Dr. Forest Tennant – Pioneer Pain Doctor

Dr. Forest Tennant – Pioneer Pain Doctor

For many people who believe that the federal government’s emphasis on pain medication has gone too far, there’s a physician in Southern California who has studied this issue for years that is seen as a voice of reason.  He’s been speaking out.

Dr. Forrest Tennant

Dr. Forest Tennant

Dr. Forest Tennant of West Covina, California specializes in pain management and drug addiction. He is a strong advocate for intractable pain patients, holding that opioids can be safe and effective even applied over long durations, and helped push the “Pain Patient’s Bill of Rights” law through the California legislature. Tennant has authored over 200 articles and books, including many to help intractable pain patients, and is editor-in-chief of the journal Practical Pain Management.

He is distributing a position statement on the opioid controversy that he says (and you’d have to agree) is quite simple.

  1. We have a long-standing standard knowns the World Health Organization 3 Step Analgesic Ladder which was developed in 1982. Only when non-opioid treatments fail are opioids used because about everyone knows they have complications.
  2. There cannot be a cap on dosages as patients vary.  The government should certify and recognize the MDs who will prescribe high dose opioids so patients who need high dosages can get the help they need.
  3. Patients who are currently on opioids and doing well should be left on them.

Tennant operates a pain management clinic, Veract Intractable Pain Clinic in West Covina, California.  Like many physicians who treat patients, he is puzzled about what he believes is an overreaction by the government which is causing real harm.

As he wrote in Practical Pain Management this month:

“The hostility of patients and their families that is being generated by the dosage restrictions is neither necessary nor appropriate.  Frankly, it appears to me that most of the government agencies including the CDC are not being forthright about two issues.  First, should not the legacy patients on high opioid dosages get a chance to testify and be heard?  Most of the hostility that is related to me by patients and families is that the CDC and other agencies won’t consider listening to or appreciating the patients on high opioid doses.  What happened to America as a Democracy?  The second issue is which doctors should provide high-dose opioids to the few patients who have clearly benefited from these doses and who need them?  We issue all kinds of special permits to doctors.  Why not a certificate for the physicians who will take on these cases?”

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Authored by: Ed Coghlan

There are 21 comments for this article
  1. Kristine at 6:18 am

    Medea, Thank you so much for the information you’ve provided. It will all help me a great deal. I appreciate you taking the time to respond. Between all of us working on this, maybe the word will indeed get around faster. If there’s anything I can do for you, please contact me at anytime.

    Kristine

  2. Medea Karr ARNP at 1:24 am

    Hi Kristine, here are some resources you may find helpful for your research…

    Practical Pain Management is the peer-reviewed medical journal that Dr. Tennant’s editorial appeared in. He has always been an outspoken leader in the chronic pain community. The journal has a great website with info for both providers and patients. I have been following their responses to the recent changes in the opioid prescribing climate very closely, and plan to follow their lead.

    The Chronic Pain Research Group has posted a critique of the upcoming CDC guidelines and I expect they will continue to push for our voices to be heard. Here’s a link: http://www.chronicpainresearchgroup.org

    There’s also the petition to congress floating around, I posted the link on my clinic Facebook page (Medea Karr FNP) and I believe someone posted it in the comments thread under another NPR article in the last few days.

    And of course the National Pain Report seems to be following all of this very closely. Maybe the editors could post a list of resources for patients and providers who’d like to be more involved in having a say about the direction pain management (or mismanagement) is moving in our country? Or maybe this would be an article you could pull together yourself Kristine and shop it around to some of these blogs? I’m doing my best to stay on top of all of this while running a part-time chronic pain practice and fighting my own health challenges, and studying for my Pain Management certification. But we need more people like you who have the writing/research experience and the time to help get the word out!

  3. Kristine at 4:07 pm

    Medea, let me know what I can do. My comments on this thread will give you an idea of what I am also trying to do.

    Kristine
    30yearfreelance@gmail.com

    Please feel free to contact me at the above email.

  4. Medea Karr ARNP at 2:58 pm

    Ok folks, I’ve been sharing links on my various social media sites, along with links to this article and to the original editorial in Practical Pain Management. I don’t have a huge social media following, as I barely have time to manage my small fibromyalgia/myofascial pain practice while struggling with my own medical conditions, but I figure the more we can get the word out there the better. I’ve been trying to follow the lead of the other brave providers in this field by encouraging my patients and colleagues to make their voices heard on this issue.

  5. Jeff Ostach at 10:42 am

    I take my medications as prescribed. I do not abuse the dosage. Yet when I go to the pharmacy I feel like I’m an addict to the pharmacist. Ever since Vicodin went Schedule 2, it’s been nothing but a headache dealing with future prescriptions that have expired. I am tired of dealing with others problems who caused these new rules to take effect. I take the lowest dosage Vicodin has. To be honest, I’am under medicated. Very frustrated with having to go to a pharmacy.

  6. Kristine at 10:25 am

    Thank you for your words, Medea. I am a patient, and I would love to see more providers like you speak out and show an interest in helping us. Keep writing on the Internet. I do a lot of research in this field, as I am a retired writer of 30 years. Wherever I can help from my bed or chair, I will.

    Kristine
    30yearfreelance@gmail.com

  7. Kristine at 10:19 am

    Brenda, I had to move from Minnesota to Florida for health reasons and I am one of those pain patients who had a reliable Dr and pharmacy too. When I got to FL I asked around for the best pain management Dr and got one. The pharmacies took a little longer but I am all set now. One of the key things for you to do is when you find your doctor, be sure the 2 doctors have a conversation(s) about your current treatment. And ask your current doctor to call your new one. It’s hard, but it worked out in the end for me and I was really frightened too. Good luck!

  8. Ingrid Hollis at 9:33 am

    Thank you so much Dr. Tennant for speaking out on this very important issue facing pain patients and their families. These high dose opioid patients experiencing severe pain after trying all other options no different than any other pain patients except for the fact that they require larger doses of medications due to provable genetic and metabolic issues. Why is the science being denied? We absolutely need to make a special certification for doctors who treat them or some kind of exception for these patients so they can continue to receive the care they so desperately need, without bias or stigmatization. The CDC should have included Pain Specialists like yourself, and pain patients and their families in the drafting of these guidelines. To take stabilized patients off their life saving medications is tantamount to torture and will cause needless suffering and even death. Why would we do this purposefully? I would not be allowed to let my pet suffer in pain and the local Humane Society would be contacted, yet these policy makers think it’s O.K. to let a family member suffer in untreated pain? Perhaps we need a Human Humane Society? I think it is fair to say that these policies fall into the poor Government policies category according the Torture Document of the UN Human Rights Council.
    Pain control should be a basic human right.
    The UN Human Rights Council had the foresight to address this very issue in 2013 in their document on torture.
    Here is the link:
    http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf

    This is from section C of the document linked above:
    “Denial of pain treatment
    Applicability of torture and ill treatment framework 54.
    Generally, denial of pain treatment involves acts of omission rather than
    commission,70 and results from neglect and poor Government policies, rather than from an
    intention to inflict suffering. ”
    ” medications included in the WHO Model List of Essential Medicines is not just a reasonable step but a legal obligation under the Single Convention on Narcotic Drugs, 1961. When the failure of States to take positive steps, or to refrain from interfering with health-care services, condemns patients to unnecessary suffering from pain, States not only fall foul of the right to health but may also violate an affirmative obligation under the prohibition of torture and ill-treatment(A/HRC/10/44 and Corr.1, para. 72).56.
    In a statement issued jointly with the Special Rapporteur on the right to health, the
    Special Rapporteur on the question of torture reaffirmed that the failure to ensure access to
    controlled medicines for the relief of pain and suffering threatens fundamental rights to
    health and to protection against cruel, inhuman and degrading treatment. Governments must guarantee essential medicines–which include, among others, opioid analgesics–as part of their minimum core obligations under the right to health, and take measures to protect people under their jurisdiction from inhuman and degrading treatment.
    73

  9. Medea Karr ARNP at 4:05 am

    Thank you NPR for posting Dr. Tennant’s wise words from his recent editorial from Practical Pain Management. I agree wholeheartedly that we mustn’t use a cookie cutter approach to managing chronic pain patients, and that if we follow the WHO stepladder approach, screen our patients carefully, and are trusted to use our training and experience to decide on the appropriate pain management plans, we can provide safe compassionate pain relief for all who need it. Non-opioid interventions work well for many of the simple chronic pain cases, but for some patients opioids are essential, and I am alarmed at the current trend toward demonizing opioids and the patients who need them.

    I am intrigued by the idea Dr. Tennant proposes about providing additional certification or licensure to providers who use higher opioid doses. In the state of Washington where I practice, nurse practitioners practice autonomously, and our state guidelines allow us to serve in a pain specialty role and prescribe over 120mg morphine equivalents per day if we have sufficient training, CEUs, and experience, but there is no specific certificate or credential involved. If this idea of special certificates to prescribe higher opioid doses gains traction I would love to be part of the discussion. The American Academy of Pain Management offers pain management credentialing for both doctors and nurse practitioners, which I am currently preparing to test for, so perhaps their credential could serve that role? It makes sense that some type of nationally accepted chronic pain prescribing permit, that would be recognized by medical, pharmacy, and government agencies, could offer more legitimacy and protection from the scrutiny that is pushing so many providers away from prescribing, and leaving patients with rapidly dwindling options.

    Thank you Dr. Tennant for continuing to inspire providers and patients, and for giving us a glimmer of hope for the future of pain management!

  10. Wendy at 1:15 am

    I wish that there were doctors like you in Western Pennsylvania?

  11. Becky at 11:18 pm

    I recently had the opportunity to meet this wonderful Dr. He understood everything I had to say about my Adhesive Arachnoiditis. It was very refreshing to know that there is a Dr. who understands us as patients. I wish more would learn his treatment, this disease is only going to get worse because of invasive spinal procedures like corticosteroids epidural injections and spinal surgeries. Thank you Dr. Tennant for all your research and understanding of our disease.

  12. Nancy-EDS at 9:59 pm

    I was so happy to see Dr. Tennant’s name here today! He is a brilliant, kind, knowledgeable doctor who has helped an immeasurable amount of patients who suffer from Intractable pain. His research, advice, websites, articles, and information are shared throughout many online support groups, including patients from the Ehlers-danlos National Foundation. (Ednf.org). Ehlers-danlos Syndrome is a genetic connective tissue disorder that causes severe intractable pain, is considered “rare”, (but is extremely under-recognized & diagnosed) and many patients suffer for decades before getting to a knowledgable Geneticist. In addition, many of us have histories of analgesic failure, waking during surgeries, and do not experience pain relief from lidocaine and Novocain. It is common for patients with EDS to have defects in P450 metabolic enzymes, and require “higher than usual” doses of opioids to experience adequate pain relief. As Dr. Tennant once explained, “genetic defects often beget genetic defects”. Amazingly, Dr. Tennant is familiar with Ehlers-danlos Syndrome. (I say, “amazingly” because many Rheumatologists do not even recognize it, and instead tend to diagnose numerous “atypical” rheumatic conditions.). I am also so impressed with Dr. Tennant’s research involving hormone abnormalities, replacements, and the roles they play in chronic pain treatment, or lack there of. Though we live on opposite coasts and have never met in person, we have emailed a few times. Next to my current doctor who saved me from the depths of hell by adequately treating my pain with opioids, I consider Dr. Tennant my hero. He has given hope to so many people who suffer with the horrendous misfortune of living with severe daily pain, during a time when to do so is basically considered a moral failing, or a crime.

  13. Brenda at 8:27 pm

    Finally someone with not only knowledge but common sense. I have been on some sort of prescription pain medication since I was 22, had my first joint replacement done at 23 after going for many years with no diagnosis or the wrong diagnosis. Thirty-five years later, I have had 10 orthopedic surgeries, 4 artificial joints and have been told I need two more. I have been fortunate to have a doctor that understands and knows me as well as a pharmacist. However, there is a possibility that we will be moving in the next year and I worry about finding a medical team that will work for me not against me. Thank you Dr. Tennent for writing this article and for being an advocate for others like me.

  14. Kaylee at 7:23 pm

    There are so few voices of reason in the national conversation on opioid use for non-cancer chronic pain patients. It’s encouraging to read something like this as one of those chronic pain patients. So far, I have not been forced to go off of my pain medications that allow me to function. I’m always afraid that day is coming. It seems like every few months I hear about the DEA or CDC cracking down on a doctor, trying to push harmful legeslation through or creating unrealistic new guidelines for doctors treating non-cancerous chronic pain. It has to stop. Medical needs of individual patients should be left up to the doctors who actually went to medical school. Government alphabet organizations have no place telling our doctors how to treat us.

  15. Kim Miller at 6:09 pm

    Thank you for speaking up for chronic pain patients, Dr. Tennant. I am very appreciative of your opinion as it’s so nice to read an article where chronic pain patients come out looking like just plain patients, not addicts, not convicts, not scammers or schemers, but PATIENTS!

    It’s been a very long time since that has happened.

  16. Jake at 2:24 pm

    Dr. Tennant is one of only a (literal) handful of doctors across the world specializing in Adhesive Arachnoiditis. Yet the population of Arachnoiditis sufferers is growing with the increase in procedures like Epidural Steroids and back surgeries (not to mention outbreaks of fungal meningitis like in 2012).

    Thank you to Dr. Tennant, Dr. Aldrete and others who have supported us through these years.

    To the other doctors out there who might need this we need YOU. These doctors are reaching or well past their deserved retirement years and are only active now because no one else is focusing on conditions like Adhesive Arachnoiditis and related things like Epidural Fibrosis.

    PLEASE look at their research and practices and help US by taking up their mantle. Without focus on this we are one of the most orphaned conditions out there given the numbers of people out there suffering these conditions. And many patients never get past the fuzzy “well, I can’t figure it out, so we’ll call it Fibromyalgia/Chronic Fatigue/etc” stage of diagnosis because of lack of understanding on these issues. Meaning I am willing to bet that the majority of Arachnoiditis sufferers never even know it.

    I am truly begging other doctors to work on this. Once these gentlemen retire or pass on, where are we going to be if no one has studied them prior? We need HUNDREDS of informed physicians across the world (every seen a patient who doesn’t speak English try to get help for an orphaned condition? I have, and it is heart breaking). Not less than a dozen who know it well and only 2 or 3 who are trying actively to improve knowledge of the condition.

  17. Kurt W.G. Matthies at 12:25 pm

    Dear Dr. Tennant,

    As a long-time reader of Practical Pain Management, (www.practicalpainmanagement.com), I very much appreciate your work on behalf of those millions of Americans who require high-dose opioid therapy to enjoy some of the benefits of a beautiful and productive life like work, family, and friends, that would otherwise be denied to us due to medical conditions causing daily intractable pain.

    Welcome to the National Pain Report, and I hope we’ll be hearing more from you on these issues in the future.

  18. Nancy Smith at 12:13 pm

    am so blessed to be a patient of Dr Tennant. I am a registered nurse living in Georgia.My pain journey started over seven years ago and most days I wonder how I ever survived each day.I have been diagnosed with arachnoiditis by three doctors independent of each other.Dr Tennant’s work has given me my life back again.I could never convey how valuable it is and how “whoever has ears to hear should hear”.No one wants to be on pain meds.But everyone has the right to fight for the best quality of life they can have.Thankfully there are those intelligent people out there,like Dr Tennant who fight with us.If any government offical or anyone else making decisons about pain meds,had to live one day in the life of many people,there would not be a push to keep people from receiving the very meds they need.Many times these have less side effects and less consequence than “over the counter pain control”.I hope one day,in this country,we return to the common sense that helped make us the great nation we are-a place that does not deny its citizens the medical care they need.Thank you Dr Forrest Tennant!

  19. LouisVA at 12:04 pm

    The reason I am alive today is because of this compassionate man, Dr. Forest Tennant. After many, many years of excruciating pain, he was the man that finally believed in me and understood what I was going through. After trying standard treatments over a long time period with very little pain relief (and many insults from a lot of doctors – he’s a drug seeker, he could not possibly hurt that much, it’s all in your head, etc.) – I became a patient of Dr. Tennant’s at the age of 60 in 2010. I was absolutely floored at our first meeting when he said “I can tell by looking at you that you are in a great deal of pain.” He explained that I had head forward posture, carried one shoulder higher than the other and on the other side, carried my opposite hip higher. He explained to me that many years of uncontrolled pain will cause people to seek body positions that are the most comfortable at that time but then one gets stuck into unusual postures that only add to the pain over the long term. Dr. Tennant began titrating me onto opioid therapy and discovered that I had a defective gene (CYP2D6) that caused me to be a poor metabolizer but, instead of giving up, he continued titrating me upward until I had excellent pain relief. I take an ultra-high dose, approximately 2500mg of morphine equivalence, and contrary to common belief that an ever-escalating dose is required to receive the same pain relief; I am still on the exact same dose after more than five years of treatment and still have excellent pain relief.

    Over the last five years, I have had my highest quality of life as an adult and can do things that I was unable to do for many years. I live in a rural area on sixteen acres of woods and pasture land and delight in working to keep my property looking good. Prior to 2010, I had to hire someone to mow my lawn and pasture, but now I am able to do these things for myself. I also grade my dirt lane and help keep tree branches cut back from the private dirt road that leads to my house, things I simply could not do until I began opioid therapy.

    As Dr. Tennant said “Only when non-opioid treatments fail are opioids used” and this is important for people to understand, but when needed, they are invaluable. I do fear the direction things are going and wonder about my future access to these medications that make my life worth living. Pain care should be between doctor and patient, not the government. Government agencies do not have medical licenses.

  20. Mark Ibsen MD at 10:17 am

    Thank you NPR and Dr Tennant. It seems so simple coming from the “Obiwan Kenobi ” of pain.

    Dr Tennant has the capability of seeing the forest AND the trees.

    May the Force be with you.

  21. Kristine at 9:17 am

    Thank you from the very deepest part of my soul for this article! I am a life-long pain patient and take high doses of opioids. This does not do much for my pain when I am active, but helps the constant pain when I am at rest tremendously. I am a retired writer of 30 years and have written for many industries. I owned a public relations and advertising agency in the good old days and was very successful. Now, of course, it’s all gone and I live on disability. But my point is that I do a lot of research on the pain medication problems and on my particular diseases. So many of us have been waiting for the words in this article! And Lo and Behold, it isn’t a mess of confusing garbledegook that the average person can’t understand.

    Other than the usual methods, like social media, etc., how can I help get your word out to the world? I cannot afford a press release company, but I know the owner of one and I’m wondering if he would provide a discount. Would you be willing to have me interview you for about 15 minutes and prepare a press release with this article attached to it (with the proper permissions) if I can get this done? I’m wondering if the above came from a press release or did it only appear in the National Pain Report website? I already know your words will reach many people, but we so need our doctors and pharmacists to live without the fear of the DEA shutting them down and stand up for the rights we all have.

    It is terrifying being lumped into the group with abusers, criminals and the DEA’s crazy decisions. We (the patients, doctors and pharmacists) must be able to stand up to the problems we are having without being frightened. This is America, isn’t it? Yet many of us live in fear. As an example of a “fearful” surprise I recently had, I was at the pharmacy filling my Fentanyl patches and my co-pay came up double from the usual copay. The note the insurance company (Aetna) provide on the pharmacist’s computer was, “Reached Opioid Use Limit.” What? If Aetna thinks I am in danger they just double my copay? Wouldn’t you think they would be concerned about me instead? I have yet to call them about this, but I plan to and I plan to publish the details of my conversation with them (Aetna). I already can’t afford several of the meds I am supposed to be on and now this.

    Well, I am going on and on, but Dr Tennent, if you see this, I would appreciate an email at your convenience to 30yearfreelance@gmail.com. Thank you again for such a wonderful article.