Neurologists: Opioid Risks Outweigh Benefits

Neurologists: Opioid Risks Outweigh Benefits

A leading U.S. medical organization is urging its members not prescribe opioid painkillers to patients suffering from fibromyalgia, low back pain or headaches, because the risk of serious side effects outweighs the benefits of pain relief.

“Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction,” wrote Gary M. Franklin, MD, in a position paper published in Neurology, the official medical journal of the American Academy of Neurology (AAN).

bigstock-Prescription-Medication-1608757-195x300The Academy represents 28,000 neurologists and other healthcare providers who treat a wide variety of neurological disorders, including neuropathy, migraine, multiple sclerosis, epilepsy, and Alzheimer’s disease.

“It seems likely that, in the long run, the use of opioids chronically for most routine conditions, such as chronic low back pain, chronic headaches, or fibromyalgia, will not prove to be worth the risk,” said Franklin, a research professor in the Department of Environmental & Occupational Health Sciences at the University of Washington’s School of Public Health.

“Even for more severe conditions, such as destructive rheumatoid arthritis, sickle-cell disease, severe collagen disease, or severe neuropathic pain, prescribers need specific guidance on dosing, publicly available brief tools to effectively screen patients for risk, and guidance on how to monitor patients for early signs of severe adverse events, misuse, or opioid use disorder.”

Over 100,000 people have died from prescription opioid use since the late 1990s, according to Franklin, when policies were liberalized to promote the use of opioids for non-cancer pain. Studies have shown that about half of patients taking opioids for at least three months are still on opioids five years later.

“For some time the opioid data have failed to show significant benefit for headache, migraine, low back pain, irritable bowel disorder, and fibromyalgia; the AAN position paper is underscoring that opioids should be avoided in these conditions,” said Beth Darnall, PhD, a pain psychologist and author of Less Pain, Fewer Pills.

“We should be steering patients in the direction of non-pharmacologic treatments: pain psychology (where they may learn information, skills, and techniques to dampen pain processing), physical therapy, and acupuncture. These are just a few options.  We know that chronic pain is best treated using a multidisciplinary approach.”

While opioid pain medications are generally not prescribed for fibromyalgia, nearly 60% of women with the disorder are currently taking opioids, according to a recent survey of over 2,400 women by National Pain Report.

“If chronic pain interferes with a person’s ability to function and participate in other treatment modalities, they should be treated with medication and other integrative therapies,” said Celeste Cooper, RN, a patient advocate and fibromyalgia sufferer who argues against a “one size fits all” approach to pain management.

“Some patients respond differently to certain medications, even within the same diagnosis population. In order words, we need a consistent plan for assessment, but individualized care plans. Success should not only be measured by a reduction of pain on the one to ten scale, it should also be measured by function. How is the patient able to socialize, maintain relationships, and contribute?”

The AAN is recommending that doctors consult with a pain management specialist if their patient’s dosage exceeds 80 to 120 (morphine-equivalent dose) milligrams per day. The Academy also recommends that its members take further steps to ensure that opioids are prescribed safely:

  • Have an opioid treatment agreement with patients
  • Screen patients for drug abuse and depression
  • Give patients random urine drug screens
  • Do not prescribe drugs such as sedative-hypnotics or benzodiazepines with opioids
  • Utilize prescription drug monitoring programs (PDMPs) to see what medications patients are taking

“More research and information regarding opioid effectiveness and management is needed, along with changes in state and federal laws and policy to ensure that patients are safer when prescribed these drugs,” said Franklin.

Authored by: Pat Anson, Editor

There are 46 comments for this article
  1. Coonhound at 5:49 pm

    DAWN, SAMSA, NIDA, NSDUH, DEA’S (Drug Threat Assessment Summary), ONDCP, etc etc. All these govt agencies regularly produce surveys to gauge the use/abuse and threat posed by certain drugs to certain age groups/populations. NIDA-budget alone is in excess of 1 Billion Dollars, yet for some reason there is never 1 national survey to assess the effectiveness or ineffectiveness of long term opioid therapy??? If this ‘epidemic’ of over prescribing has been going on since the late 90s and a high percent of those taking NARCOTICS for >90days are, as Franklin states, still taking them 5 yrs later, then there is a virtual gold mine of information available out there from those who actually could tell you from personal experience. Yes that would be LEGITIMATE PATIENTS.

    They believe drug addicts and base National Policy on these surveys BUT when it comes to prescription NARCOTICS, we have no voice. Unless you count those ‘concerned’ doctors and social policy wonks like Franklin and Kolodny who claim to speak for us and want to protect us from harm. I don’t remember electing these clowns to speak for me. I am an adult. A US citizen. I am disabled w/ 2 chronic systemic INCURABLE autoimmune diseases. I would like to think I can make, or at least help make treatment decisions w/ the help of my doctors. Its the new wave, empowered patients (except when it comes to PM).
    I have found that most of mine value my input (as opposed to dismissing it) and ask if I’m ok w/ their therapeutic decisions, as I am the one that must live with them. Novel idea no? It isn’t easy, one must educate and advocate. Then just quickly jettison overbearing authoritarian doctors who want uneducated patients (Internet bad, dark closet good) who blindly follow direct orders w/out question.

    First, I can tell Ms.Darnell that I wouldn’t even need counseling. Heck, if I just had access to a jacuzzi 24/7, a live-in maid/cook/chauffeur/masseuse I could dramatically cut down on the NARCOTICS that I take w/out listening to 20 min of her hogwash. Yes those evil concoctions that allow me to just barely keep up an appt, my dog, medical to dos,(labs, testing,appts, pharmacy trips, battles w/ insurance companies over meds), and just enough of will to live that I don’t go out and play in traffic.

    Problem w/ these people? They are confused. Don’t they know that all other avenues have been explored BEFORE going on COT???? No doctor in this day and age would use NARCOTICS as a first line therapy. I agree that there are many helpful therapies IN ADDITION to meds. I use several myself. TENS, exercise/stretching, Euflexxa (knee), joint injects (shoulders) ,occipital nerve blocks, adjuvant meds, none of which I can really afford on the pittance I get for ‘early retirement’ (SSDI). I am just extremely fortunate that I have a very supportive family that is able to help.
    I think another thing these people miss is that for most of us it isn’t just about pain. Even when my pain IS managed I still have more broken pieces than humpty dumpty and all the kings horses and all the kings men; you know them-the endocrinologist, pulmos, neuros, rheumys, orthos, urologists, and GI docs cant put me back together again. Some may say I’m crazy, and I may be, but I’ve heard this on my support forum from far too many, Id almost trade in my lot for cancer. At least then I might stand a chance of getting better. Instead, my team of doctors (now at 8, yes eight) just treat my symptoms and keep me breathing (literally-respiratory arrest in 2000). For those who say there are no good reasons to use benzos AND opioids? Stop breathing on way to hospital for just a couple minutes (i may seem a bit longer)then you (Beth) can tell me how counseling will prevent anxiety attacks from occurring whenever you get dyspnea and bronchospasms, w/ coughing so hard you give yourself a hernia. W/out pain managment and opioids, not the only option, but the basic foundation, EVERY OTHER SYSTEM AND SYMPTOMS associated w/ them over my whole broken down body, get WORSE, Now Franky and Darnell tell me again how these NARCOTICS can be more harmful than good.

    IF a disabled citizen who’s immune system is destroying itself on the cellular level isn’t in enough pain and in need of opioid analgesics then I dont know who they make them for. Oh yeah, Cancer patients.

  2. Jessica Mendes at 10:59 pm

    How wonderful to find this article, and to learn of others who speak of the risks associated with pharmaceuticals, as well as other ways of managing pain. If I may, I have launched a web site dedicated to non-medicated pain reduction through the understanding of pain and training of the nervous system, as well as cutting edge neuroscience. It’s focus is on neuropathic pain but includes all kinds:

    http://www.painmaps.com/

    I am actively seeking contributors and submissions: stories from the wisdom of pain sufferers, or practitioners with a different take on chronic pain.

  3. ginbug at 4:44 pm

    Do you know what the only real difference is between a fibro/chronic pain patient & a terminal cancer patient? The cancer patients suffering will soon come to an end, whereas the pain patient will continue to suffer in a 24/7 nightmare for years to come!
    I’m so sick of people that think they know everything! Just because someone is a doctor does not mean they are experts on everything! Case in point, read some of the things that dr. kolodney has written on here, & you will quickly see how truly clueless he is about chronic pain & how to REALLY treat it nor does he fully understand how the brain perceives & processes all pain signals!!
    Another clueless doc that does way more harm than good, not to mention, puts out biased & completely false or misleading info is dr. drew!! No matter what famous person gets addicted or dies, he ALWAYS twists the facts to make RX drugs the evil villain, no matter what actually happened! He acts like he is the only doc that knows EVERYTHING about addiction, yet 5 people on his show, celebrity rehab, have died!! That is a huge amount considering that there were not that many that appeared on there! His treatment of Jeff Conway, whom he claimed to care about, was appalling!! Jeff need help as he was playing w/ fire by abusing legal & illegal drugs; but I honestly believe he was in an incredible amount of pain that was created & made MUCH worse by the so called doctors he went to after hurting his back! I cannot remember how many epidurals & surgeries he had; but I remembered being shocked by it! All dr. drew did was to exploit him & all the others in the guise of a caring doctor trying to help! If he cared about Jeff, why didn’t he even try to manage his pain? Instead all he did was to try & make him feel guilty & that he had to get off all drugs & called him not only a drug addict( clearly true; but why?) he also called him a surgery addict!!
    This is what these docs do, they do all these extreme procedures & “treatments”, have you take a bunch of meds. that does little to none for the pain; but damage the rest of your body beyond repair, then when you are still in pain, they may give you little to no pain meds. & if you tell them you need more, well then now you are assumed to be a drug addict & now you are on your own!!
    These docs along w/ the dea, have & will continue to use the media to mislead & only show a very negative, one sided view of opioid use!! We have got to ALL start telling & showing joe public the real truth about the abuse that chronic pain patients are forced to endure by the medical community in a BIG PUBLIC WAY!! and tell dr. drew, dr. kolodney, & all the others like them, what they can do w/ what they publicly call a “garbage can diagnosis” ! It is time for all of us to take out the trash!!!

  4. Stephen S. Rodrigues, MD at 12:39 pm

    Doc, Why am I still in pain?

    Ever wonder why Cervical and Lumbar Disc, Jaw and Carpal Tunnel surgeries fail? Patients continue to complain of “joint” pain after joint replacement surgery? Face Pain patients do not respond to open brain surgery? Migraines attacks become stubborn?

    Simply put, Conventional Medical physicians and researchers have stubbornly fixed chronic or long-term pain in the wrong pain category. “ALL pain has a cause, so ALL pain has to be treated with the appropriate therapy based on the category of pain.” As a CAM provider does, think differently to see pain into 3 simple categories.

    Structural Pain —This 1st category of pain is a sign of danger, like cancer, aneurysms, infections, tumors and malfunctions. Physicians can analyse the “Structure” of this pain in the blood or on a scan. Immediate care of this pain is mandatory in a hospital or ER. If you still have pain it is being caused by the 3rd type of pain. See below.

    Injury type pain —This 2nd category of pain is what happens when you fall and twist a knee, ankle, and break bones. This pain automatically heals by nature with no conscious thought or effort in about 3-12 weeks. This pain is really “no-big-deal” but after 3-4 months any residual pain is being caused by the 3rd type of pain. See below.

    Nonstructural type pain — This 3rd category of pain is the type of pain that ALL of us have to deal with on a daily basis. It is invisible to physicians and technology. The pain is the sole purveyor of this pain. Once this pain reaches a critical density, then it requires treatment or therapy to heal. Surely as time goes by without the proper therapy this pain will grow into the biggest deal and take away your life. No matter what words you use to describe this pain. No matter what parts of your body this pain is located. No matter what diagnoses is used. No matter what is seen in the blood tests, X-rays or scans. This is Myofascial Pain and Dysfunction which is the greatest masquerader of illness and the greatest destroyer of life.

    The critical flaw in logic leading to our pain epidemic is that this 3rd type of pain is being treated solely like it is the 1st category pain type. Delays, undertreatment or no treatment will allow this pain to grow into a destructive powerful masquerader. This flaw in logic has crept up on society by science fiction movies and technology.

    Humans have been treating this 3rd type of pain for millennia (except in the past 15yrs) with many simplistic holistic tools. NO need to wait, wish, pray or hope the treatments are already here in the CAM world of medicine. This is a “Whole” type of medicine which can treat the “Whole” patient in a holistic manner.

    We need the AMA, DEA and HHS to allow patients, providers and therapist to have the freedom to pick and choose which aspect of CAM myofascial pain therapy is best for their unique set of circumstances, life, chemistry and pain.

  5. Johnna Stahl at 8:58 pm

    Gloria: I agree, thanks for sharing. 🙂

  6. Johnna Stahl at 8:49 pm

    Rob said (and of course BL agreed): “Legalization of cannabis for medical usage is a step in the right direction but will it follow the same path as has happened with opioid usage?? – due to increasing needs for drugs (helpful and harmful) being abused as remedies for nonmedical societal ills!”

    Ah, the Chicken Little argument, as if cannabis is some new drug that hasn’t been around for centuries, when it’s actually easier for some kids to get than cigarettes. And as long as alcohol and cigarettes are legally able to help adults deal with their “ills,” the Chicken Little argument against cannabis is baseless.

    In case ya’ll didn’t hear, Colorado and Washington haven’t imploded with the advent of legalization. In fact, these states are doing well, thank you very much.

    I’m not sure how to educate people who don’t understand the difference between opioids and cannabis — the way each drug works differently on the brain, and the mechanisms which may cause addiction from the use of either.

    I’ve taken both, so I know the difference. But I’ve also done enough research to know that cannabinoids affect the brain differently than synthetic drugs; attach to the endocannabinoids in our own systems; and actually provide benefits, like as an anti-anxiety, anti-inflammatory, and neuroprotectant.

    As for “nonmedical societal ills,” I would assume that pain would be one of those — especially as under-treated pain is just as prevalent (if not more so) than over-treated pain. When a society doesn’t treat its ills, for whatever reason, that doesn’t mean they can then be classified as “nonmedical.”

    And if those that cannot afford insurance or to participate in America’s broken health care system want to use cannabis (let’s say, instead of alcohol) to chill out or lighten their day just a little, I don’t have a problem with it. And throwing out straw-man arguments just makes people look uninformed (or challenged by monetary conflicts of interest).

    Anyone who may abuse or become addicted to cannabis will not die from consuming it. Do I need to repeat that? The benefits will ALWAYS outweigh the risks. End of argument.

  7. BL at 6:49 pm

    Rob, I have two questions. First, do other countries have regulations regardiing opioids as tight as the United States ? Second,do they have easier access to the treatment of mental heath issues than we have in the United States ?

    “Legalization of cannabis for medical usage is a step in the right direction but will it follow the same path as has happened with opioid usage??” I have often wondered about this. If maybe the reason the states are being allowed to legalize marijuana and medical marijuana is so the government can see how many people abuse it and become addicted to it. If the federal governemnt wants to, they can make the states reverse the laws quickly. In other words, since the federal govenment is only interested in if a drug can be abused/diverted/addicting and to what extent and there is no pharmaceutical company to comduct clinical trials, it is like a trial, without the oversight clinical trials have.

  8. John Quintner at 1:01 pm

    Rob, I hope your words of wisdom are fully understood by those who read these comments.

  9. Gloria Garrison at 9:37 am

    I was in PM for five years with a doctor who sympathized with my MRI as ” a mess.” I had the gamut of meds and of course the required interventional injections to maintain the need for meds. All of a sudden it seemed, the ” oh you poor thing” became weaning off meds, ” just learn to live with it..” This seemed to come on the heels of the opiophobia encouraged by PROP, DEA and whoever else contributed their initials. I turned in my paperwork and walked out of PM and opiates..that was almost 2 years ago. I was tired of the mental pain of UA screen, and the seeming “guilty until proven innocent” I felt, the literal anxiety attacks every month after an hour of driving to get to the appointment and then the pharmacy..all day anxiety attack. I got out before PM went to interventional only..and he was “done” with the injections for me..so see ya, wouldn’t wanna be ya. I have gotten all sorts of congratulations for ‘getting off those pain meds’
    Well hooray for what ? I am on gabapentin and OTC and the side effects are more dangerous than opiates with the gabapentin. I literally loose concentration and muscle responses and that is low dose! Other modalities I use are neuromuscular massage and acupuncture..all out of pocket of course..that is limited monthly..I dislike the attitude of just find some other ways of “dealing with it” assuming everyone can “just do it”..No, I am not looking around for another PM or meds, I have gotten off the opiates, I think sometimes PTSD can apply to a lot of us who have been treated like second class citizens..I leave the treatment plan between the doc and patient.as. for me I leave PM and the hell behind..Just my story only..one day at a time

  10. Johnna Stahl at 2:19 am

    Virginia Rzekonski says: “What do they offer as [an] alternative?”

    Here’s the thing: For treatments covered by insurance and offered by the medical industry, there are no comparative alternatives to opioid treatment (especially for the long-term). And what I mean by that is, in my opinion, opioids relieve the most pain — and if you compare this treatment to all others, the success rates for other treatments don’t come close to those of opioids.

    But now it appears that relieving pain is not the goal… Chronic pain patients need to manage pain — in other words, learn to live with it — not treat it. And while this may sound logical, leaving constant pain untreated not only puts enormous stress on the body and mind, but also creates the likely potential for the pain to increase to even higher levels — levels that drugs may not even touch.

    Leaving chronic pain untreated is like leaving the water hose running in your back yard — the yard will be able to soak up some of that water, but eventually, your back yard will flood and become a disgusting pool of dirt, plants, fertilizer, and bugs.

    Sure, doctors can offer anti-depressants, maybe an anti-anxiety or two, and other drugs prescribed off-label for pain, like anti-seizure medications. But if you’ve already tried these options, or if you don’t want to try these options, doctors have nothing else to offer (that works).

    So, a lot of doctors are now saying that unless you have cancer pain, your pain doesn’t rise to the level of deserving treatment — which means you don’t really have a debilitating and disabling medical condition.

    And when the medical industry has nothing to offer to treat a long-term chronic pain disorder…

    Yet the insurance companies require that if you have a disability, you must seek and be under treatment from that very medical industry…

    Ipso facto, if you suffer from chronic pain, and you refuse available “standard” treatments, you’re not disabled.

  11. Johnna Stahl at 1:29 am

    To continue Drew’s mention of PROP (Physicians for Responsible Opioid Prescribing), the President and usual spokesperson for that group is Dr. Andrew Kolodny. Here’s one of us quotes:

    “It’s a whopping dose of hydrocodone [Zohydro] packed in an easy-to-crush capsule,” said Dr. Andrew Kolodny, president of the advocacy group Physicians for Responsible Opioid Prescribing. “It will kill people as soon as it’s released.”

    How often can an “expert” be wrong before he’s not considered an expert? (If you ask war criminal Dick Cheney, he’d say never.)

    See, Dr. Kolodny is a psychiatrist and an “addiction specialist,” whose very practice depends on those suffering from addiction.

    Back in 2011, he said: “I don’t think they [Congress] realize that in many ways the American Pain Foundation is a front for opioid manufacturers.”

    It’s a little like the pot calling the kettle black, isn’t it? For Dr. Kolodny’s treatments for addiction also include products offered by Big Pharma, like methadone, buprenorphine, and naloxone (all of which are abused and contribute to the overdose “epidemic”).

    And in the little research I conducted on PROP, I can’t find any mention of who funds this menacing group, only that Dr. Kolodny is the registered agent.

    In other words: Watch out. Sold out.

  12. trudyyers at 11:00 pm

    I am appalled that they take this stance on pain. I am a fibromyalgia sufferer and low back pain, and neck pain and severe neuropathy to my legs and feet. If I didn’t have my opioids-I couldn’t tolerate the pain-I would commit suicide. I think they need to be careful taking relief away from suffering people. Why is it a big deal if they are on it for extended periods of time? so what? Relief from pain should be a human right!! I am forced now to see behavioral health-a hugh waste of my time and money! and no way is tiny acupuncture needles going into my skin-and medicare doesn’t pay for it either. I sick of these agencies trying to stick it to us!! let us have pain meds and some measure of peace

  13. Rob at 4:07 am

    Working with both chronic pain patients and Pain Specialists lands me on the side of patients being prescribed opioids for chronic pain conditions which are not adequately reduced with other prescribed medications. Combined with such prescriptions should be a spectrum of therapies for which evidence is now available regarding their use to help patients to cope appropriately with the psychosocial consequences of suffering from a chronic pain condition, including having knowledge of the possible adverse physical effects of using the opioids for pain relief. The current medical stance is driven partly by results from research on the adverse physiological effects of the enancing the opioidergic system through prescribed opioids and partly by the morality of making a potentially abusive dig publically available and fear of legal sanctions when such abuse occurs. However, “dependency” is different from addiction or drug abuse – it means that phyiological withdrawal is a clinical problem to be managed when reducing or stopping the opioid. Unfortunately, the opioid abuse in America has been shown to be higher than in other opioid-prescribing countries for various reasons, and this is why there are the present moves towards restriction, as evidenced by this post. The benefits of longterm opioid usage by many chronic pain patients are illustrated in the many of the above comments. Allopathic (Western) medicine is reknowned for being conservative – for many reasons – and insufficient treatment for pain relief as a major societal problem is also well recorded in the academic chronic pain literature. The optimum treatments for chronic pain conditions are sometimes difficult to achieve or don’t yet exist, so unreasonable restriction on opioid prescriptions may lead to more adverse patient events (eg. other drug abuse or increased suicides) than it solves. Fortunately there is hope that the enormous amount of research being done to better understand specific chronic pain conditions and better treatments for them will lead to future sane discovery and availability of safe new drugs for optimal treatments. Legalization of cannabis for medical usage is a step in the right direction but will it follow the same path as has happened with opioid usage?? – due to increasing needs for drugs (helpful and harmful) being abused as remedies for nonmedical societal ills! Society needs to broaden its perspective at many levels to take to account of the enormous burden of suffering from chronic pain conditions thereby making best-evidence remedies available to its citizens – long way off but worthwhile fighting for the necessary changes in our times!

  14. Drew at 4:04 am

    Unmentioned is the fact that Gary Franklin is not only the SOLE AUTHOR of the “position paper”, but he’s also a secretary of PROP (Physicians for Responsible Opioid Prescribing). As such, all he’s really doing is voicing the position of PROP “as if” it were the position of AAN. There is no doubt that he is NOT speaking for the 28,000 members within the academy, but rather, trying to influence them with PROP’s well known anti-opiate/opioid agenda.

    Gary Franklin & PROP are classic “addiction catastrophizers”: they attempt to elevate the concept of addiction over and above all other things, as if nothing else, including pain itself, matters.

  15. Cyndi at 4:01 am

    i just really wonder how we can count the number of suicides based on not getting enough pain control.

    Want to see the suicide rates sky rocket?
    Follow this idiots advise.

  16. rick at 10:07 pm

    and this is why people such as myself have to self medicate from whatever we can get from the street.
    I take 5mg hydro or oxy 2 x a day.. one 5mg when I get up and another 5mg around 10 pm. so, am I an addict ? I don’t think so. I take those 5mg along with two 500 Ibuprofen..just so I can get thru the day without having to sit or lay down because my back and sciatic nerves don’t kill me. I’m not disabled enough for disability, my neurosurgeon seems to think my pain aint that bad, and my insurance wont pay for a pain Dr. so, I gotta do whatever works, so I can stay working.
    if only a Dr could walk in my shoes for a week, he would understand how painful it feels to not be able to stand, walk, bend and everything else a normal person can do.

  17. ccabek at 9:08 pm

    Another idiot doctor who thinks he knows the world of pain, cause he as a degree as a Med Doc. Woppie…
    Let’s get him feel the way we do even for one month. Bet he changes his mind really fast.
    I just wish we could put the imbeciles who are pushing this away from chronic or any pain patients need to get stung with pain.
    I have been on fentanyl for at least 10 yrs. And I am not addicted.
    Generally, those people on pain med who are actually in chronic pain, do not get addicted, they do get dependent.

  18. BL at 8:48 pm

    Johnna Stahl, I guess the only reason the character suffers from chronic pain is because the character also abuses and is addicted to drugs. I assume the character will be receiving pain meds for chronic pain which will lead to the drug abuse and addiction. Well, that movie will do more damage to chronic pain patients who are receivng pain meds.

  19. Johnna Stahl at 6:32 pm

    One theme that emerges again and again is that doctors (and the DEA) don’t understand what it is like to live in chronic pain. So, we can assume that the words of patients aren’t enough to cross the barrier of actually experiencing this condition…

    I read that Jennifer Anniston is in a new movie, playing the role of a chronic pain patient whose life (of course) falls into drug abuse and addiction. I don’t know what she did to prepare for the role (except to stop wearing make-up), but it would be interesting if doctors could experience a similar process.

    For instance, constant pain has a heaviness to it… My head, where most of my really bad pain resides, feels like it weighs more like 50 pounds, rather than the average 10. And pain constricts movement — almost every (if not all) movement. So, doctors could go through a training program where they would have to wear a fat suit for a week. (You know, when doctors begin to be trained to treat pain.)

    Kurt W.G. Matthies: Well said.

  20. virginia rzekonski at 4:26 pm

    we need to contact these clowns. what do they offer as alternative? i’m all ears

  21. Brian at 3:29 pm

    I broke my back at 17 (compression fractures mid back), tore ligaments in my lower back about the same time. I have spondylothesis L5-S1 and bone spurs in my neck. I had intermittent bouts of severe pain lasting 3-4 days every few months until I was 48 when the situation became chronic within a few months. Chiro & PT were no help.
    Acupuncture was painful but moderately helpful for range of motion. I developed self hypnosis from reading. It helps a bit at times but not when the pain is severe. I use a TENS & heating pad a lot. I work with a pain specialist who does nerve blocks and a general practitioner who takes a real interest in treating chronic pain.
    Now 62, I’ve had chronic pain for 15 years, treated with opiates. I still work hard, living in the country and I’ve never misused or overused my meds, nor provided them to others. I have some IBS and migranes which are treated with non-opiates. According to the Mayo clinic, many men like me probably have Fibro but are not diagnosed. So long as there’s no specific test or cure, I don’t mind just dealing with the symptoms.
    Regarding to the data noted in the article, of the 100,000 who died, how many were ever legitimate chronic pain sufferers? And how many were the unfortunates sucked in by the Oxycontin morass? If you read past the obvious, as you should, you would realize that properly prescribed and monitored patients are not at high risk.
    I challenge any thinking feeling doctor who breathes fairly regularly to demonstrate clearly how I’d be better off without my current pain management. I would willingly participate in any rational test program. I have quit all meds before, most recently in summer 2012, only to have so much pain I was useless.
    It’s a fact that veterinarians take more pain management training than do physicians. That’s pretty obvious from remarks of those who suggest that severe chronic pain can be treated with some psycho babble about ignoring the pain and some PT. God forbid you ever be stricken.

  22. Kurt W.G. Matthies at 11:21 am

    I’ve never consulted with a neurologist — I hope I never need to.

    I’ve been managing the risks of opioid therapy for many years.

    As long as I receive function improvement from this treatment option, ie, I can get out of bed, walk, sit, stand, and as it says in the US Constitution, pursue happiness with my family and friends, I will continue to accept the risks.

    The biggest risk I see are the naysayers who deny the great benefit some of us receive from these medications and would take away my access to these medications.

    Life is full of risks. This is one risk I’m willing to take to maintain a quality of life.

  23. Deb at 11:12 am

    Honest to God! You KNOW this was written and recommended by a group of NON suffering people!!!!! God help them, should they experience crippling pain!!

  24. Marty at 9:17 am

    I agree with some of the article. I take opioids for my back pain which are very helpful however they don’t seem to do anything for fibro pain which is why I am concerned about them being used for it. My mother and grandmother both suffered from Fibro and they didn’t have any medications and worked their entire lives. I worked until my hip gave out and would still be working if possible. Lyrica worked for me for a long time until the side effects became to much and I lost my vision a few times. Hopefully they will soon find something to help with Fibro since it seems to be a number 1 illness these days.

  25. Cynthia Dziedziula Pudrith at 8:43 am

    Find me something that works and I’ll gladly start it. You have no idea what chronic pain is unless you have it.

  26. BL at 8:43 am

    Johnna Stahl, if I remember correctly, the first funding for research was made available a few months ago. But, I don’t know the number who for it.or if any funding has been awarded. From the way this has been handled so far, I don’t have much hope that anything will come from it that will benefit more than a few, if any chronic pain patients, in the next 10 yrs or more, if at all. I often wonder if it wasn’t included in the ACA just to get more support for it.

  27. Toni Kresen at 8:16 am

    Back when I was allowed opioids, I had a life. Now, most days are spent in my bedroom in bed. I tried acupuncture – found out my insurance didn’t cover it, but also – HOW is someone with Fibro (I was diagnosed with it January of 1992) supposed to lie there for that amount of time without moving at all? Moving with those needles in you is VERY painful but lying there without moving AT ALL is EXTREMELY painful – the Fibro REALLY kicks in! I tried PT. After each session, I would have to sit in my car for at least half an hour until the pain subsided enough so that I could safely drive home only to end up in bed because I was in too much pain from the PT. I tried EVERY medication (found I am allergic to several of them) that they “say” works for Fibro, Peripheral Neuropathy, chronic back pain, DJD, arthritis, tendonitis, neck pain, constant headaches, and even more that I live with on a daily basis and the ONLY thing that works for almost all of my myriad pains of various high-levels is the opioids. I merely exist now because of idiots like Franklin who have NO idea what works or not because they are NOT in pain like this. (I’ve NEVER been in a “study”, so WHO the h*** are they studying?) I am also sick and tired of being accused of trying to seek out a doctor for narcotics. I AM NOT A CRIMINAL! I had a LIFE with the safe use of opioids – ONLY taking them when absolutely necessary. But now, instead of being able to work (I actually was able to OWN my own computer repair business AND I had gone back to school for an Associates Degree), I have to be on and stay on disability – rarely leaving my home, much less my bed. I have never abused opioids. I have never sold them or given them to anyone. I never took them for any “high” unless having lowered pain and thus being able to leave my home is a “high”. I’ve never even been “addicted” to them! So I now sit and hope that each idiot doctor that refuses to help me will soon end up in the horrendous pains I am forced to endure and will find out personally how much opioids DO help – even Fibromyalgia. I now wish that upon Franklin and the other idiots that want to treat everyone as if they are the same and as if they are criminals. Live ONE day in my body Dr. Franklin! I KNOW you would then change your mind! AND Dr. Franklin, benzodiazepines (which I do not abuse either), do help as well. When taken with opioids, they help even more! Benzos are just as addictive and people OD on them too, but NO ONE has ever said those on a benzo should get urine tests! We are human beings in tremendous pain – animals get treated better than we do!!!

  28. Johnna Stahl at 2:07 am

    Fibromyalgia
    Chronic headaches/migraines
    Irritable bowel disorder
    Low back pain

    Is it just me, or are the disorders that no longer deserve treatment with prescription pain medications those that are mostly found in female patients? (With the exception of low back pain, which men probably suffer from more than women.)

    I’m just wondering… What is the ratio of male to female patients in a typical neurological practice?

  29. Johnna Stahl at 1:58 am

    I’d like to ask Dr. Darnall a few questions:

    From an 8/16/11 article out of Oregon:

    “Many hope the Prescription Drug Monitoring Program will help stop people from abusing prescription opiates, and increase awareness about how they’re being used. ‘It remains to be seen,’ Darnall said.” The article also mentions that Oregon is the only state with a pain commission.

    So, I’m wondering, it is now three years later… Would you say the PDMP is stopping people from abusing prescription opiates? And how is the drug abuse problem in Oregon today? Has the state’s pain commission made a difference?

    Also included in the article:

    “The National Pain Care Policy Act, part of the federal Affordable Care Act, will improve training for healthcare professionals, by increasing research funding for pain and improving access to pain care.”

    A short google search appears to indicate that nothing has been done to fund this part of the ACA, as it deals with pain, but also for mental health. If anyone knows differently, I’d love to hear about it.

  30. Wendy at 11:57 pm

    It is definitely time to become politically active! Don’ have a particular suggestion at this time, just know it is important not to turn inward. There may be others. What many do not know is that the University of Washington pain program is connected with PROPS, the anti opiate group. Distressing too is the made up medical term of ‘ opioid use disorder.’ Never mind how many lives these medicines have saved!!

  31. miki at 9:53 pm

    Okay, so Neurologists are Doctors which means they PRACTICE medicine. No patient is the same. No treatment should be the same. I take opioid medication and it DOES help me. I struggle on a daily basis..if i did not have them, I wouldn’t function. I do not sell them, i don’t loan them, i don’t take more than prescribed. I don’t enjoy the feeling or want to get high..I want to function. Period.

  32. James at 7:52 pm

    Oh, **** you and your regulations. You know what people are suffering, those going through fibro and chronic pain? And they aren’t addicts and are too ill to care for dependance!

  33. BL at 7:28 pm

    Where this group and others, got the belief that either all insurance will pay for non medication forms of pain management and/or that everyone can afford it ?

  34. Kathi Brill20+ years... at 7:24 pm

    If only they could feel what I feel, they said death may happen, after the past 20 years of having this pain that ramps up to a solid 9-10 death would be great. My beliefs tell me I cannot do that so I only take 1/2 the amount I am supposed to, I am not a druggie nor am I selling my pills I hate that I have to jump through hoops because of the people who don’t understand that by writing articles about chronic pain doesn’t make you understand it. Let me slam you hands , feet and back with a 20# sledge hammer, That will make you understand after getting that everyday for the past

  35. B. Halper at 7:21 pm

    Unbelievable! Do they feel that we as fibromyalgia patients are stupid? I certainly know that the oxycodones mask the pain, and I also know the risks! I’m well aware of possible kidney and liver damage (I don’t like the word “addiction” in our case as we are not taking this for our jollys), certainly dependency as I know I am dependent upon these meds to lead a somewhat below average life. If the concern is there in the medical field, stop with these insipid “studys”, and use that energy for developing a cure for fibro! We really have nothing esle. For me, the Lyrica’s simply don’t work, I’ve tried all three the FDA recommends. I know many who are very pleased with them, and I am thrilled that they found something. To reduce if not stop all together the oxycodones being Rx’d to fibro patients can be a death call, it certainly would be for me, I cannot live with this horrid pain if I didn’t have these meds available to me!

  36. Kaylee at 6:23 pm

    Ridiculous! I have had chronic back and leg pain for over a decade. I was diagnosed with RA earlier this year. I am 30 years old and have been on a fentanyl patch and percocet for breakthrough pain for 7 years. I also take meloxicam and do physical therapy. I got a spinal cord stimulator last fall. Without the meds I would be unable to work, unable to care for my son, unable to keep house, cook, drive a car… basically I would be unable to do most anything that’s enjoyable.

    I wish the people giving this advice could experience what we chronic pain sufferers live with every hour of every day. Then maybe they would understand that for some people, such as myself, long term opioid therapy can be extremely beneficial.

  37. Margo at 5:18 pm

    Am I living in a communist country? There are so many drugs out there being abused, including alcohol. Bath salts, synthetic pot, spray paint, and whipped cream cans are used to get high. So let’s go after the Chronically ill. Ugh!!

  38. Stephen S. Rodrigues, MD at 5:04 pm

    My mission is to advocate for ALL pain treatment options, free and readily available to all. It will take a herculean effort and I figured at least 5 yrs to implement.

    Everyone here is a “Ms Rosa” in various stages. Ms Rosa was fortunate to find a CAM provider who took her insurance. Everyone should have this same opportunity. Agree or not, advocate for yourself or not, it is about ALL who suffer with long-term pain.

    Call The U.S. Department of Health and Human Services
    200 Independence Avenue, S.W.
    Washington, D.C. 20201
    Toll Free: 1-877-696-6775
    or and
    https://www.change.org/p/u-s-department-of-health-and-human-services-the-first-line-use-of-complementary-and-alternative-medicine-in-general-medicine

  39. John Tokalenko at 4:52 pm

    The refusal to address chronic pain can be described as nothing but evil.

    Marijuana is effective, but that’s “illegal.” Now these control-freak kooks want to effectively make the last option for many “illegal,” as well.

    And before some control-freak kook accuses me, no, I don’t take opiates – I’m actually allergic to Norco. Thank God I do not suffer like so many from chronic pain.

  40. Kendra at 4:16 pm

    I have lived with Fibromyalgia for @ least 7yrs & I’m just being diagnosed. I live with pain everyday. I am 27 years old and I am unable to play with my 4 year old son, I am unable to take shower, change my clotes, get dressed, cook dinner, or walk with help. I spend most my days in bed laying on a heating pad praying it will help or someone to take me away from this life because I CAN NOT take the pain or the fact that I can’t be the mom & spouse that I’m suppose to be @ my age. Now, my doctors tell me I might have Lupus or MS so my pain management doctor has taken me off all my pain medication because they was not helping with the pain. Instead of helping me with in ways to relive the pain (medication or non) he told me he couldn’t help me. I have tried physical therapy which has put me down for 2 days after every visit & my insurance won’t pay for acupuncture, so what am I suppose to do?? Am I too stay in bed until the day God takes me home?? That’s not a very good life for my son or my family.

  41. Dawn Gonzalez at 3:11 pm

    im just curious about HOW many of these neurologists were trained and Actually specialize in pain management therapy??? Especially intractable pain that comes with many neurological conditions? Like Arachnoiditis?

  42. Al Cornelius at 2:46 pm

    Go figure!! I just went into the doughnut hole for the first time In years. I’ve been taking the same meds for 5 years and never worried about the doughnut hole before that. Now 4 months early this year and only a 80.00 less differential in what the insurance companies will pay for I’m in this doughnut hole. Called Medica and was told that with us baby boomers getting to the ages we are that the prices have been raised considerably. I guess it has being 4 months away from the renewal of my part D. To the subject here. I believe that the drug manufacturers and all those who are tied financially to the manufacturers will have something to say about taking people or regulating people taking pain pills. The money being made right now is a lot more then these neurologists think.

  43. Kim Miller at 2:33 pm

    Whenever I see the recommendation that Fibromyalgia should not be treated with opioids, I can’t help but ponder the thinking behind this when Fibromyalgia is the root cause of literally dozens of secondary complications that are also painful. Take for instance, Willis-Eckbom Disease (Restless Legs Syndrome), Interstitial Cystitis, Migraines, Peripheral Neuropathy, Chronic Costchondritis, and the list goes on and on, I have only listed the ones I personally have. If I had no treatment for any of these conditions because I suffer from Fibromyalgia, I would probably jump out of a window in a very high building!

    As the R.N. noted in this article, stating a “cookie cutter” way of managing ANY type or group of diseases is worse than a bad idea; it’s impossible. To stop from feeling like I am being electrocuted in my legs, arms, torso and face, I am given a benzodiazapine by my Neurologist. That was only done after I augmented on every dopamine agonist they make or, with the patch, broke out in blisters.

    Now what happens since I receive a very modest prescription of opioids from a pain management provider to take the edge off some of the other problems mentioned that are directly related to Fibromyalgia, along with DJD, ruptured disc in neck, episodic Baker’s Cyst, and I am certain I have left out something? WIll my Neurologist stop my benzodiapine as a result of this recommendation? Will my pain doctor stop my opioids? What exactly does any of this have to do with my PERSONAL situation. I feel as though I am already undermanaged as far as my pain situation goes right. Remove either of these components, and that high building is seriously looking like a solution I could be considering.

    Signed, I can’t take anymore!!!!!!!!!!!

  44. Susan Plath at 2:21 pm

    Please do not tell people who have lived with Fibro and chronic pain for over 35 years what to take….walk a day in our shoes first!!

  45. Mark Maginn at 1:34 pm

    Well, here we are again. A neurologist group telling us once again that opioid treatments for disorders like fibromyalgia should be eliminated as they show no real effect. I wonder who they examined. Many people find relief from fibro symptoms with opioid use. This is yet another group who most likely wants to limit opioid therapy, if it should ever be used at all, to cancer patients. The rest of us can go pound sand.

    Additionally, if an opioid is to be used we patients are to be treated like would be criminals or addicts. This is found in their recommendation that patients using these meds should be subject to urine tests, another invasion of privacy. No other patients but pain patients are to be subjected to urine tests.

    I do agree that all patients should be screened for depression and drug abuse and PMPS should be consulted in all states that have them. But put the damn urine bottle away and treat us like the adults with pain that we are.

  46. Tina at 1:27 pm

    Well I disagree I have lived with chronic pain for 14 yrs. and have done with out medication and tried other forms to help with the pain that were unsuccessful. My quailty of life without taking narcotics is even more non exsistence than when taking them at least when taking them I can manage to shower, go to the grocery store and do routine things without them I might as well be put to sleep like an animal. And after 14 yrs. I am not addicted, nor have I overdosed, I believe most overdoses from people with chornic pain are done because they just can’t live with the pain and stigma any longer. Not to mention my insurance doesn’t cover acupunture so how am I suppose to afford that. I would give it a try I am not against it anything that would help I will try but I know that having no narcotics is not the answer. At least for me.