only ones being punisged here. Were not getting high. We cant! If we take too many pills well run out early and because of the law we cant get our prescriptions filled early. The only people that are being affected by the cdc guidelines are legitimate pain patients.ark my words NOT 1 DRUG ADDICT EVEN KNOWS ABOUT THESE IMMORAL GUIDELINES. NOR WILL THEY BE AFFECTED BY THEM. FOR THOSE OF US THAT WILL BE DENIED OUR PAIN MEDICATION, MANY WILL GIVE UP AND KILL THEMSELVES because the pain is unbearable and many will search the streets. There are already counterfits pain pills on the streets. This is a great time to be a heroin dealer. They should that Yhe CDC,PROP AND IGNORANT PEOPLE LIKE YOU FOR OUR HUGE UPTICK IN BUSINESS.

Kim

I’ve had chronic pain for almost 20 years and feel your pain of being rear-ended by a vehicle travelling 55mph, this happened to me in 2009 by a large carrying capacity truck that was partially loaded and I too was pushed into the car in front of me. in 2010 6 months after the accident I had a MRI that revealed a 6mm herniation C7-T1, increased from a 3mm herniation abutting the C8 nerve root, minimal diffuse bulge C6-7 unchanged from previous MRI, 2mm retrolithesis and 4mm herniation C5-6, increased from minimal diffuse bulge previously and an annular tear C4-5 unchanged, now 5 years later and working a few jobs I shouldn’t have(not to mention, my pain doc wouldn’t have anything to do with restrictions)however encouraged me to continue working these jobs, just a darn job that paid the bills not even in the field in which my degree is in and now I at broad based, centralized herniations with spinal stenosis and spinal cord impingement, and bone spurs again at multiple levels, even after that major MVA and continuing to work as a respiratory therapist my MRI didn’t appear to be at horribly changed as it has in the last 5 years in addition my pain has not been this out of control since 2001, prior to being seen by pain management for the first time, ever

Kim

what the pain clinic does there is to make recommendations of needed medications to your primary, I had a primary previously who would not prescribe my medications even with the doctor from the pain clinic calling him to say it was ok and this primary had my medical records dated back for 5 years, this doctor wanted me to attempt to attend acupunture 3x’s a week instead. Call them everyday to see if there are any opening they don’t keep a cancellation list, be persistant, it took me 6 months to be able to get into see them, I was in horrible condition when I first was seen by Dr. Starr and have worked 3 jobs now I shouldn’t have due to the physical requirements. I’m in so much pain despite not working any of these jobs,ranging from 4 months to 2 years. I’m not able to catch up with my pain anymore, I am having very little hope for the future, my pain is getting harder and harder to manage and have had some small accidents in recent months that have set me back quite a bit You might be able to get into see Dr. Grande sooner then Koshkin, she’s thorough and gentle, very nice and fresh out of residency from the Cleveland Clinic, you can email me at klrrrt2@aol.com if you would like to talk or have any questions.

Kim

that sucks, you go to UNM so do I please reply to me and tell me who your primary is

To Dave : Just what would you have the patient do and how is it that WE are to blame for the problem ?

In 1958 two states signed into Law a mandatory life sentence for a second conviction of marijuana possession- any amount. The GOVERNMENT hired a so called expert and he came back and claimed marijuana was the MOST dangerous drug in the world and was responsible for nearly all the crimes committed in our country. That myth has long been debunked.

So now you tell us we should what – work with the government to rid the country of opiates. More than 75% of the drugs sold on the street are provided by high level organized crime and only 5% come from patients that are prescribed the medicine. This is according to the FBI.

What exactly is your point ? Trust the government to provide us with proper pain relief or just “TAKE THE PAIN”

Can you please spell out exactly what WE are doing wrong. I’m dieing to hear your response and your solution to this problem.

Thanks,

John. S

Robert Kutzner

Agreed; humans have the right to choose however they want to live. Likewise, physicians, real physicians, have the responsibility to provide only evidence based medicine and cause no harm. That is exactly what the Centers for Disease Control and Prevention is saying. As physicians we have the moral obligation to treat suffering from pain. But when the pain lasts longer than a few weeks then the patient should be referred to a pain specialist where other treatment modalities can be instituted like myofascial release, behavioral modification, diagnostic and therapeutic injections, muscle relaxants, NSAID’s, anticonvulsants, etc.. CDC is also correct in that these patients need a multidisciplinary integrated approach. You cannot fractionate this care by bouncing the patient from specialist to specialist. Integrated multimodal care will provide a definitive diagnosis, prognosis, and treatment plan. It is only, and I mean ONLY, in this way that we can prevent chronicity, physical dependence, addiction, and overdose. Physicians that practice outside this long proven scientifically based standard of care should have their medical license revoked and, depending on their level of patient exploitation, imprisonment. Patients that choose only narcotics to treat their pain should receive addiction therapy while getting their pain managed. Otherwise these patients are choosing the easy way by just taking pain pills which is lazy and self destructive while doing nothing for their underlying pathology except adding addictive behavior, physical dependence, and the plethora of morbidities associated with chronic opiate use. Pain patients are by definition very high risk patients and should be managed by specialists who have the integrated resources to treat such patients.

Angel

The very essence of this first paragraph shows why this is doomed to fail. Keeping opioids from chronic pain patients is the goal. It’s no coincidence chronic pain patients are the majority of disability applicants. It’s the just die and stop taking up medical care costs attitude again. What we need us a chronic pain patient bill of rights that includes the right to opioid therapy. More of the same and they must not have listened to anyone professional or patient that knows chronic pain can successfully be treated with opioids

Kristine (Krissy)

Dave, I have worked on communicating with educational entities, but if you read the number of government restrictions on medical care it is daunting, confusing and saturated with authors who contradict each other, come from divisions of government that are outdated and money-sucking and filled with “we’ll get to that in five years” proposals (which never come through as authored, nor on time.) I’d hate to blame my doctor for not attending a program that isn’t in effect yet.

Nancy

Well once again we are shown that our Government is not for the people, by the people. I doubt if they read one letter we wrote their mind was already made up for them long before we even had a chance to voice our opinion. We no longer have a voice in anything. California voted no casinos yet the lawmakers and the radicals are trying to find a way around the people’s decision and I am sure they will begin opening up Casinos as planned. My daughter works for an oral surgeon. If any of you have had any type of surgery of the mouth you know that it can be very painful. However, they are telling the surgeons do not prescribe any narcotics for these post op patients. The CDC advised them to refer them to a pain specialist for the narcotics. I am talking about 8 pills of Vicodin or Percocet for their first two days after surgery. We all know to see a pain specialist their is a long wait and I seriously doubt if they will see a patient for a one time script of 8 pills. This has gone way too far and will cause patients to go to Emergency Rooms for relief or possibly the streets! I took my granddaughter to Urgent Care because she often gets strep throat and if not caught as soon as symptoms appear she can become very ill. I was taken back by the signs all over the Urgent Care center advising patients that no narcotic pain meds will be dispensed. Narcotic medicine can only be dispensed at the Emergency Room. So what does that do for our already high health care costs. So if your child or you need stitches or has a broken arm and need urgent care you no longer can get any type of pain relief for your injury. Their are so many substances/diseases out there that are so much more dangerous like alcohol, cigarettes, chemicals in our foods, the many bugs coming in from third world countries, the water in the towns where Fracking is going on (drinking water that if close to a fire will ignite) etc. Let’s focus on putting out those fires and leave the doctors alone to do their jobs which is to provide care, treat diseases and relieve suffering. We are going backwards in this country. Hopefully why a new Administration comes in office they will start eliminating these ludicrous agencies that are not serving the people who pay their salaries. I am weaning off my narcotics and it has been a horrific and painful experience. I am trying to learn other ways to cope with my nerve pain. I am not sure how I can manage or what kind of life I will have but I am tired of being treated like I am a drug addict, the hassles of trying to get a script filled just causes me more stress and exacerbates my already pained life. Well… Read more »

Alissa Purda

As if we who are in chronic pain needed something else to feel hopeless about

Dave

I find it interesting how many people in pain are quick to blame government and take no responsibility for the sorry state of affairs in pain care today. They act as if they had nothing to do with government or pain care- as if they were only consumers of government and pain care. And with a passive orientation to the pain care system like that- i certainly don’t wonder why pain care is so poor today.

Renee Nichols

Are you listening, CDC? Everywhere I hear that people who really need some pain relief are not getting it, or have to buy it on the street where it is less regulated than when the doctor prescribes it. I have spinal stenosis which sends shooting pains down my legs. Can’t take aspirin or ibuprofen because it aggravates my asthma. So I get told to go take a tylenol. If that worked, I wouldn’t be at the doctor, now would I? I listen to people in my chronic pain group and more and more of them are talking suicide. Thanks for driving ill people over the edge, CDC.

scott michaels

AGAIN,
EVERYBODY LIKES TELLING THEIR STORY ON THESE PAGES.. WE ALL KNOW IT HURTS AND THE CDC SUCKS.
WRITE THESE LETTERS AND SEND THEM TO THE PRESIDENT AND 1 TO TRUMP AND CLINTON.
UNINFORMED POLITICIANS STARTED THIS MESS, ONLY THEY CAN FIX IT.
WRITE YOUR LETTERS TODAY AND OFTEN. MAYBE THEN, WITH THOUSANDS AND THOUSANDS OF LETTERS, WILL ANY ACTION TAKE PLACE. THE BEST WAY IS A PHYSICAL PROTEST. WHINING ON FLIPBOARD ACCOMPLISHES ZERO. THE NATIONAL PAIN REPORT SHOULD BE HEADING THIS OFF AS WELL.

Teresa Crisman

I was correct in my assumption that my dr. would discontinue my pain meds today. Right about that, but not right about the reason. She walked in saying They(group of drs, one clinic) couldn’t be my provider anymore. She said I was ” Doctor shopping”. I was stunned and told her it was not true! After claiming I filled a Rx in my village which has no pharmacy, after I said not true again, she showed me a pharmacy print out with some other drug dispensed to me, and again I said not true, asked her to call the NP who supposedly ordered it. I finally figured out it was when my NP had ordered cough syrup in Dec. So, now I am labeled as a fricken doctor shopper and have been cut off from all narcotics without any support. I am not stupid, I have to be physically addicted and its gonna be rough the next few days. Then add my pain will keep me bed bound.

UNM pain clinic can’t see me sooner than Oct., I called to attempt to get in sooner and told the nurse why. The real shocker came when I found out Univ. of New Mexico pain clinic DOESN’T PRESCRIBE OPIATS!!! My startled exclamation “What the h###l do you do then?”, will not help my case. so very tired…..

Will Smith

I have struggled with chronic back pain for 35 years after having a spinal fusion operation and now have failed back surgery syndrome. I go to a pain specialist and have been taking opiods for about 3 years. About every other visit to the doctor I have to submit a urine sample which screens for drug level and for any illegal drugs. Each of those urine tests cost $500 and sometimes I have to pay the full bill. Every visit is about $200-300 dollars. If I cannot take opiods I am left with one final option, a spinal cord stimulator. That procedure has a very high rate of complications including paralysis. So I either take opiods or I risk paralysis, I do not like my choices. My doctor and I have discussed this and I am not a candidate for radio nerve ablation. I went through a very painful process to determine this with nerve block injections.

So now we have some bureaucrats making policy about something they know very little about. It is already a real headache to get the paper prescription, find a drug store that has the drug in stock and when I travel I have to spend hours getting addition medication approved so when I am out of the country for several months I have enough medication! How much more difficult do they want to make my life? If I am forced to do the spinal cord stimulator and have bad complications I will assure you that I will sue everyone that was involved in this decision process to stop the opiods I require for at least some measure of life with pain.

Carla Cheshire

Chronic pain patients may want to consider a move to Portugal. I just saw Michael Moore’s new movie, Where Will We Invade Next? which explains that all drugs are legal there. Guess what? Society has not fallen apart, the policy has been a success. In Portugal the police stated philosophy is to treat addiction as a health problem, to treat addicts with respect and dignity. The outcomes are much more successful than prohibition and punishment. The movie is filled with excellent ideas, many of which were started by Americans, I urge a viewing!

Doctors are not the cause.

If no more scripts were written starting today it would not change the overdose rate.

Drugs come from sources the CDC fails to mention and it’s just plain sad. Nothing will change but the number of patients that take their own life caused by untreated pain.

We still can’t learn from our past mistakes and the CDC Docs will be to blame for this travesty.

Thank you

John S

JG

This is nothing more than torture and the powers that be should taken to court via a class action suit. I am tired of hearing the same thing over and over again. Being rear-ended by a teenager traveling @ 55 mph not only had one impact but caused another by pushing my vehicle into the one in front of me @ a stop light! He was texting and l, as a result, had no regard for the people around him in vehicles. I have had a total knee and, just recently, a lamenectomy. To go through the agony of each day is becoming more and more unwanted.

There was a time when I embraced life and all it had to offer … unfortunately, that is no longer the case.

If we cannot find someone who will fight this battle with us, I’m afraid there won’t be much left for me or others that suffer from chronic pain to do.

Congratulations to the CDC for, once again, attempting and thereby succeeding to control what we, as American citizens use to alleviate our pain.

And, you’re right, they didn’t listen but, in reality, they never had any intentions of doing so.

marty

Up at 1:00 am as usual in tears. First article I read is this one which multiplies my tears. Don’t they get it?? Most of us have tried everything under the sun to avoid having to take opioids but as the years go by these old bodies just don’t respond to much or can’t move enough to have any benefit. Finally started opioids a few years ago and at least have some sort of daily function. Who are these people who are playing God with our pain and our lives? Why do they want to kill me?? Why do they want to send hundreds of thousands of people to the streets to get bootleg drugs that surely will kill us. I am now torn on what would be best for my family and myself. I have never believed in suicide but my beliefs are beginning to waver because I am old, in pain and so worn out from fighting. The only thing I see coming in the future are more heroin addicts and more OD’s of epidemic proportions . I hope you are ready for the fallout and you continue to sleep like a baby.

Alayne Gelfand

I have been a *chronic* pain patient — look it up — for over 40 years, since I was about 16. Do you actually think I didn’t start with aspirin, Tylenol, ibuprofen? Do you seriously think I didn’t try herbs first? Chiropractors? Acupuncturists? Physical Therapy? Neurologists? Neurosurgeons? Do you truly think that I enjoy taking medication? That I get a *high* out of it? Do you assume I perhaps require psychiatric intervention, that my pain is “all in my head”? That I want to become a junkie so have invented my pain so I can get prescription drugs? Do you think honest, caring doctors haven’t suggested everything BEFORE giving me opioids? If you believe any of that, you have not done due diligence in researching the subject of chronic pain.