By Ed Coghlan.
Let me tell you a little secret. Part of how we have tried to grow the National Pain Report is to continually search for important voices. Sometimes they are patients or loved ones who have a story to tell. And sometimes it’s a doctor.
Let me introduce you to Dr. Debbie Nickels Heck from Muncie, Indiana. She was a woman who went to medical school in her 30’s, is a mother of three, a grandmother to seven and a woman with some very strong opinions about the environment in which chronic pain patients are being treated.
We literally met on Twitter—and I’ve been following her for a while and thought she was intriguing.
So I reached out and said…”hey can we chat?”
She said sure.
Then I didn’t follow up…realized a couple of weeks later I hadn’t and reached out again.
I sent her the following questions:
- What is happening to patients?
- What is a patient to do?
- What alternative therapies do you recommend?
- What will the government do?
- What should the government do?
Pretty basic, right?
What I received in a response was the following: (I decided not to edit):
Excellent questions with very easy and difficult answers. The solutions are easy (reverse bad laws) but the govt is run by people who react to hysteria, not medical evidence, and once changes are in place, reversal is horrendous to get done.
The alternatives for patients are truly few when opioids are PART of their treatment plan and obtaining them has become so difficult due to legislative actions made by those who have reacted to media hysteria without medical justification and doctors afraid DEA agents will be knocking on their doors taking away their licenses to practice with accusations they are “writing too many opioids in dosages that are too high” without any background on individual patient needs. HOW can medicine be practiced in such an environment? And yoi want to know what alternatives PATIENTS have? What alternatives do DOCTORS have when fearing prosecution for having done nothing wrong?
There are such a wide variety of types of pain which is something those outside the field don’t understand. Those with diabetic neuropathy may only need meds in the anticonvulsant class and respond to them. Other types of chronic pain NEED opioids to get complete relief but usually do best when also COMBINED with various antidepressants found to be very helpful. However there are about 15% of the population who will gain significant weight on some of the SNRIs that work well like Cymbalta but a newer one, Fetzima, is a better choice and doesn’t cause weight gain in those vulnerable. It’s very helpful in treating pain conditions, especially fibromyalgia, and it’s been helpful with my own arthritis and some neuropathic conditions. Muscle relaxants are helpful in many chronic pain conditions.
Acupuncture has proven helpful for some people. Reflexology is another alternative therapy many have found useful as an addition therapy. I’m a great believer in massage therapy. I had a massage therapist in my office who helped my patients greatly with general muscular pain as well as myself with my fibro.
I’m in GREAT disagreement with those who state you shouldn’t take benzodiazepines with opioids because those with chronic pain very often also have significant anxiety. As with ALL of medicine it’s in knowing how to use them carefully. I’m a great fan of valium because it has a muscle relaxation effect which helps pain patients in 2 ways. I’ve found they can often reduce their dosage of pain med with a low dose of valium if they are feeling significantly anxious if they take a low dosage about 20 minutes before taking a short acting pain med as the relaxation effect allows them to need less as their pain is then less intense. This is FAR different than having patients take it on a regular 3-4 times a day basis but on an “as needed” basis. KNOWING your patients makes a difference as opposed to running them thru on conveyor belts.
At this point when patients with intense unrelenting pain can’t get the pain meds they need, they are becoming more anxious and being told they can’t even get what they need to help them relax. Is it any wonder we’re seeing so many such patients committing suicide when deprived of what HAD allowed them to lead normal lives for years, all due to those who obtain substances ILLEGALLY causing legislators to enact LAWS to prevent LEGAL prescriptions?
So what’s the answer as to what patients can do? I don’t know because I’m also one of those patients who has been trying to find a doctor to listen to me with no response. My blood pressure skyrocketed and I know exactly why. Pain. My neophyte family physician 5 years out of residency refuses to treat it because she “just doesn’t want to.” However, she’ll refer me to a cardiologist and nephrologist to try to figure out why it’s so high when I’ve already given her the answer. She won’t do anything about it because she “wasn’t trained” as I was and refuses any suggestions I’ve made as to conferences I continue to attend for updated information on pain management so she CAN become knowledgeable. It’s not like she hasn’t HAD ths opportunity. She’s just CHOSEN NOT to take it. How can the treatment of pain improve when our current crop of “doctors” have attitudes such as this?
I don’t know if this is helpful but it’s a perspective from both unfortunate sides. If I can further elaborate, I’d be glad to but I tend to get a bit verbose so I tried to keep it as concise as possible. Thanks for asking me.
Debbie Nickels Heck, MD
Editor’s Note: I’m going to ask Dr. Nickels Heck to send us more “thoughts” like these.
You can follow her on Twitter @DrNickels
You can follow us on Twitter @NatPainReport
You can follow the author on Twitter @edcoghlan
Are there other voices in the chronic pain world you think we should amplify? If so, let us know at by email firstname.lastname@example.org