National Chronic Pain Advocate Joins California Effort to Improve Pain Treatment

National Chronic Pain Advocate Joins California Effort to Improve Pain Treatment

By Ed Coghlan.

“There’s an imbalance in our drug control laws and policies between treating pain and reducing drug diversion and addiction. And it’s hurting pain patients.”

Those words from Diane Hoffmann, Director of the Law and Health Care Program and Jacob A. France Professor of Health Care Law at the University of Maryland.

Diane Hoffmann

This conflation of opioid addiction and opioid dependence has contributed to what Hoffman calls “chaos” in the chronic pain community.

“The efforts to restrict prescribing and eliminate Medicaid coverage of opioids, like what has been proposed in Oregon, and the outright abandonment of patients is outrageous. We need more leadership from the medical community,” she said.

That’s why Hoffmann is part of a unique effort to create a pain policy for the state of California that organizers hope will be something other states can use as a guide for a creating patient-centered pain policy.

The Summit will attract over 100 California thought-leaders and luminaries in pain management (physicians, payers, administrators, policy makers, etc.) to develop a California Pain Strategy. The goal is to localize key recommendations from the National Institutes of Health’s National Pain Strategy in the Golden State.

Read More about the California Pain Summit here

“California has been one of the more progressive states when it comes to legislation and policies addressing chronic pain management and can be a leader in developing ways to counteract the chilling effect the Centers for Disease Control Guideline has had,” Hoffmann said.

Hoffmann has authored a dozen articles on policies and practices that lead to undertreatment of pain.  including “The Girl Who Cried Pain” which argues that women are more likely to be under-treated for their pain even though they are much more likely to suffer more chronic pain conditions than men.

One of the guiding documents for the California meeting will be the National Pain Strategy which Hoffmann called a useful template but since it has not been funded, “you wonder if it will ever be implemented.”

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Authored by: Ed Coghlan

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How can someone judge how much pain medication a patient needs if they are not involved with the patients care directly? Know what the individual patients suffers from? Know what drugs this patient can take, tolerate, or has an allergy to? How can you give a blanket recommendation that a certain level of pain medication should work the same for a 35 year old 120 pound woman that has chronic pain as compared to another that is a 55 year old male weighing at 225 with different disease processes that is causing his chronic pain. That is just insane and unethical. It is just unethical to deny medical treatment that can enhance ones life because others abuse the same medication but are not in treatment. More insanity. We really do need the medical community to step up on the behalf of its patients because they are the first responders of treating a patients pain. The doctors know first hand what is working and what is not. A good physician should know that all patients need individual plans to fit their needs when is comes to opioid pain therapy. The word here is patient plan-it is not just about writing a script. It is about a patient plan where as the patient and doctor work together to achieve a better medical outlook for the patient.


I have been hesitant to post. I have been a pain patient since 1979. I’ve been through NSAIDS galore till I had bleeding ulcers, more than once. IVe had 13 surgeries in my 65 year, 3 of them on my right shoulder. I have to have dental surgery now and am so scared to. I’ve never taken opioids to get high and never would. However I am so afraid that when my teeth are surgically removed that I won’t be able to get the pain medication I need to handle the pain. I can’t keep putting it off because it’s not helping my situation of having 2 teeth I can eat with. I have had 4 teeth crumble in my gums and although I tried to remove them myself, had no luck and my gums grew back over them. The years I have left in my life, I would like to think will not be terribly painful ones. The Tylenol#4 that I have been taking handles the daily pain I have for most of the pain I have, but I still have pain that I have to live with and can accept. I am currently seeing a nurse practitioner who is an excellent example of her profession. I trust her, which means a lot to me. I have been fortunate to have good health care professionals to help me and pray that my future will not be one of frustration and pain. I continue to pray for us all.

Rita Giovinazzo

Follow the money. When it boils down, this is all about money. Chronic pain patients are costly The ‘alternative’ and ‘supplemental’ treatments are more expensive than meds in my case and I’m sure for many others. Who benefits? Where is the patient input in this California summit? I really want to know why Drs aren’t doing more for their patients. These are after all guidelines, not law and why is the DEA involved in patient – doctor care in the first place? Forced tapering and completely cutting patients off is legalized torture. Patients delaying necessary surgeries because they may not get proper pain meds after is ridiculous. Those in hospice care suffering in agony because more pain meds may bring on addiction??? Seriously, I mean what the hell happened to bloody common sense, let alone empathy for another human? I wish to hell the media would stop using the headline ‘opioid crisis’ and call the problem what it is; addiction to illegal drugs pouring into this country. ADDICTION is the REAL problem. If it wasn’t ILLEGAL fentanyl and /or heroin, it would be some other drug.


i Have multiple injuries resulting from numerous accidents racing motorcycles back in the 1980s. After trying everything from acupuncture to chiropractic to nsaids, anti seizure meds,steroid injections and biofeedback – only opoids provided the relief from pain I needed to live a normal life.
I’ve been taking morphine for over 20 years – with no issues. I am not an addict. I did not abuse opoids. I took morphine exactly as prescribed by my family doctor – someone who knows me well. I had a good life – I was able to work and provide for my family, be actively involved in my kids lives and enjoy time with them and my wife.
For the past year I’ve been forced to reduce the amount of morphine I take by half. I don’t sleep, I often can’t work, my blood pressure is very high. I totaled my vehicle after passing out while driving after not sleeping for days. And I hurt all the time, which is beyond frustrating.
I haven’t enjoyed life for quite a while. All I can think about is how much it hurts. And it is going to get worse. Every month my doctor reduces my dose even more because she says she had no choice,
How could something like this happen? It makes no sense to me that politicians would take away medicine from people who need it and are suffering and dying without it, to fight a crisis that medicine did not cause or contribute to.
If they want to reduce the number of heroin overdoses the solution is to reduce the availability of heroin or the illegal importing of the additives drug dealers are using to make heroin more potent.
The solution should not involve forcing people to suffer and die who have nothing to do with heroin addicts or their dealers


Maybe they could actually look at facts. Pain patients dont abuse,anyway you look at it.


I’m in pain everyday and my doctor will not increase my pain pills (relief wears off in only 2 hours) because he claims the DEA tells him what he can give me. They’re not the ones living this hell.


Thank you Diane Hoffmann! Even though I don’t live in California, I’m thankful to see anyone trying to help us!

People are being distrusted when seeking treatment for injuries or conditions that can’t be seen by ex-ray. Not even going for a prescription, but for treatment for what starts as something that can be treated without long term narcotic pain medication. They are becoming chronic pain sufferers because of the stigma. Then they are abandoned. I dare say that some of the accusers and profilers are themselves taking their effective pain medication.


Stephen W: I will speak only from my own experience, but you can find discussions in the literature of the difference between physical dependence/tolerance to a medication and being addicted to it. Although not all health care or law enforcement entities (certainly not those currently in power) recognize this difference, that doesn’t mean it doesn’t exist. Many chronic pain sufferers may be dependent on their meds but they are NOT “drug addicts” in the pejorative, judgmental and dehumanizing sense that the term is almost always used. That’s another story.

Use of an opiate medication–even responsibly–can over time and depending on dosage–result in physical dependence. The person may experience unpleasant symptoms if the med is abruptly withdrawn, but otherwise s/he is able to live a fairly full and functional life. S/he experiences no adverse consequences in any major life area. Addiction almost always exerts a negative impact on the life and health of the individual, whether it is expressed in terms of physical or mental/emotional health issues, job/legal difficulties, relationship issues, financial problems, etc. Addiction almost always affects the person’s family, friends, employer, finances and sometimes society at large (driving or committing other crimes while under the influence).

Of course, in a ideal world there would be ways to relieve chronic pain that do not involve potentially addictive substances and actually work, but we aren’t there yet–and may not even be close. Until we are, there needs to be a reasonable way to reduce drug-related deaths by identifying, diagnosing and treating addiction while allowing qualified physicians to treat chronic pain patients. That is currently not happening. If it were, there would not be the number of anguished and desperate people in pain posting to this and other websites.


I found to court cases here in Canada where Judges ruled that The Charter Of Rights and Freedoms was violated. The Judges said that Plaintiffs had the right to choose their pain medications. They have the right to make their own decisions as long as they don’t trample on the rights of others.The court cases were about marijuana but the judge’s comments applied to all treatment.

Kathleen Ganley

It is hard for me to be hopeful about this after everything that has happened. As someone else said, I read hopeful news and then I read devastating news for pain patients. I have been commenting on a few of these articles about the CDC “guidelines” that state physicians can prescribe up to 90 mme per day of opiate medication. Why do I keep reading about physicians refusing to prescribe any pain medicine and dumping patients when the 90 mme is acceptable? It is so very confusing to me. Can someone who has the facts explain this? Are there also state laws in play here? One woman wrote she has the word “chronic” or some other term on her written prescriptions and thus it does not apply to her. I believe she lives in Florida. Is that acceptable in Florida and if it is, why do I read of other patients in Florida being completely cut off? I am starting to think that many physicians are going overboard and refusing to prescribe even what they can legally because they don’t want to have DEA eyes on them, even if they are doing nothing legally wrong. Basically, the opposite of “do no harm.” Could this be the reason for the wide disparity of patients’ experiences?


SOME of us are a pill away from being forced into the permanent cure. I aplaud your effots but it will come to late for the above mentioned people.This is simply depopulation. GOD will punish all those taking our meds away. Away with you he will say for killing my ellect people.

Ms. B J Elam

Thank God someone is trying to fight for patients with devastating pain.

Aaron Zywicki

The People Who Need Pain Medication Are Forced To Suffer In Pain ! While Drug Addicts Get The Meds They Need What A Sick Twisted Country !


Sounds like great news! I’m suffering so much since major neurosurgery in June. I am much more disabled than ever and I can’t get help anywhere. Nobody addresses my weakness, numbness, and tingling. They just want to talk about the government and pain medicine in the ER. Thank you Diane Hoffman and Ed Coghlan.


I hope this conference holds some hope for a more humane and common sense approach to drug policy as it affects chronic pain patients. That patients will have a respected pain advocate/professional to speak for their cause is progress. (Perhaps even better would be to include actual patients who are living the “war on pain” experience.)

Chronic pain patients, especially those 65+, are NOT the problem. We have real medical conditions, often incurable but manageable with appropriate treatment, which can include opiates. It is true that we may depend on our medication to care for ourselves and to remain mobile and functional, but we are not “drug addicts”. Overwhelmingly, we are neither misusing nor selling our medication. Significant differences between physical dependence and addiction are being ignored or dismissed by current policymakers determined to apply their personal convictions to the lives of strangers.

I have been fortunate in that I have been able to obtain the mild opiate medication I take to manage my medical conditions, care for myself and perform the essential activities of daily living. However, along with thousands of other patients, I have been subjected to mandatory urine testing, a draconian “pain contract”, must-last warnings and far too many condescending lectures about the dangers of Tylenol #3. At almost 82 Y/O, I have been demeaned and made to feel like a criminal. I have a great deal of empathy for patients who have been summarily tapered or taken off their medication due to government overreach under Trump/Sessions. Chronic pain patients are not the faces of the “opioid epidemic”.

Suicide likely is not the preferred method of death for most, but it can become an increasingly viable alternative when facing months, perhaps years, of untreated debilitating pain with no hope of relief. Should this ultimately be my fate, I intend to leave ample written evidence that my death was the result of “severe, untreated pain”.

Stephen Weller

opioid addiction and opioid dependence

There’s a difference?


I’d love to have a face to face with Diane Hoffman to dialogue about the realities of living with intractable/chronic pain, the current opioid ‘guidelines’ and how they impact people who need access to pain control.

Can’t really travel anymore but if she’s game to come to CA and meet for lunch, and is interested in having a real conversation on the subject, I’ll buy.

She can even borrow my free pass and visit Yosemite for a couple of days. At least someone should be able to enjoy it after all.

We can only pray that such a summit will produce useful recommendations and consensus guidelines that help to protect patients & medication prescribers. I see local providers kicking their chronic pain patients to the curb for such ridiculous issues and interpreting the CDC Guidelines to the prescriber’s advantage. They ignore any sections that could be used to the patient’s benefit. When are organizations going to use the same “evidence” or lack thereof to cut back on the surgeries being done across the country that rake in billions of dollars, yet studies show long-term lack of benefit? It’s far easier to take away medications from chronic pain patients because they are not united to fight for their rights. But try cutting out the bread-and-butter surgeries and injections that make orthopedics, neurosurgeons, and others thousands of dollars a day, and then see what happens. They will cry foul and get their physician organizations to fight it. It’s all about the MONEY. When they make it, it’s OK. When they have to pay out for it, they want to find any way to cut the costs. A pain specialist in Portland, OR recently ditched all his pill patients to focus on surgical interventions that make him more money and decrease his risk of DEA or medical board review. Insurance companies and more justify it to cut patients off opiates and other beneficial medications. For them costs outweigh patient function. They don’t care that you can’t work anymore or get out of the house to do your basic shopping or chores. It’s time for some major changes, but for some patients it may be too late. Many have been forced to sign statements admitting they are “addicts” to get treatment for their pain. Forcing patients to burprenorphine or methadone for the rest of their lives is not good medicine, but it is good MONEY.


I live in the state of Arkansas. I am female and live with chronic pain everyday…I can’t even get a prescription for Tylenol 3 for (30) tablets until I go to pain management, and who knows what will happen there. This is ridiculous! I am out ragged because patients whom really have chronic pain can’t get any relief, and the ones who don’t can! I truly pray these laws change. Sick and tired of going to the hospital emergency room, just to get some relief !!

The people that don’t need the medications for pain r the people that r bucking the system by faking the injury and selling the opioids on the streets and killing our children and addicts.Something has to be done to slow the epedemic and give the opioid medicine to the people who really need it.And the ones that really need it r not getting it and R suffering this very minute.The DEA has to really crack down on this problem.I dont know anymore.

Howard Hill

So true the insurance companies are going way to far when they are calling doctors an telling them what they can prescribe for chronic pain

Jennifer Kassner

Thank GOD someone is FINALLY considering doing something about the “chaos” of those suffering from debilitating pain with NO medication options anymore! And there should be some kind of formal apology for how unmercifully our opioid pain meds were stripped from us with no warning and having us being treated like heroin abusing addicts just for taking our meds as prescribed and according to our pain contracts!! The cold turkey detox that we endured nearly killed myself and others, literally, when 10 years of opioid use was ceased very uncerimonomiously from us!! I pray that your forum com’s up with workable answers. It would be nice to get back to living!!

Debra Podjaske

I thought Is. I have really bad chronic pain and use my opioids medication properly!! Have been got the last five years, so to penalize us that do is so wrong!! You need to figure out a way to weed out the people that abuse the obioids, this is not that hard, I can pick them out every time I go out or to my Dr office. I know I have tried everything out there and nothing helped. I am tested and pass so why I am being penalized???


Kenneth miles

I had wentvto pain clinic for 5 years and seen my meds go from doing good to just keeping me depented on meds but i stop going in july 2018 and not i am not depented on the drugs but living in so much pain and cant do nothing anymore and i have a child who is disabled and it isso hard to take care of him when i cant take care of myself and it has ruined my life living in chronic pain wish i never stop going but i was tired of just keeping me up with a habit

Albert J Oneal

I live in Tallahassee Florida I see a pain management doctor in Panama City Florida do to only one pain management doctor in Tallahassee Florida dr. Joseph Pagano which is not taking patients because he’s so busy and booked up for at least 8 months at least that’s what the front desk is telling me anyway it’s a shame that the chronic pain patients that follow the rules are being punished the real problem is Black Market drugs are overtaking our society and they’re blaming it on the chronic pain patient which is not true at all people that I’ve worked all their lives and have had the misfortunes of an accident chronic illness or whatever causes them chronic pain should not have to suffer I myself have been reduced on my medication and it has slowed me down tremendously I can no longer work my part time job I have to have help doing just normal things washing clothes Everything Has Changed tremendously it brings on anxiety depression and an array of other things something has to be done fast Florida sucks with Rick Scott and office he pulled a fast one on us by limiting the opiates apply for acute pain patients to a 3 day or 7 day supply people coming straight out of surgery can not make it on that small amount of medication chronic pain patients were exempt thank God but doctors have lower dosages they say it’s not their fault and they have to go by the guidelines because my doctor saying I need more medication but his hands are tied hopefully something will change he tells me hang in there and I’m hanging in there as long as I can the suicide rate is tremendously becoming an epidemic because people are just giving up don’t give up thank you Albert O’Neal


Once again, this meeting seems to leave out the perspective of the ones affected the most by these policies – the chronic pain patient! Who will be there to represent them? I do applaud the efforts of everyone, but still, where are the patients to bring their valid concerns to the discussion?


To All Concerned: It is really very simple in concept. Separate pain medication from illegal drugs for a start. Take stock if you will and look and see how many overdoses are from Heroin as opposed to prescription drugs. I think you will find the majority are from the former – Heroin. Not a drug that can be prescribed, so why include it in the discussion?
Second: If you are hell bent on restricting the medical community and making Doctors responsible for what their patients do, the restrict the number of a particular medication – say Oxicodone – to a reasonable quantity. Not like the Florida Doctor who was just sentenced to prison for prescribing 32 Oxycontin to a patient per day! That’s outrageous and quantities like that should be immediately flagged. There is no human being that could possibly take that many Oxycontin in one day.
If those items were dealt with it would put pain patients in a much better position. Being a Chronic Pain patient I learned last week what it is like for real under the current circumstance. I went in to a RediCare facility last week for an x-ray on a possibly fractured right leg. I left with out the x-ray because all the would do is talk about my use of pain meds and how I was a junky looking for more meds. They kept that conversation going even after I told them I didn’t want any medication of any kind, just an x-ray. Being treated this way was humiliating to say the least, and after telling them no meds were wanted to have them continue was angering. Something has to be done as soon as it can be, Pain patients, irregardless of the cause of the pain should be treated with dignity and respect. Just because you have an illness no one can see does not mean you should be treated as if you are an illegal drug user. There are many “Hidden Illnesses”, why should any of these people be so ill treated.

I think what your trying to do is awesome. Fibro and hip dysplasia and left to try and work with minimal pain meds. Hopefully California can come up with great policies and it will find its way to Mi eventually. Thank you.


Let them walk a day in my shoes and feel the pain that never subsides. So you can mask it it’s always your partner and it’s not a friendly guest. without pain relief how can one try to live a normal life. You do the best you can and greet your teeth and go on without any hope of relief when they catch you off. Slazys people suffer severe pain their minds with change very quickly and so would the policy. What are the new drugs that aren’t addictive that give great relief without side effects are they coming or you just going to cut us off of anything that helps. At least make it a national policy to legalize marijuana in all states so we can at least maybe have some sort of relief.Take two aspirin and call me in the morning just does not work. Wake up America with all the people that are in pain around you all day be nice to him if they didn’t hurt maybe everybody wouldn’t be so crabby and anxious and downright miserable. True addictions are bad but a lot of people are not addicted and are in control and do not sell or give away meds to other people for-profit or whatever. There’s enough laws and rules to find the doctors that are unscrupulous and sell these for profit only and those that really care and want to treat patients with a serious problem. Get government out of the doctor’s office let the doctors and the patients figure out what’s best for them not a bureaucrat telling us what to do and that we can’t have or can’t do this or that.again maybe they’ll suffer a significant pain and they will cry out saying I wish I had some morphine or Oxycodone to stop this being in government so I suppose they’ll have a way of always getting it while leaving the rest of us to do without and to suffer and to tax even more.


I am so confused. One day I read an article that sounds promising and hopeful for pain patients and the next day I read an article that seems hopeless. Just this morning a read a tweet on twitter about a young man(along with his wife who is an RN) who has made the decision to end his life. His prescribed meds have been taken away and he’s tried everything else. So many people are choosing this path.How did we get here?? The great United States of America! I’ve written my congressmen, local and national news to no avail. What is left to do? The powers in charge have already made up their minds. I’ve always been a person of faith and I’m trying really hard to hang onto that faith but it’s faltering. Please pray for me and pray for all of us pain sufferers that this madness will stop and stop soon before any more of us has to needlessly die.God Bless

Good for Diane Hoffman! Thank God we have someone in a prestige position who may just change things around after all. If California can get this atrocity straightened out hopefully other states will follow suit! Sadly there’s just not enough people in America to realize how many millions of people live in chronic pain. Two weeks ago I had to go to a class to help me obtain custody of my niece. I was reprimanded the next day in ways I will kindly leave out . All because the teacher saw me holding onto the handrail climbing steps one by one mind you. What do you know this gave everyone the impression that I was under the influence. I feel like I need to make a sign stating I was in a severe car accident, I have two metal screws in my right ankle and smashed both knees. I have severe osteoarthritis in my lower back also, so if I appear drunk please forgive me! Can you imagine the outrage? The humiliation? Seems to me if you don’t wear a handicap sign around your neck you’re not going to get anywhere in this world and even if you did people are still going to judge you. What a crying shame our world has truly, truly become….

Corruption is the reason.