Chronic Pain Treatment – It Should Start At The Beginning

Chronic Pain Treatment – It Should Start At The Beginning

By Dr. Geralyn Datz.

There’s a patient in my office, crying. He is also shouting. He can’t get his pain medications. His primary care doctor has told him, “I’m not allowed to write these medications for you any more.” I know this is a lie. His doctor can write the medication. His doctor does not WANT to write the medication. I know his primary care doctor doesn’t want to assume liability for the prescription now, due to the perceived pressures from the opioid epidemic. Or maybe the insurance has limited the supply or type of this pain killer. Now, the patient has been referred to me for “pain coping skills”. This is what providers call a ‘dump’. The patient is dumped on another provider. There is no plan there is no net. No warm hand off. The patient does not want to be here. The patient thinks I can talk some sense into their provider. The patient does not want “pain coping skills.” The patient is not motivated, nor insightful.  What do I do? How did we get here?  I want to go back, all the way back, to the beginning. I want to go all the way back to the point of when this patient was first hurt. The first week of his injury. And I want to bring my magic wand.

Dr. Geralyn Datz

I want to be in the head of the primary care provider who treated him first. I want to enlighten the brain of that provider and I want the words coming out of their mouth to be, “This is going to be okay. The vast majority of these injuries heal.”

“It may take weeks, it may take months. But we will get there. I need you not to despair. You’re going to need to adapt to this problem for now, though. I need you to go to physical therapy for awhile. I know it’s inconvenient, and it may be painful. But it’s the best thing for you. And I need you to do some sort of activity on your own. Walking, doing the Wii with your kids, or maybe some daily stretching and abdominal work at home.” I need the provider to talk to the patient about what he thinks about pain medication, does he want it or not? Has he ever had pain medication before? Does he have a history of addiction or other risk factors for addiction? I want to look through the providers eyes and see what the patient thinks about his injury. What he’s worried about, whether his job will accommodate him or not, and talk to the patient about those fears and figure out solutions, just encourage the “patient to hang in there” so that the patient can be compliant. I want the provider to know if the patient needs a back brace ordered or not, or a TENS unit, so he can use some non-medication based options during the day or at the end of his day. I want the provider to tell the patient to quit smoking because now he has a back problem, and smoking makes back pain worse, and that is not good. Then, I want the provider to write the medications that are needed, and see the patient back within no more than two weeks. And I want the provider to be paid for this time, because it’s going to take longer than the 5 minutes.

Often in medicine we are focused on the injury, and trying to fix it, and we miss three very important things. One, there has to be an acceptance that we can’t always be comfortable that injuries happen, accidents happen, pain happens. Pain is a part of life. Second, we have to focus understand the patient’s response to the injury. How is the person coping and dealing with the injury? If they are not coping well, this needs to be addressed. Third, we have to be careful not to shape expectations towards being fixed, and chasing down cures, but instead to rehabilitation and recovery. Recovery takes time. Most patients are not told this. Several weeks after an injury has not healed, fear and depression may set in. At the very least, severe aggravation! The person begins to resent, even hate, their pain. This is a brain-based process. These thoughts create new circuitry and signals in the brain, followed by neurotransmitter release, and these new pathways get memorized. They became learned associations — pain leads to disgust, which leads to doing less, which leads to negative behaviors (too much rest, smoking, unhealthy eating, alcohol, sleep loss), which leads to more pain, which leads to fear of future pain, which leads to more disgust…..on and on. The neural highway is laid. And because someone told them “There’s nothing more I can do for you, you can only take the medication,” the person believes it. And this belief too, becomes part of the neural pathway. 

Here we sit. The patient and I. He senses my compassion. He senses my feelings that we have met too late in the process. He is angry but underneath the anger is fear. Fear of being left alone with this pain. Fear of being tortured by pain. Fear of the unknown. I give him space and listen longer than any provider has listened so far. This calms him down. I know my limits. I am not a magician. But I have knowledge and tools that can help him. And right now, I’m all he has. I tell him his brain has been hijacked by pain, and worry, and sleeplessness and anger. I tell him there is a way through this, even though I can’t write medications for him. I have done this with many patients. I want to help. He agrees to come back. I shake his hand and tell him, thank you. 

Dr Datz is a clinical health psychologist and pain educator in Hattiesburg, MS.

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Authored by: Geralyn Datz, Ph.D.

There are 32 comments for this article
  1. Maureen Mollico at 7:11 pm

    Dear Dr. Datz, Thank you for your excellent post!
    As a person who has suffered daily for 26 yrs with chronic spine pain…I have traveled a long long road of several spine surgeries, treatments galore, failed spinal stimulator etc etc. trying to find the cure…to…then finding acceptance…to now trying to conquer new fears of what am I going to do without my meds if I am cut off?! How could I possibly live?! The pain will kill me.
    This ridiculous Government issue that has us exhaustingly swimming against the tides sent me into another direction of researching constantly about CHRONIC PAIN and how in the world am I going to handle life without meds.
    It has caused me to go way back to my initial injury and 1st fusion surgery and the thereafter.
    It has caused me to come across the whole ‘brain pain’ or CNS sensitization theory a couple of years ago and therefore I am now on a path to figure my own body out in that sense. I am a PAIN WARRIOR..I WONT GIVE UP!!
    Soooo, I 100% get all that you wrote and appreciate your heartfelt compassion for your patient. It may be too late for me also. But, I believe that you are right.
    I believe and have been telling people for several months, who have known me throughout my long pain journey, that ‘if only I could go back in time’ I would’ve done things sooo differently.
    If only I knew then all that I know now.
    I truly believe that being on my meds attributes to my high level of pain, or at least plays a role in some of it.
    Yet, without a ‘great’ support system (of which I have NONE,) I know that I could never LIVE without my meds.
    I’m currently seeing a therapist to help me learn more about this in prep of possibly being cut off meds anyday. I am preparing myself for the worst before it happens. I am caught in a catch 22 and I am scared.
    If only I had been sent to a doctor such as you back in the beginning.
    May God help us all. Keep strong warriors! Don’t give up.

  2. Sheryl M Donnell at 10:43 am

    Bravo for you!!! We need as many people who are not so sick that they still can get to Washington. Our biggest problem is most of us are too sick to do so. Thank you.

    And I agree, Tobacco is big money so they don’t get rid of it yet it kills far more people. Slap a black box warning on our medication and leave us be.

    Same with Alchol. It kills far more than our MEDICATION.

    Drinking and driving kills even more and yet people still get a slap on the wrist while we are dying for taking PRESCRIBED MEDICATION THAT HAS BEEN PROVEN BY THE FDA ITSELF TO NOT BE RESPONSIBLE FOR THE EPIDEMIC AND THEY ARE STILL TRYING TO MAKE US BEDRIDDEN AND KILL US.

    Take our voices everywhere you are able. I have sent mine to everyone I can to get them to listen.

  3. Rhonda potter at 4:11 pm

    I am no where close to being addicted to my pain meds but I am sure as heck addicted to nicotine. Nicotine jumps down people’s throats and causes death and addiction at a higher rate.
    If my meds ard stopped i know I can not deal with becoming bed ridden and dying everyday living with this horrendous pain. I am going to the capital to lobby for pain meds. I will make my statement there for everyone to see. I will have signs as well. I will have to end my life to stop this ungawdly pain. I pray they find a cure!!!! I want my life back!!!!!!

  4. Robin West at 4:01 pm

    I was diagnosed with CRPS in 2004 after a knee replacement (unsuccessful). Yes my life
    has changed from living joyfully enjoying family and my wonderful grandchildren! I now have
    full body CRPS and live in fear of having opaites taken from me! I’m not good at putting my
    thoughts in writing….I just wanted to thank Rhonda Potter and Susan OBrien for their comments! Bless all of you who suffer from this dreadful pain disorder….pray that all of you
    keep up the fight! I will never give up hope that the CDC and the government will finally see
    what is happening to the people who are suffer from chronic pain!

  5. seref gun at 7:49 am

    I used one of the tens units in the market. Surprisingly it did its job and gave some relief and reduce my pains on my muscles. Of course don’t expect that it will heal you very quickly but it is worth to use.

  6. Cynthia o at 12:54 am

    Very very well stated, Rhonda Potter. If only there were a way to get these letters delivered to people who have the power to turn this nightmare sound. Rhonda’s heart and pain are on her sleeve…for all to read. We must get these letters to places they need to go.

  7. Rhonda potter at 10:07 pm

    America is not a third world country.
    We are medically advance. We keep patient’s alive with this technology that should not be. We are so medically advanced that persons that should be dead are alive.
    Why would you save a person’s life with your technology and not treat his or her pain? Why do you keep them alive to just to suffer? That is inhumane. Just let them die! Just let us die! The pain is so horrendous that we must kill ourselves as a way to control our pain.
    You have made us live everyday with excruciating pain. You have no idea of our suffering. There our no cures but you keep us alive and refuse to treat our pain. Let us die!!!! We deserve to be pain free but you refuse to let us. America has the medicines that can give us some type of life by treating our pain yet you refuse to give them to us. Is that some type of manslaughter? You will be the cause of our deaths. You are killing us. You are murdering us.
    There are more car wrecks causing death but you don’t take our cars away.
    Opiates do not jump down people’s throats. Opiates do not turn themselves into herione. These are all actions made by people. Hold them responsible! Hold the drug dealers responsible.
    We really don’t care what other countries allow or think. We are not other countries. We are America.

  8. Rhonda potter at 9:30 pm

    Love your reply. You described the pain perfectly. Sometimes I can’t even talk.
    Awesome comment!

  9. Susan OBrien at 4:16 pm

    I am a nurse who specialized in pain management and then developed chronic pain after an injury and surgery that worsened the condition. It is NEVER helpful to just stop a patient’s pain meds unless they are found to be abusing their meds at which time they should be referred to rehab. Stopping pain meds in a chronic pain patient can lead to misuse and abuse due to the fear of not getting any relief. Then you start medicating suffering rather than pain. Suffering is not well managed with opioids.
    Interstingly, I have seen physicians prescribe boat loads of benzodiazepines and sleeping pills that lead to habitual use and abuse but no body is talking about that. Making medical decisions based on how your colleagues feel, or your fear of getting in “trouble” is cowardly. Every patient is an individual and as such should get care based on their situation, response to treatment and what gives them the ability to live the best life they can. The sad thing is that MOST clinicians don’t understand that I DON’T want to have to take a pill just to be able to get out of bed! I want to work, to go ride my bike, take a walk, and clean my house without having to stop because the pain gets so bad that I cry (in private -almost every day). I UNDERSTAND that I will NEVER be free from pain, and I can accept that; but I should not be expected to endure daily, unrelenting severe pain that makes death seem like a viable option. Yes, I have tried EVERY prescribed/suggested option to manage my pain but the only thing that consistently takes the edge off is opioids. I wish this wasn’t the case more than I can express. I have done years of PT and psychotherapy. I have had dozens of medical procedures that I was told would “fix everything” but didn’t. I use a TENS unit, yoga, relaxation, traction, heat/cold, aromatherapy, rest, nutritional supplements, massage etc and they can help for a short time but I can’t stop in the middle of work to lie on the heating pad when my pain is making it almost impossible to function. I wouldn’t wish this life on my worst enemy. There are days when I dread waking up because I never know if it’s going to be a bad day or a day where death seems like the best option. I’m so tired of this misery. I just want to be myself again. Chronic pain changes who you are and until you have it you really will never know how it feels. You can sympathize with me but you can never tell me you get it unless you have chronic pain as well. I’m tired of being lumped in with people with opioid addiction but I still have compassion for them and the illness they are struggling with. It is time that the individual receives treatment, not just the diagnosis! The lack of multidisciplinary pain management clinics in this country is appalling and a large reason there are so many suffering needlessly.

  10. Janice at 9:14 am

    Spot on! Is hoping the DEA all COME down with kidney stones evil?

  11. Ibin at 7:43 am

    After two surgeries, lower back with the latter being a vertebra fusion, heal time was about 6 months. I walked, and walked, amd walked, after I was able to. Told by the surgeon, this would keep “scar tissue” from forming so bad. When appropriate heal time,had passed, I wemt through all the “next step” medical procedures. I do mean all. Over 20 years later, nothing has changed much. I fight pain daily, nightly, absorb a great deal of pain and I think a great deal of what….I or the physician could have done different. What can I do now?Did I get a less than perfect surgeon? Did I do enough to “help” myself? I did…….what the doctor advised. I did….all “next” proper methods to gain pain management.

    I don’t think I could “go back” and do anything much differently. Yet, here I am 20 plus years later, in worse pain, than 9 months ago. What can I do…..now. I would “like” to be able to keep providing for my wife and I. I would like to be able to do what I could just, 9 months…..ago. Self employed, driven to succeed from within, the drive is still there yet, the flesh yields to the pain. I have broken several bones, had minor surgeries and I knew that the pain would cease, eventually. Never ending pain generated from invasive surgery, an injury that can not……be corrected fully, a disease generated pain, never ending pain that is real, is almost impossible to cope with.

    When pain persists, after all effort by our physicians, medication, appropriate for the individuals pain generating condition may be the only way to manage the pain. I agree that “strong” medication should not be prescribed before a personal effort to manage the pain with other pain treatment methodology is used. I can only say, that I I have not given up hope, ever, for the pain to cease. Reality can be sobering. Reality realized after a reduction of the only, last treatment for lifetime pain has been all but removed. I agree with other pain management patients that we accept our fate. Why can others, not in the same boat not accept that we are telling truth?

  12. David Cole at 7:12 am

    The bottom line here is we have a government takeover of our health care, chronic pain patients and doctors alike at been put through hell. Bottom line doctors didn’t even read the CDC guidelines, everybody just jumped on the bed wagon, opiates bad. Now we have chronic pain patients committing suicide. Nobody gives a s***. I think opiate prescriptions are down 40%, and yet opiate related deaths are skyrocketing and expected to go up even further. I believe there are several reasons for this. These educated idiots have just driven chronic pain patients right into drug dealers hands. Primary care physicians have became nothing but a lying cowards. The CDC guidelines clearly state that primary care physicians shouldn’t prescribed over 90 mg of opiates per day, yet they’ll tell you we can’t prescribe them at all. Pain doctors are scared of the state-regulated regulating boards. This is nothing but a made-up crisis it’s been going on for years. Let’s face it there’s two hundred million people in this country that have no problem with addiction, let’s say there’s a million that do. So let’s take away the medicine from the 200 million because of the million. Does that make any sense? hell know it don’t! I told my primary care doctor when this started people were going to die. The biggest problem here is nobody ever paid attention to what the CDC guidelines said in the first place they are recommendations only for primary care physicians. This is the worst atrocity ever put on the most vulnerable in our society, the disabled, elderly and Wounded Warriors. as far as this article goes, I’m so sick and tired of listening to Goody Two-Shoes and their b*******, if you don’t understand the need for pain medication for chronic pain patients, you may as well just go pound sand because you know nothing. Only chronic pain patient know what it’s like to deal with horrible pain day-in-day-out week after week month after month year after year. I live with an intractable nerve disease. I too have all the horror stories like everyone else, I did almost commit suicide, and am not out of the woods yet. My pain meds have been cut by 2/3 so far, after 8 years being on the same dose. Bottom line government needs to get out of Medicine, they need to go after the criminals and help those that become addicted and leave chronic pain patients alone. Don’t we have it bad enough already.

  13. Laura at 10:31 pm

    Sorry, but when you’re dealing with spinal stenosis (think: liquid fire pouring down your limbs), being told “pain is a part of life” by some fully functioning able bodied person just does not cut it.

    I hate to say it, but one of my brightest days was when my neurosurgeon, who had frequently humiliated me by telling me “it’s only pain, go back to work!” suddenly disappeared. I found him…at home, crippled up with cervical spinal stenosis! He finally got it.

    I truly hope that every self-satisfied person who claims that “pain is a frame of mind” will get a non-life-threatening kidney stone. Then come back and tell us how your mediation worked.

  14. Becky at 7:32 pm

    Unfortunately, there are few compassionate doctors as you. Thank you.

    Also, unfortunately, there are bodies that cannot be healed through the brain, physical therapy alone.

    Unless you one day have pain at a continual solid 8 on the pain scale with a minimal scarce pain meds, you would not understand the fear and the need.

    Until we all walk in the shoes of those whose pain is so fierce that the pain patient says there are many levels within the 9 on the pain scale, and the 10 causing the body to lock up hard, then faint from pain.

    People in this kind of pain do need those minimal two to four minimal pain meds to not want to commit suicide.

    People with continuous chronic pain at an 8, cannot take care of themselves to make food even or bathe at will.

    When you meet the truly seriously critically bad pain patient, you will know. I feel for you then since you are a compassionate person, the turmoil you may feel. Not that I want you to.

    There are genetic syndromes and acquired diseases or conditions, which involve bone to which the worst pain exists.

    One quick last note, those who suffer at the hand of American doctors who feel righteous and confident they can train the brain to not translate cytokines I feel so sorry for.

    Hope you are able to help those in need and prevent death by suicide for true chronic pain patients. It is the choice of those to take heroin that seems to be driving this boat. Rare are the chronic pain patients who have not tried everything, and did not self inflict their pain condition. 🙁
    Hope that you will be a champion of those that truly want to help.

  15. MichaelL at 6:05 pm

    Most of my patients were private pay. They did not have the extra money sitting around to pay psychologists. (who are not MD-s) Out here in fly-over land things are different. But, we don’ let that stop us from treating pain patients badly!

  16. Rita KIMBEL at 2:27 pm

    2003 after coming out of a very dangerous surgery, I was in a state of pain that was off the charts . The surgery was an anterior cervical disc dissection and fusion at the C5-6 level. That’s because my family doctor did a manipulation and thrust on the back of my neck popped the disc. Excellent neurosurgeon did this repair and after many months of pain it was diagnosed that a scar was left on the cord. An incomplete injury to the cord has left me with left side paralysis and the neurogenic pain to go with it. So after the surgery I go back to this family doctor to get weaned off the 27 pills he had me taking for the last 5 months. He knows it’s at a point now that the oxycontin was the only thing that would be able to treat my pain successfully.After a month, I come back for follow up visit. The medical group decided he should not treat me and another doctor takes over my care, she sees on my chart that he had prescribed the oxycontin and almost hit the roof. I was weaned off it immediately. That was 2003, little did she know he signed her name to the script, I knew right there that was not the place I wanted to be. He was my family doctor for 13 years, but after he joined a large medical firm things changed. It took another year and another doctor to take over my care. Been with him my current doc for 14 years, just recently he had to stop writing oxycontin scripts for my pain due to CDC regulations. He had it under control, I was living life without pain. It’s been 9 months and I’m still fighting to get my medicine back. The pain has me down, hardly functional, I’m suffering. Thanks for neuro-stimulator implant So yes it started at a doctor and is ending at a pain and spine doctor. What point we’re you trying to make…

  17. Jeanine Schaefer at 9:57 am

    I’ve been that patient…..(without the shouting, but getting very frustrated)….and not because I couldn’t get my meds, but because yet another dr was assuming I hadn’t tried everything I could. Pain meds are simply a best or only option for some patients, and to pretend like its any different, and flat out deny what is known to help relieve the problem is cruel.

    Ultimately, the Dr is justifying not even considering giving pain meds to patients, and trying to make themselves feel good about it by thinking they are being compassionate….they aren’t. They are wasting the patients time. They are doing it in a better way than just saying no, but they are doing it, all the same.

  18. Rick at 9:56 am

    I’m tired of hearing pain is part of life, life is painful. I’m sorry folks but if your ass is on fire, I don’t care how strong your mind, you cannot douse the flame. Do you tell a cancer patient to get over it, don’t catastrophize, YOU can beat this baby!!!! Mind over matter at this point looks a lot like denial. Mental health folks mean well, and DO play a part in chronic pain survival, but pls don’t put that kind of pressure on me because of your utopic posturing.

  19. Duane Pool at 9:46 am

    I appreciate your heartfelt compassion for this patient, but I can not understand or condone how you ( and the primary physician) failed to refer this patient to a pain management physician. The patient was dropped kicked to your office without any evaluation by a pain management physician. Unacceptable. The CDC Guidelines are intended for primary physicians, so yes, he probably could have provided a short term script for this patient, but not long term. In my opinion, in that case, if this a long term chronic pain situation, this patient should be given the treatment option and the choice, of seeking an assessment/ care from a trained pain management physician who has greater latitude in prescribing. I believe given the correct treatment options and guidance, this patient can make the best decisions for himself given proper education, oversight and with informed consent. I feel this primary physician dropped the ball by not referring, or educating the patient about ALL of his treatment options appropriately. If the patient had been evaluated by a pain management physician and then referred to your services, I would give this content more weight. In my opinion, this is just another case where the medical field failed a patient who is relying upon them.

  20. Mary Stephenson at 9:23 am

    I believe every chronic pain patient lives in fear the minute we go to see our Dr. I’m always afraid that he will cut me off what has worked since a chiropractor gave me a sideway whiplash, blew 1 disk out in my neck and it broke into 3 pieces. 1 piece wedged into my nerve root at C5-C6 and the other two floated in my spinal canal. It took 22 months to discover it was just a herniated disk, so massive damage was done to basically my whole right side of my body. From right eye to my right foot. And across to left side as well.
    I truly have tried most everything after 2 surgeries to heal the nerve root that was damaged with the gel like substance from my disk sitting there so long. The damage is non repairable. I’ve been on a low dose of a pain pill and muscle relaxers for over 30 years, same medication. The acupuncture collapsed my nerves in my right arm trying 2x a week for about 3 months. That was my last resort. So acupuncture didn’t work for me. I wasn’t a candidate for any fixes that the Dr wanted to try. No Dr. Wanted to cut me anymore because nothing would work. My nerves are in a lump on my shoulder, nothing makes them go away. My relief is my medication for 30 years. My fear is if the CDC keeps taking medication away from patients who truly need it we will start committing to killing ourselves. I have tried everything out there available from injections, to tens, massage and on and on! Why are we being punished for what others abuse. My medication is not for fun, I get take to take a shower, do dishes, laundry and try to live some kind of a normal life.
    Something must be done to help the pain patients besides taking away their medication. I can maintain on my low doses of medications. Please don’t take that away from me, if you do I will probably be dead. Thank you for reading a portion of 30 years struggle of my life in chronic pain. It only took the chiropractor 2 seconds to take my life away as I knew it. I’ve been on disibilty since 1991. I’m just trying to live some kind of life with debilitating pain. There is more to this story but anyone in chronic pain know what I’m referring to.
    Someone please help us, I’m a citizen of these United States and worked until I couldn’t anymore. Pain is grueling! Never goes away always there 24-7!

  21. Bob Schubring at 9:19 am

    Brilliant insights, here. To construct a trusting relationship with anyone…spouse…child…colleague…trading partner…and yes, patient, one must begin the relationship by being trustworthy. People observe how reliable we are, and respond to that. We cannot command trust into existence. Trust must be earned.

    In the acute phase of an injury, the simplest way the physician earns that trust, is to understand the patient’s complaints and respond to them. When the complaint is that the injury is too painful, the pain must be treated.

    Having once done that, it is simple to tell the patient that the healing process is gradual, when muscles and tendons are injured. That physical therapy may be necessary. That the pain may come back, during the first few therapy sessions. That if the pain comes back, it can be treated. And that gaining more strength will help to prevent pain from recurring.

    By accepting the fact that persistent pain is real, and planning immediately to treat it, the physician and patient team up, to prevent the injury and the pain from becoming chronic. Or at least, to make whatever part of the injury and pain is chronic, to be the least-disabling that it can be.

    Lying to the patient, is exactly like lying to one’s spouse. It destroys trust, and then destroys the relationship.

    I remember how some folks my age, got educated to become physicians. Back then, in the 1970’s, it was widely believed that every physician would become wealthy. College students battled each other for medical school openings. They knew there were about 3.5 students applying for each opening, and 2.5 of them would be turned down. So winning top marks in classes, meant everything. Even if one had to lie and cheat to get the grades. My engineer cousin warned me not to take Organic Chemistry in the winter term but to take it spring term, when most of the pre-med students had gone home. The college graded on a curve. Instructors had a quota of how many ‘A’ grades they could give out. Pre-meds seeking those ‘A’ grades, had begun sabotaging one another’s laboratory work, to force other students to get ‘B’ and ‘C’ grades.

    Perhaps some of these students became so adept at cheating, that they never became adept at reasoning and understanding. Perhaps they continued the cheating habit into medical school. Perhaps they came to rely on pharmaceutical sales reps to teach them what to prescribe, because they didn’t really know, from their own judgment, what would work.

    Somehow, this habit of making false statements to patients, has become ingrained. Un-learning it is the key to fixing all the problems it has created.

    Merely having the power to make up lies that some patients are willing to believe, does not make the untrustworthy act, the right thing to do.

    Then again, if one cheats in an ethics class, does one learn anything about ethics?

  22. Mark at 8:43 am

    I had been taking Methadone and Percocet since 1996 for generalized pain caused by tumors in my body. I have been going to a pain clinic for the past 8 yrs and have continued these meds. At the clinic 2 of the CNP’s would not write the prescriptions ordered by the doctor. I was told to see the doctor. When I saw him he told me he thought I had a condition called “opioid induced hyperalgesia”. Being on the pain meds for so long, he said, caused my receptors to be going berserk so to speak. I said your crazy. I had the same pain beforeI started on the meds. He weaned me down on both meds and as expected I got much worse! He expected it and so did I for different reasons. End result is I am now taking half the meds I was. I am still in pain but not as bad as I at my first. I can walk without my cane again and do life’s daily task. Around the house and yard. How long I can stay like this I don’t know. I wish everyone good luck and better yet God Bless!

  23. Mark Ibsen at 8:24 am

    Some folks cannot wean. They begin to die.
    The doctor who “can’t” write Rx anymore is not lying.
    The DEA may haunt him
    His medical board in his state may go after his license.
    Pharmacists may refuse to fill Rx from this doctor
    He may be shunned by his colleagues
    He may feel totally alone,
    And
    His lawyer cannot help him
    His medical society colleagues may shun him
    And
    He may have been warned, obliquely,
    That he is “risking his freedom as well as his license by prescribing to patients like these”

    It’s like struggling to keep your business alive when the mafia moves in.
    The pressure is too much.
    The rewards too low.

    It sucks to be contsantly threatened by vague threats.
    Doctors are now some of the most vulnerable members of our economy.

    Each of these things happened to me.
    Still happening.
    So sorry.

  24. Cheryl Parr at 8:14 am

    Very good article but I do agree some information is missing. You do not mention those of us who’s surgeries weren’t successful and complications or permanent damage that PT no longer helps and we have tried everything else.
    I have been on pain medication for 6 years and am disabled now. My insurance has now decided that I’m taking too much medication after almost 2 years on this dose. Now I’m dealing with more pain.
    I would love my quality of life back. I’m a nurse and not stupid. Most of us would much rather not be in this situation.
    We have tried everything else and medication gives us some relief.

  25. Pained McFedup at 8:06 am

    Well, yes she’s a clinician with mental health credentials. Obviously she treats holistically and compassionately. But she doubled down on him late in the narrative when she said she can’t write prescriptions for him. Duh! Addressing the powers-that-be who STARTED this whole mess: Where’s the sense in driving (that in itself is nearly impossible for we who suffer greatly) two hours one way, once a month, scrunched up in a box on wheels at 70 mph to pee in a cup (which I still find humiliating, like I’m a convict), then wait to see the nurse who COUNTS MY PILLS (that may be the most humiliating of all – I’m not 4 years old!!!!!) then being seen, by this time feeling fully dejected and depressed and I feel like I’m begging for what used to be routine) and shuffling (by this time I can hardly stand) out to reverse the process and do it all again in a month. (A month! For years, I was given three or four months’ worth of prescriptions to be filled at the proper time. Why, oh why, can suddenly I cannot be trusted to hand these to my Pharmacist to take care of for me?) The monthly trips are taking their toll. Heaven forbid I can’t come on a scheduled visit, because I’ll run out. I’m physically dependent, so that is not an option. I am 61 years old. It is complete and utter nonsense to offer me expensive physical therapy (again, painful driving to and fro), or other costly treatments I don’t need or want, and probably won’t work anyway. Swallowing a tiny tablet a few times a day is cheap and affordable (4 cents per tablet. FOUR CENTS!) and it allows me as normal a life on disability as possible. Most days I can even do laundry, cook simple meals, enjoy my grandchildren, even sleep through the night, and that’s important for a Fibromyalgia/chronic Lymes /chronic fatigue patient. One lost night of sleep can take at least 10 days to fully recover from. These cheap little tablets are my lifeline – they really were before my dosage was cut to get under a certain “morphine-equivalent.” I’m in constant pain now, but still manageable. They’re easy to take, to manage, to get on with my life, such as it is (but I’m happy). Here is the disgusting, sick and twisted irony of this entire witch hunt. And all who may be reading this, mark my words. You witch hunters, Dr. Kolodny and others who decided I and hundreds of thousands of sufferers like me, who nefarious tied the hands of our good and caring doctors, who have cluelessly lumped us chronic pain patients in with heroin junkies, know this: All of you responsible for this witch hunt will be entirely responsible when chronic pain patients commit suicide, OR go underground where I’m sure the business awaits and the black market is gearing up for us coming in droves, and make no mistake, they see what’s happening and stand to make fortunes. I categorically and absolutely WILL NOT suffer withdrawal and stoppage of the medication I’ve been on for eight years that helps me live. In your driven lust to “rescue” us from the “horrors” of pain relief (!!!), you are creating perhaps one of the biggest influx and manufacture of street drugs. You have killed the War on Drugs, fed the monster, and the monster in all this is YOU.

  26. michael t wrenn at 6:59 am

    I am not currently on pain meds but I have been there….in that same position where the dr says no after years OF BEING ON MEDS..QUESTION … WHAT IS GOING TO HAPPEN TO THE PATIENTS THAT NEED THEIR MEDS.I AM SURE there are going to be a lot of legal matters for drs.to deal with when a family ends up with a dead relative because the dr.just “dumped that patient”.I REALLY WANT TO KNOW WHAT ARE THE DRS RESPONSIBILITY IN NOT PROVIDING MEDS THAT THEY HELPED GET THE PATIENT HOOKED ON.

  27. J. Kathleen at 6:46 am

    Thank you for your compassion. You so eloquently described the process I’ve gone through for the past 4 years. After 3 years of cycling through horrible nerve pain flares, I was ” dumped” by my neurologist, and primary doc, to the pain clinic, where I was met with compassion for my pain and fear and education about the complexity of chronic pain and the brain etc, I kept wondering (through angry, clenched, tears) why why why, had they waited so long to help me in this way? I’m no longer angry and use all those skills–movement, meditation, acupuncture, etc., as well as my prescribed meds etc. It’s a puzzle piece approach and it has helped me a lot. Still healing.

  28. Rhonda potter at 6:00 am

    You have no idea what chronic pain is.
    I have two auto immune diseases with no cures. Severe interstitial cystitis with recurring hunners lesions and rheumatoid arthritis.
    The hunners lesions are like cancer in my bladder. They do not stop growing. I’ve had them burnt off and they return. My bladder is being boiled in acid.
    You would be the one telling me to have my bladder removed. Why don’t you have your bladder removed? Even this won’t work.
    You do not care cause you certainly could write an RX for pain pills. Why can’t you?

  29. Pain Survivor at 5:38 am

    The bottom line is this doc isn’t going to write the medication for this patient either! What’s the patient supposed to do now? Sadly many of us need pain meds to cope with this terrible pain.
    This article was no help, in fact it was more insulting than anything. It basically suggests that if this magician of a provider had been consulted earlier, this patient wouldn’t have chronic pain? If we’d just do more
    PT or accept our situation we wouldn’t need treatment? Nonsense.
    No one wants to live their live in constant pain. I’ve had it for years. I’m sick of the media and some doctors acting as if CP patients are drug addicts. I would gladly stop pain meds if anything else worked as well. I take noncontrolled meds as much as possible, try to manage PT and rest. Acupunture helped a lot but I can’t afford it as it’s not covered. Then we’re under more pressure by disability insurance or social security.
    This patient mentioned is in despair, of course he is. Living like this is awful but what else can we do? We can only do our best and try not to let anger and resentment kill us. Anger towards the doctors who caused this or let us down, towards people who will never understand CP and towards those abusing the system.

  30. HJ at 5:37 am

    Mixed feelings. My biggest fear is losing my ability to financially support myself. I’m open to treatment as long as I can still work (which is where my insurance coverage comes from that allows me to seek treatment).

    In my case, the medication allows me to work. It allows me to sleep at night so that I can work.

    Why do you say that the first doctor didn’t want to write for the meds anymore, that the lie is that they can’t write any more. And in the end, you can’t write medications for him.

    You say you calmed him down. Or did he just resign himself to the fact that the situation is hopeless? Does he come back? Is he still working?

    You might think it cruel of me to ask, but have you projected onto him your sense of accomplishment or are you reading his resignation as being acceptance? For your own comfort sake. The patient has a life outside of the doctor’s office and I don’t see that you’ve seen the big picture.

    I pray that he is able to work, that he hasn’t given up and felt rejected by first his doctor and then you, and I pray he can accept his limitations until he heals — that it doesn’t impact him financially too much. My work gives me a sense of purpose and I’m terrified to lose that. I pray that someday, I’m not having to argue my case… I can’t trust that fear wouldn’t cause me to cry, to blubber… to be unable to rationally express my needs.

    I once walked out of a doctor’s office feeling like I had no options but suicide. You’re in a very hard place, especially in this political/social environment. Hopefully, he truly does not need the medication. I pray that. I wished that for myself. I take mine with reluctance and I skip doses when I can. But I’m scared that my next doctor’s appointment might bring a change in dosage without an explanation.

    I’m not an addict, but I also can’t live with pain that takes away my sense of who I am (my job, my focus, my ability to express myself verbally) and the things that give me meaning in life (my time with family/friends when I’m up for it, my ability to enjoy nature if even from my back window).

    I loved your compassion and I wouldn’t want to disappoint you, too. I’d want to be what you see in me and I sure as heck would want to heal without the need of medication. Are you also there when it’s clear that his pain has become chronic? From the narrative, it’s not clear to me how long he’s had the pain.

    Maybe he’s not shouting “because he can’t get his pain medications.” I’m glad you saw the fear. He may be shouting because he can’t work, because his marriage is strained… I appreciate your compassion but I think part of the difficulty is expressing the details and depth that would help us, as sufferers, see his situation clearly enough that we don’t see ourselves in it anymore. I wish that doctors had an objective way of measuring pain, and that the impact of pain on people’s lives was clearly factored into a decision. Some details are missing here that would have made me feel more comfortable with the narrative.

  31. Janice at 5:24 am

    Yes, I am afraid that I am going to be that patient some day soon! Lord give me strength when that happens because I don’t know what I will do.

  32. Karl Zaremba at 4:50 am

    Very Good Article. Something to think about for those of us in chronic pain. I have dealt with my pain mostly one way for 12 years. I have tried other things in addition but yes the meds work well. I am in fear. I work, I work pretty hard. Can I work ? What level of discomfort do I have to learn to live with. I am older now ( 62 ) and more resistant to change than 20 years ago. I also fear the discomfort of withdrawals. Individually all these things seem manageable. Together they do seem overwhelming. I am also resentful. I have not diverted or asked for any meds outside of the doctors prescribed regimen. From what I gather from others I dont take an extremely large amount. Why do I have to go through this ? Why are we changing what has worked well for me ? Is that selfish. Maybe ? We shall see but yes, I am in fear.

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