Chronic Pain and Public Policy, A Bridge to Nowhere?

Chronic Pain and Public Policy, A Bridge to Nowhere?

David Nagel, MD

“Happy Pain Awareness Month!”

On September 1st, I received an email from a friend proclaiming those words.  To celebrate the event, I went to work and experienced what has become a daily ritual.  A patient, Mr. S, told me his physician would no longer prescribe opioids for him, stating he could no longer do so because of our “governor’s new law.”  That was a blatant lie.  Still, I understood his fears.  This physician had treated Mr. S with opioids for twenty years.  He had been a model patient, working at an executive level.  His dose was remarkably stable over the years, and, because of the medication was able to function at a high level.  Mr. S was freaking out, wondering how he would be able to maintain his demanding pace without it.  He like, many other patients, wondered out loud why he should have to suffer unnecessarily because of the mis-behavior of addicts.

It is a story I hear nearly every day.

David Nagel, MD

Fittingly, this month I celebrate my thirtieth year as a pain management specialist. I recall my early years.  We knew very little as we were taught very little.  We flew by the seat of our pants, and were told everything we were doing was sacrilegious, unethical. We were ostracized as much as the patients we were seeing. We persevered because we came to understand our patients were suffering from very real problems and deserved much more respect than they were receiving from the health care community and society as a whole.

Armed with that belief, it was a natural for me to become involved in advocacy.  This is not a natural role for me.  I am not a fighter.  Too often, I will walk away from confrontation.  This was a fight that I could not escape.  In 1998, after sending an innocent email to colleague, wherein I expressed concern about the lack of a public policy on opioid prescribing in New Hampshire, I was asked to help found the New Hampshire Pain Task Force. Our first charge was to develop such a policy.  Our goal, as we saw it, was to ensure that those in pain had access to pain medication, and their doctors had a right to prescribe it without undue pressure from regulatory agencies.  The Federation of State Medical Boards made our job easier by releasing their model policy that same year, which we adopted.  In doing this, contrary to current public criticism, we were not naïve.  We believed that opioids had a role in managing pain for some patients.  We believed it was the obligation of health care professionals to become knowledgeable in how to use this mode of treatment, and how to manage pain in general.  We acknowledged the risks including addiction, but we believed this risk to be exaggerated.  We pointed out the two parallel health care crises of poorly managed chronic pain and prescription drug addiction, the former greatly out-numbering the latter, and that public policies directed at both, often conflicting, were harmful to both. We believed a balanced policy was necessary, and we offered our services in making this happen.

I still believe everything we said.  So, what happened?  Albert Schweitzer said that “Pain is the most terrible of all the lords of mankind.”  As a physician, and a human, I find it very difficult to be in the presence of someone who is suffering.  Perhaps that is why my colleagues and I are so good at delegating this responsibility to nurses. It is so much easier to walk away.  Still, there is a terrible uneasiness one feels when doing so. When I first chose to prescribe pain medication for someone greatly suffering, I was surprised to see the relief on the faces of my fellow doctors and nurses, people who would have been just as willing to criticize me for doing so.  The year was 1987, and that was not something I was supposed to be doing. I did not think it to be a courageous act, but I found it had the effect of treating both my patient and those ministering to him.  So emboldened, I advocated for change.

In the subsequent decade, the promotion of opioids for the management of chronic pain became commonplace, perhaps even “cool.”  Many more lives were improved than harmed, and many were saved.  There is no medical intervention that is without risk, and opioids have theirs as well.  It is my impression that prescribing became too easy.  The prescription floodgates went from a trickle to a torrent, serving an important purpose for previously impotent providers who were in need to have some tool to manage suffering; that of their patient and their own.

This dramatic change did not go un-noticed in our task force.  We believed doctors really needed to develop the skills to prescribe opioids, a step that seemed to be overlooked. The decision to prescribe an opioid is not easy.  There are many considerations.  In our state, we provided Scott Fishman’s book; Responsible Opioid Prescribing A physician’s Guide to all physiciansI believe it was the rare physician who either read the book or were even aware the state rules existed.  Using the physician mantra of “see one, do one, teach one,” prescribing for acute and chronic pain proliferated in the absence of these prescribing skills.  We became aware of the growing problem when we created the Prescription Drug Abuse task force in 2003.  I find it interesting in retrospect, how un-noticed our efforts went in the law enforcement community, the same individuals who are now blaming physicians for the crisis.  The net effect was flooding the community with cheap and available prescription opioids more in-directly than directly, and certainly not intentionally.

So, who was using these readily available opioids?  Were we really creating new addicts?  I don’t think so.  While there may be an opioid crisis, it is not at all clear there is an addiction crisis.  It is my impression addicts are switching from one drug to another.  Addicts follow the economic law of supply and demand. They use whatever is cheap and available.  It is my belief that when opioids became cheap and available, addicts shifted their behavior to these more dangerous drugs.  It is also becoming increasingly clear that prescription opioids were not the not the only source fueling this increasingly out of control problem.  It is important to ask the question: why are street drugs such as fentanyl and heroin so cheap and available as well?  While doctors do have some role in the creation of the opioid crisis, it is quite apparent that the problem is much more complicated than policy makers and law enforcement officials believe it to be.  Many fail to acknowledge the rights of those who suffer from pain to have access to reasonable treatment modalities including opioids.  The myopic public policies that have proliferated as a means of controlling the opioid crisis reflect this.

It is my perception that we have a problem of both over and under prescribing.  Many patients who don’t need opioids receive them too often in too high a quantity.  Many patients who could benefit are denied access by providers who are either afraid of the potential ramifications or who have mis-guided pre-conceived notions about those who suffer from pain.  Since the passage of the CDC guidelines, we are seeing a growing third public policy crisis, that of “opioid refugees” (the other two being chronic pain as its own entity and addition).  These are patients, like Mr. S who have been successfully managed with opioids for many years who can no longer find someone willing to prescribe.  Where do they turn?  They either go without or they seek other sources, street sources… or they die, just another overdose statistic, because that is the route they usually take.

It is 1987 all over again.

Patients are angry, and they have every right to be.  They feel abandoned by a health care system, a public policy apparatus, and a law enforcement community that myopically and arbitrarily has the chosen the needs of the few, those who suffer from opioid addiction, over the needs of the many, those who suffer from chronic pain.  I feel this anger every time I see a patient or give a talk.  I recently gave a talk to the Marfan Foundation.  One skill I do have is the ability to assess the feelings of those I am speaking to.  My audience was angry, and I sensed the anger was directed at me, a pain specialist and a physician.  Rather than bore them with a prepared talk, I turned the session into a dialogue, and the reasons for their anger became apparent.  In some ways, the net effect was therapeutic.  They were not alone. Neither was I.

So, are we on a bridge to nowhere?  I believe we are.  After 30 years in the field, it is hard to not be discouraged.  The problem with the pain hierarchy is that those who suffer have the least power.  That needs to change.  The problem of pain and public policy is like a large tree that we are trying to fell with a hatchet.  What is encouraging is a growing advocacy movement increasingly determined to take on this policy nightmare, one that hopefully can go toe to toe with the addiction community, not necessarily to their detriment, but hopefully to the benefit of both.  The goals of the advocacy movement do not stop there, though.  Beyond seeking the recognition of chronic pain as its own medical condition worthy of respect, they also seek access to other therapies, either those already existing or the development of new ones.  It is sad that the public policy apparatus is oblivious to this.  That also needs to change.

Hopefully, together, we can turn the hatchet into a very loud chainsaw and force change.

Happy pain awareness month!

David Nagel, MD is the author of Needless Suffering, How Society Fails Those with Chronic Pain, and is a frequent contributor to the National Pain Report.

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Authored by: David Nagel, MD

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Why is the GOVERNMENT & ACLU ignoring this???

U.S. Statute
U.S. Code › Title 42 › Chapter 7 › Subchapter XVIII › § 1395
42 U.S. Code § 1395 – Prohibition against any Federal interference

US Code Notes
Authorities (CFR)

Nothing in this subchapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.
(Aug. 14, 1935, ch. 531, title XVIII, § 1801, as added Pub. L. 89–97, title I, § 102(a), July 30, 1965, 79 Stat. 291.)

Eileen Maldonado

The VA policy is stop all opioid prescribing? Trump crying about football players kneeling and our friends/family service men and women will be denied pain meds. OMG what will it take? I’m still getting my meds. My pain mgmt doctor goes up on his price a cpl times a year. So I may not be able to afford to go by next year. It’s now costing $500 a visit and we must go every 2 months. I do like him. He cares about his patients. He is concerned about how things are going for all chronic pain patients. We now have a group so we meet when we go in for our visit. We also have a counselor there that we talk with, learn breathing exercises & meditation. I’m hoping that before every thing blows up that the policy makers, FDA, DEA, chronic pain patients,their doctors ,family members and anyone involved in their care can all come to an understanding about what’s most important to get us by. An the “opioid epidemic” we should all be working on to keep our kids alive. Find solutions for the addictions that many were created from the pill mill Dr era. Which left so many addicted, with no real pain or injuries when they got started now having to seek out opioids/heroin any way they can. We are smart people,yes it’s the hardest thing any body can try to kick. But as a community, and with the knowledge and support of all involved we could figure this out.
Thanks for your advocacy. I hope to do more in my community as well for all chronic pain patients, addicts, and everyone involved in this such a sad state of affairs.

Cheri Furr

We ARE on a bridge to nowhere! If you’re frustrated, imagine how us chronic pain patients feel! I have had CRPS (which too few health professionals know about, much less the average person on the street) for 17 years and been on my share of opioids and stigmatized because of it. I have always gone to the same neurologist and filled my prescriptions at the same pharmacy. I have never taken more than prescribed and am very responsible with my prescription. But now I’m being lumped in with teenagers who steal from the medicine cabinets of their friends’ parents and people who buy heroin and powdered fentanyl of unknown strengths cut with God knows what off the street. More investigation NEEDS to be done to find out where these drugs come from and why they’re so easily obtained so their inflow and availability can be stopped. But don’t penalize a long-time chronic pain patient. We have enough stigmas to bear without being blamed for the opioid crisis–unrelenting pain that wears one down, illnesses or conditions with no cure, having to go on disability, depression and isolation. We live a fine balancing act all the time. If chronic-pain patients are denied the only thing that can’t help them, the suicide rate will increase until it equals or exceeds overdose deaths.


Some are mentioning a plant Kratom, but it’s illegal in my state. Knowing the tide was turning against opiates, I ordered some under the radar, but found that it absolutely does nothing for me. Many say MMJ helps us chronic pain sufferers, but that’s also illegal in my state. I do not want to end it all – my family would suffer immeasurably, and as a Christian I want to be accepted into heaven and I cannot be sure of that with suicide. I also know I cannot withstand wirhdrawals. So what to do? I have a feeling thousands upon thousands of formerly law-abiding citizens will be going underground to partake in the illegal supply and demand drug business. The suffering being thrust upon us is cruel and inhumane. We will find a way, in spite of the cruel entities who wish us much suffering.

Terry Longtin

Well I hate to sound like a broken record… What can (legitimate ),chronic pain patients suppose to do? In othere words it is happening today, now! My doctor is cutting my meds a lot and will continue to do so. He says he has to follow DEA guidelines, and in all of my research I have yet to find ANY so called guidelines. Pain patients appreciate every blog that you write, we really do but we need advice on what, Specifically, what steps, if any, can we take to get through this. These paranoid pain doctors are literally ruining people lives and eventually causing suicides and also turning law abiding citizens into criminals just so they can eack out a semi-normal life. Please try and give us concrete steps that we can take to protect ourselves. Nobody has any solutions as to what steps can chronic pain patients take? We need action not blogs. Don’t think that I don’t appreciate your blogs but even if everything you say is 100% correct, it doesn’t help us even a little bit. I am terrified to go through withdrawals and turn into a couch potato. I have a life, a grandson, a wife, etc. I need a weapon so I can protect myself. We are all scared to death. I have been taking 5- 15mg oxycontin IRs and 3-40 mg ERS for years, I won’t go into the awful pain I have to endure or my ailments, you get the idea. I wish I could sue him because he is being irresponsible and neglegent with my life. I really don’t know what to do. So maybe you doctors can get together and help find solutions for us, and do it fast because it’s all happening right now and we need help! The baby boomers are going to be known as the suicide generation.


Dear Dr. Nagel, it is refreshing and hopeful to receive another writing from you.
Thank you for your never ending endeavors all of these years to work for your patients and for us out here in the CP community. Your involvement along with the other doctors out there fighting for us helps me feel safer just knowing that we have professionals like you there to support and fight for us.
Thank you and God bless you!
By the way, your book is excellent!! Keep up the great work! Maureen Mollico


@Gail…what online site and which type of Kratom do you use?
If you don’t want to post it…plz email me at Thank you!

Terry Longtin

It seems to me that every time I read this newsletter it’s the same stuff over and over, the same old information. What is anyone doing to help us. October 1, 2017, my insurance company will stop covering opioids, not 80%, not 50%, but 0%. So even if my doctor, who cuts my doses down every month, continues to prescribe my meds, I can’t afford the $2000 per month for the meds. Isn’t there some kind of law that prohibits doctors or health insurers from making people go cold turkey? There’s going to be a lot of suicides out there. I’m taking 195 mg of oxycodone and oxycontin every day for the past seven years, the reasons are incidental. I’m absolutely petrified of going cold turkey, not to mention living with pain so horrible I won’t be able to function even a little. I guess what I’m asking is, instead of everyone bitching and complaining on a chronic pain blog, WHAT IN THE HE’LL CAN I DO? I wrote my senators and my congressman and received a polite response but no answers to my dilemma. I’m 58 years old and in pretty good shape all around and I’m retired on disability for the last seven years, I actually have a busy, full life hanging out with my 10 year old grandson, painting, doing crafts, I keep our house clean and take care of the yard and our flowers, nobody could ask for more, and just like that my entire existence is in jeopardy. I will probably end up living in bed or on a couch, I won’t be able to function at all. I can see why people get suicidal. This will affect everyone in my family and make their lives 100% harder as well. Nobody talks about the lives of family members being turned upside down. I would imagine the divorce rate would also skyrocket. The time for talking is over! I need something that’s actually going to help my situation, it’s going to be more than I can handle I’m afraid. So I guess I need some concrete actions that are going to help me now, today! I’m going down hill even just thinking about it.


My provider is a considerate, compassionate doctor that utilizes every test available to”vette” hiis patients. Drug screening at every visit along with examination AND conversation about the patients conceived future. He actually cares about his patents. With five children, an active practice, and “orders” to not exceed 90 mme, his “job” has become more difficult. He has to hear of/from his patients hardship that were remaining active whether monetarily or just active enough around their home to remain self sufficient, self reliable. The CDC mis-guided-line is a forced social conformity negating the patients needs. Neglect of appropriate treatment and prescribing of sufficient medication that has been……allowing the patient some amount of simple freedom. To me, this is a challenge of our rights. DOT.GOV is in place to facilitate the pursuit of life…..liberty…..and hapiness. These goals of the people are directly challenged by the CDC mis-guided-line without the any concern of the core people prescribed opioid medication, some for decades making their lives…..possible to pursue what we are inheritly guaranteed by the Constitution of the U.S.A. A social reform is in the works but, it will not be successful. The prescribed opioid medication populous of this country are not the “core” problem of drug abuse. The so called “opioid crisis” is mis named. There is a drug abuse situation and it can not be resolved by the “guideline”. Patients are suffering but, willing to attempt to help the perceived problem of drug abuse through our providers prescribing. TOO many people are sufffering the fallout of the remedy (90mme, maximum) for drug abuse. It is 2:11 in the morning, EST, as I write this. Sleep is not in my normal routine now. Total destruction of an orderly life, I had only 8 months ago. Can.t work, can’t sleep. Only fight the asinine theory of medciation reduction and removal of opioid medication from society. The attempt to reach the “elect”and present evidence of needless increased pain that has been treated, sufficiently for decades. The attempt to help people that did not ask for life long pain. People that have been responsible with the use of opioids medication. People that are now considering either illicit drugs or worse yet, end of life. Those blessed with the aches and pains of sports or age that come with ……life, are blessed and, don’t even realize it. They choose to call the patient with incurable pain weak, or a drug addict. Walk a mile in another persons shoes before passong judgement.What will it take to make the “elect” take notice?

Stacey Fields

Thank you for having the intestinal fortitude to speak out for pan pa tients who are suffering under the Hitleresques Misguidelines. We need a network of pain doctors who are not afraid of treating their patients properly or at the very east who speak out against this genocide. I have chronic pancreatitis and lately I have been thinking life is not worth living in all this pain so I get why people are taking their lives or even turning to street drugs. Pain can make everyday life miserable. Please keep speaking out and enroll other doctors to speak up as well. When the elections roll aroudn again we MUST vote out these greedy politicians who support the torture of pain patients. Make no mistake this IS malpractice and maybe if we all start suing they will hear us!

Tim Mason

My Doctor is not afraid to stand up. I am at 120mg morphine equivalent dose.
I too stood my ground on my visits. Two back surgeries, Post laminectomy syndrome and adhesive arachnoiditis.
I have had to many epidural steroid injections to count from another pain management doctor.
I found an article by Forest Tennant M.D., Dr P.H, that states the justification and circumstances where greater than 90 mg equivalent dose in not only justified but required,
Check him out. If you can’t find it I will supply the link.
Be Well,


Dr. NAgel…why don’t doctors band together to help helpless, sick patients who can’t go to protests , many can’t even type. The doctors have to stand up and fight for us. When is that going to happen? We don’t have any power, nor do we have money (most of us). Doctora have both of,those things. Are doctors even protesting to the CDC and DEA? Don’t their consciences bother them? How many will have to commit suicide or die from stroke or heart attack during withdrawal, before something is done to stop this insane and inhumane crusade?


Such a great article and comforting to know there are advocates out there for us. I’m not a natural advocate but feel chronic pain suffererers need to band together. If laws are passed – and that which makes us able to at least function a bit – is taken away from us, what will we do? It does create a panic feeling for me. My pain management specialist has set systems in place that monitor my taking of the opioids and I take them exactly as prescribed. I will gladly join the team of advocates to make a difference and spread truth and knowledge about this issue.

Yeah Ralph just take some krantom you will be just fine, don’t tell him that!!! He has the gate’s of hell to pass thru and your going to tell him to take what is essentially a snake oil product? At least give it to him straight, RALPH your going to wish yu were dead.


Unsafe care is against criminal law in Scotland where the NHS operates separately from the rest of the UK. It is time we patients started bringing law suits. The Scottish Health Minister has a criminal responsibility to provide as citizens with safe care. Putting patients in withdrawal is unsafe care. I saw a TV reality show about Primary Care Physicians at work: one put a patient into withdrawal and did not even diagnose her diarrhoea, stomach cramps and feeling too ill to get dressed as withdrawal, he had not tapered off her Morphine and she was in a wheelchair from pain. This went on national TV as acceptable practice.


I’m in the UK and have read all the opiates research published by the Royal College of Anaesthetists here.
Their editorial line is clearly anti opiates slanted but none of their sound and well referenced papers justifies this and FAILS TO FIND any conclusive evidence on harms from long term opioid use by chronic pain patients. Yes constipation and drowsiness as well as sexual dysfunction but as we patients know these are nothing to be out of pain and they certainly aren’t dangerous side effects just minor ones far less than from most other pain medications. The opioids nonsense us spreading over here because of reporting of the US “crisis”. I am now having to fight my primary care physicians to keep my meds although none of them are qualified in Chronic Pain. I am looking to set up an action group of pain patients prepared to sue the medics for forcing consent and breaches of human rights law to medication removal etc when they are not pain qualified. Here forcing consent is a criminal offence and the UN Conventions on Human Rights apply giving the patient max opportunity for rehab and to live a normal life. Disabled people must be believed, & treated with respect and dignity under these laws. Please post if you want to contact me.

Debra MCdonald

Two weeks ago today I had surgery to amputate an infected toe. Now my pain physician decided that when I needed additional pain meds, I was given only a partial dose of what I regularly take. What are we supposed to do? I have neuropathy almost up to my knees and my hands. That with the awful back pain I have 24/7, I hurt all the time. I would like to amputate something on HIM so he could feel what I do. Are all pain doctors sadist? Or just mine?

cynthia o.

so beautifully written, the story of our tragedy told very well. i hope it is seen by President Trump. btw, he is allowing/encouraging petitions at once a petition reaches 100,000 signatures, he looks at it. this story has to reach the people who need to hear it….i hope it finds its way there.


And still, we’re committing suicides by the hundreds DAILY now, we’re still in excruciating pain, we’re still being treated worse than our Veterinary clinics treat our animals, all because these “poor me, I have no choice” pussy physicians can’t band together for American humanity (not 3rd world enough for you) and uphold a very serious HIPPOCRATIC OATH they took, for fear of losing their precious silk lined pockets. NAZI GERMANY all over again and our physicians are now in charge of our death sentences. You’ve made your choice to tuck tail.

Ralph, fear not, my friend. I was in the same boat after my Doctor retired. I was in severe pain and was losing hope. Then I discovered a natural plant called Kratom. One of my current pain issues is a torn rotator cuff. I ordered some of this powder and upon my first dose, a teaspoon, my pain went from a ten to a one. Today I even shot some pool and felt great. Check it out. Just do a Google Search and you’ll read testimonials after testimonials. It increases your natural painkillers in the brain and also binds to opiate receptors. You don’t need to suffer! Take care.


This one is scared also, have EDS, am in so much pain…an aye sometimes her eyeballs hurt, have neuropathy, take Gabapentin, supposed to take 600mgs 3 x a day, but it makes me swell up, so just take 300mgs 3 to 4 x per day, tis also to control her petit mal seizures, takes 5mgs 4 x per day for pain,doesn’t do much, tis quick release, an it fades quickly, also 1mg of lorazepam a day for panic attacks, am better off than many..but still scared for yon future.

Deb Brown

I wish we had more physicians like Dr. Nagel. Maybe we do and they are afraid to stand. I applaud and respect Dr. Nagel for his words. I was with my Dr. for almost 25 years and then moved to Florida hoping the warm weather would help with the pain. It has been a struggle getting my meds ever since. I had been on the same dosage for about 17 years never having any side effects, nor needing to increase it. I was managing life and my pain. I too was a model patient. Now, its a struggle every month. I can no longer manage my pain with the reductions imposed. I am not able to join in on family outings. Its very difficult just to leave the house anymore. I desperately seek a doctor who looks at me as a patient not a number. Who has the courage to stand for his/her patients and do what is right for them. I truly do not understand why we do not have a data base that lists courageous pain management physicians in every city and state that are willing to stand with and help the patients that have adocumented need and have proven themselves to be up standing patients. Why as patients are we required to beg for help and have it fall on deaf ears? Why are the good physicians not banning together to help us? Are there more like Dr. Nagel out there? Is he the only one? Where are they and why can’t we find them? Ralph, I wish I knew of such a Dr. I could tell you to call but I unfortunately do not. I will keep you in my prayers and I wish you well.

Well Ralph,you can say goodbye to your life and hello to pain and will suffer like you never have before and with the fact that you have taken your meds for 20 years your suffering will intense and prolonged.You will never live without pain and withdrawal again,so get in line with what your government wants you to do,and that is get on the street and score some of that top quality herion our troops are fighting for you to have over in Afganistan.God bless America!


Ralph, hopefully all will be well with you, it is horrible out here. Most everyone is denied/reduced and cannot find a doctor now. Pain is undertreated and that is if you are lucky enough to find a doctor. Heard the VA is even worse. I also feel like our movement is becoming stronger and we will get this fixed. We are not asking for anything more than anyone else gets and takes for granted in this country. The ability to be medically treated by a doctor who has our best interests at heart. We have been abandoned and one day, there will be many who will hang their heads in shame for what they have caused our community. All we can do is keep fighting for anyone to listen and realize we are people, with families etc. not just a number on some chart.


My name is Terry and I’m a chronic pain patient. I have been receiving pain meds from a pain management doctor. I was taking three 40mg oxycontin ER daily and five 15mg oxycodone IR for the past seven years. I’ve never failed a urine test, ran out of meds or anything else that relates to abuse. I won’t go over the laundry list of my ailments, just know the pain meds are warranted. My doctor has been lessening my meds every month due to his paranoia from the DEA, he admitted as much. My pain levels range from 4 to 9 on a scale of 1 to 10, mostly I live at a 4 which I call my new zero, which is fine, I can function quite well as long as I have the meds. Here’s my dilema. Our insurance company sent us a letter stating that as of October 1, 2017, they will no longer be covering any form of opiates. So if I want my meds I have to pay full price, one script would cost $1100 and the other $900, that’s every month! So obviously we can’t afford that, which brings me to the problems. Number one, if I don’t get my meds I’m going to go through unbelievable withdrawals, it would be cold turkey. Now to be safe it takes months to wean a person off so much medication. So basically life as I know it is over, I will not be able to function at all. Aren’t there laws or rules to wean people off opiates?There are going to be a lot of suicides when it takes place nation wide. In your experience is there anything that I can do? If I had time to wean off of them at least that’s one thing and then I would have to find a substitute medication. I’m so scared and I feel like I have no rights whatsoever. Especially since the opiate “epidemic” is a bunch of false and twisted lies. The epidemic comes from people who got hooked on them and when the doctor stopped giving them the meds (like for knee surgery etc.), they obtain the drugs illegally, and those are the people that have created the problem. Chronic pain patients are being punished over nothing that they ever did. Any advice that you could give me would be greatly appreciated. Thank you.


Ralph Maddox, you may have to see a Pain Management Doctor in the private sector. That is what many vets are having to do if they want their pain managed.


Again, please continue to send emails or letters or phone your congressmen. They are the ones who will either support us or ignore us. There are too many pain patients across the country to not make a difference, but we must all be active in continuing to push our agenda. If not, we certainly will all be in a very sad state of daily pain without help. I know for one, I do not want to go back to those days.

Thank you Dr. Nagel for your support. I hope you also write to your congressmen and Dr. Price. I all to well remember the familiar attack on pain patients and those who suffer from the medical field and others, at that time, many protested, spoke before committees in Washington, banded together and won. This is when the “pain scale”, you know the smiley faces in the hospitals to rate pain, was born. Don’t give up so easily. Demand treatment for pain, after all, pain is a very serious issue and can cause other damaging health issues. Maybe it will take a lawsuit, or a class-action lawsuit for us to get our message across.

We are not the problem to drug addiction. We are not the cause. We are not the means. We are simply people who suffer, and would like to live their lives as pain free as possible. This is not too much to ask of a physician. This is our right.

shirley romo

Thank you Dr. Nagal, I hope you continue foreward educating the medical community we, chronic pain suffers are teal and have a need for this to continue a productive life. Without opiods we are hopeless, no cure for us.

Kathy C

There really is no “Hope” the Propaganda Machine has turned Pain Patient into Criminals, along with few Doctors. When we look at who benefits, we see how this lop sided agenda benefits a few Industries. They have even removed the mention of pain from the so called “Studies” that are promoted by the Media. The nonstop nonsense coverage of the “Opiate Epidemic” has the public and Politician mindlessly uttering the same misleading lines promote by Media. A Media that picked the narrative of some Drug Dependent individuals who claimed they started with Prescription Drugs. There is no way to test the truth behind that, but they do get sympathy for reiterating it.
The “Awareness Campaigns” are nto working. Pick any subject even the mots innocuous, and find that “Awareness” has made the situation worse. Awareness is meant to make it appear they did something, or ‘Educated” the public. The Public is now arguing over the very nature of reality. This “Epidemic” has been a Marketing Blitz, and an Opportunity for Peddling not only a lot of Snake Oil, but an Ideology too. The Public can appear to be ‘helping” by allowing Overdose Reversing Medication, to save the lives of Overdose Victims. These products prices were driven up, as the “Opiate Epidemic” was used to market them. The number of times the product is used is then broadcasted to give the appearance of “Helping.”
Following the Media coverage of this debacle has been eye opening. A recent discussion about the “Research” of Torture and the response by Psychologists, most notably left out any mention of Pain. That word has been edited out of the every so called “Discussion” The Medical Community has come out denying that “pain” even exists. The edit the word out of every Articles, whether the Story of a Veteran that overcame the odds to recover or women in childbirth. Pain is now a dirty word, and people who experience it are weak, deluded or looking for a handout.

Tim Mason

Patients are not only angry because they have been duped by guideline that has the analogy that everyone wears the same shoe size, they are angry because they are in PAIN. Chronic pain so bad that it interrupts your thought process makes for an angry demeanor. We are told that picking up crayons and an coloring book will help or listening to music or staring at a certain wavelength of light will diminish your pain to near nothing.
We live in an absurd world and have allowed those with naïve intellect and phobias to outbreed us and become teachers and legislators.

Thank you for speaking up for us, the chronic pain patient. I have multiple limb RSD/CRPS, and Fibromyalgia, and until last year continued working. I rarely take opioids because my pain dr disapproves of them. My pain psychologist disapproves of his disapproval, because my pain really isn’t agressively managed until I hit an 8, which for me means that air and clothing cause enough pain that I can’t sleep at all for a few days. Once wound up like that, only opioids and ganglion blocks can lower it back to tolerable (5 or 6). If I were on a daily regimen I might still be able to work.
The lyrica, antidepressants, antispasmodics, spinal cord stimulator, meditation, physical therapy,etc all do work, don’t get me wrong. I don’t spend my days in a fetal position crying to have parts of me amputated, which was where I started prediagnosis. Hydrocodone only dulls the pain a bit more. Oxycodone doesn’t work at all. Neither produce a high, like Tylenol doesn’t for regular people. Over the years I have become allergic to one medication after another and I dread the day when nothing is left except the medication that my docs don’t want to prescribe.

Kevin Mooney

Excellent article Dr. Nagal


Thank you, Its been an exhausting year, to me its been a step back in time. 2003 a trauma to my neck,2004 a year after step fail therapy with an assortment of medications I had a spinal cord stimulator implanted that curbed some of the pain. Still not able to live with it,my family’s doctor added oxycontin in 20mg 2x a day. Finally I was out of pain, no longer talking about neurogenic pain, no longer asking to amputate my hand. Mind you it made me constipated, but that we dealt with,no other side effects. 10 years later my milligrams got to 80mg 2x a day but I functioned,raised my young children and kept a house clean with a C5/6 spinal cord injury and my friends and relatives had no idea I was taking oxycontin. That all changed on Jan 1st 2017, I was forced to detox, with the kind concerned doctor who made me pain free all these years, he was broken too, right with me on this ,fighting for me, writing letters, making phone calls. Insurance denials fought, he tried everything he could for me, it was out of his hands and I layed on the couch for 2 months taking the suggested morphine, milligrams too high for the CDC regulations. Now I face this, humiliating visits to pain management doc once a month for lots $$$. Haven’t seen my family doctor since March, relief still not what it used to be but at times tolerable. My calls and letters to government officials go unheard, I’m only me. They all want donations and my vote, I’m so done with the fight, out of steam, can only hope for the day the CDC regulations are lifted for chronic pain patients.

I was suffering with chronic pain and my physician suddenly retired. I was on norco for pain for about ten years I went through withdrawal hell and my pain was extreme I felt there was no hope left. Then a week ago I discovered Kratom! I ordered some online after reading terrific testimonials from people with chronic pain. After one dose, about a teaspoon, my pain went from a ten to a zero. I can’t say enough positive things about it If you are suffering, please check it out. Not only is my pain gone, I feel energized but relaxed at the same time. Just try it!

Ralph Maddox

It IS refreshing and even HOPEFUL, reading this. I pray that this physician and others like him, can convince the anti-opioid bunch that we do suffer, needlessly. I have been on opioid therapy for more than 20 years. I take as prescribed and submit to drug screens onh a regular basis. My primary care doctor is retireing at the end of Sept. 2017, and I am Scared To Death!! I have no idea what type of doctor the VA will give me. And the VA policy is to STOP ALL OPIOID prescribing. HELP!!