Not Every Pain Patient Is The Same – and Shouldn’t Be Treated That Way

Not Every Pain Patient Is The Same – and Shouldn’t Be Treated That Way

By Ed Coghlan.

Editor’s Note: From time to time the National Pain Report likes to engage physicians on the front line of treating chronic pain and gain their perspective on the state of chronic pain treatment. We were introduced to Dr. Amy Pearson of the University of Iowa who is establishing herself as a leader in the field. She agreed to answer a few questions:

National Pain Report: “Dr. Pearson, Let’s discuss the opioid issue – What’s your position on prescribing them?”

Amy Pearson, MD

Dr. Pearson: “There’s no one-size-fits-all position on opioid prescribing. When a physician is considering opioid therapy for his or her patients, he or she considers all of the available evidence as it applies to the patient. Just like any other medication, opioids have good evidence for some conditions, but poor evidence for others. Physicians are always adjusting their practices as more information comes to light.

National Pain Report: “Many chronic pain patients who have used opioids for years to combat pain are upset at the perceived “crackdown”. One observation I hear from many is if not opioids, then what? No one seems to be talking about alternatives. What say you?”

Dr. Pearson: “There are a lot of options for chronic pain, but the answer to this largely depends on the condition being treated. Medications are just one of many ways to treat chronic pain, and often the best chronic pain treatment requires a multidisciplinary, active approach. A patient’s team might include a pain physician, a primary care physician, a pharmacist, a surgeon, nurse specialists, a physical therapist, or a pain psychologist. Depending on the condition, certain specialties are more heavily relied upon. For example, I may have a patient who is improving his fibromyalgia pain with regular aqua therapy and biofeedback sessions. I may have a different patient with persistent pain after spine surgery who is optimizing her home exercise program and medications in preparation for a spinal cord stimulator implant.

National Pain Report: “Pain is hard to measure–what might be a 5 for one person is a 7 for someone else. What can you recommend to patients about talking with their physician about their pain and the treatment alternatives?”

Dr. Pearson: “This is a common problem in medicine, but not insurmountable. A pain “score” is just one part of the pain evaluation, and it’s important to follow trends. Most of the time, descriptors like the quality (cramping, burning, aching, searing, dull) and location of the pain can help physicians hone in on the problem. It helps to know what has worked and what hasn’t, and whether the pain is associated with anything in particular. One of the most important trends to follow is whether treatments are helping you achieve your goals, whether that’s being able to go out with a friend, rely less on assistive devices, or sleep better.”

National Pain Report: “How can we restore an integrated approach to treating pain? Is it a system problem, is it a medical training problem. What exactly is your prescription to improve how we treat pain?”

Dr. Pearson: “Treating pain is an expensive endeavor for patients, their families, and the medical system because of the multidisciplinary care and time involved. Many patients are complex, with multiple contributing medical problems. Often times, my patients have more than one pain problem. For example, someone might have diagnoses of fibromyalgia, a disc problem, and rheumatoid arthritis. Each problem has subtle differences in how it is treated, and influences which interventions a doctor might choose. I am lucky to work where I have enough time to sit down with a patient, review their scans and treatment, and make a comprehensive treatment plan. I realize this is a luxury that is not very common in modern medicine. I think as a whole, we need to realize that pain care simply takes more time and resources to achieve meaningful results, which will pay off in the long run.”

National Pain Report: “While the pain story for 2017 was the opioid issue – what progress did you see during the year in terms of treatment, new technologies etc.?”

Dr. Pearson: “In my field, one of the most exciting developments is in the field of neuromodulation. Pain doctors have been using devices called spinal cord stimulators to improve pain, especially when pain persists after a spine surgery. There has been a wave of new literature coming out on different ways to implant and program stimulators to get better results than we ever have before. This technology might help us reach even more patients with harder-to-treat conditions. The field of pain medicine is moving more towards a focus on restoring function and quality of life, not just passively managing symptoms, and I am very excited about that.”

National Pain Report: “As a pain specialist, it must pain you – if you’ll pardon the very bad pun – that insurance still doesn’t many cover alternative treatments that are available. What must happen for broader coverage of treatments?

Dr. Pearson: “There are physicians and professional societies working many unpaid hours to advocate for patients’ access to the right care. Many hours that could be spent treating more patients must instead be spent on phone calls, advocacy, and paperwork. We need more patients and physicians at the table when it comes to shaping health policy, reimbursement, and access to care. Insurance companies and politicians need to see the personal connection. We also need more research funding for treatment of pain so we can prove the value of new interventions. We have established that pain is a problem in our country; now is the time to focus on what we can do about it.”

Subscribe to our blog via email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Authored by: Ed Coghlan

Leave a Reply

24 Comments on "Not Every Pain Patient Is The Same – and Shouldn’t Be Treated That Way"

newest oldest
Notify of
Gregory John Mooneyhan

No, there is no one size fits all model. It’s not like wearing a stocking cap. Most people who have chronic pain have tried a multitude of different treatments and disciplines before resorting to being on the regimen they are on now. For some people, meditation, acupuncture and writing in a journal do enough to take their mind off of the pain they are in. For others, poly-pharmacy is the only thing that relieves symptoms that they have. While there are various different options out there to help relieve pain, most people in today’s society have become so accustomed to using narcotics as the end all-be all for pain management. And for a decent percentage of patients, unfortunately, that is the only thing that works for them. We are talking about people with rods, screws, bone graft and artificial discs up and down there back. You want to tell that person they won’t be able to get their oxycodone anymore and that they will need to rely on OTC pain relievers and physical therapy? That wouldn’t be a fun conversation for any doctor to have with their patient. The CDC/FDA/and DEA are already making it hard on these people with the increase in prior authorization requests. Soon, doctors are not going to want to have to deal with the hassle and are going to just have to deal with having that awkward and tough conversation with their patients. Every person deserves to live, whether it be a CPP or a person who unfortunately has become addicted to narcotics. The problem is that the government is funneling more money into keeping the addicts alive as opposed to making the already strenuous life of people in pain easier on them. It’s so sad.

Being cut off of high dose opiates last year ,made me thankful for the Medtronic neurostimulator I had implanted in 2006. It’s at cervical 5/6 for intractable hand pain due to a spinal cord injury. I had a DO insist on doing a cervical manipulation to ease my neck tension, he thrust down on the back of my neck with his weight and force, popped the disc right thru to my spinal cord. My life should have ended that day, I’ve been sick ever since. Now I have to deal with the pain 24/7 again and I thank the CDC for reminding me how crooked the government is. Everyone blame the others, my milligrams will never reach the point of total pain relief again because the CDC says so. My pain doc will release me from care if I ask him to go over the CDC recommendation, he won’t do it. I don’t blame him, he has to keep his license from being in jeopardy. My pain is different, it is insane, it won’t stop, now that after 15 years of work to find the right treatment, I’m back to being a stranger, away from my doctor that got me to pain freedom, tossed to a doctor that has to get to know me. My pain is different…

Thank you, Dr Pearson. My daughter’s 8 level is a screaming 10 blackout for me.. two things.. 1. Would someone please interview Dr. Pradeep Chopra for comments on EDS pain management? 2. TENS units AND spinal cord stimulators are temporary pain helpers. If you know of truly critical Lyme patients with serious pain, then would have read that the electric signaling needs to change often drastically dramatically ,,the same pattern the body adapts to in about an hour or so and is non effective after that period of time. I will try to find the book to quote or the NIH article for next time on the electrical stimulation limitations. . . Still my daughter suffers tremendously from EDS and Lyme. Still I pay out of my own pocket for so much to try to help my adult disabled child. The gov does not approve anything for chronic Lyme nor does research.. EDS is unknown as to why the collagen works differently, does not absorb the same as non EDS people. Sigh… I wish someone would help.

Thanks Dr. Pearson for u r input. As someone who has an illness that causes chronic pain, I would like to hear from more MD’s. I’m frustrated when my pain specialist of 8 yrs is turning his back on his pain management plan for me & other patients ,due to, the CDC guidelines. Medicine he told me would be the best to take ,he is now back peddling & has a totally different outlook . It’s hard 2 know who r what to believe. I have lost so much trust in medical doctors.

Here is another thing. Just because it is MRI compatible does not mean the imaging center will do the MRI. Just like the disclaimer in Boston Scientific’s patient booklet. “If you agree the trial works then you are agreeing that the implant is for you”.

I asked the MR operator what would be happening if I had a MR compatible device installed.
She said “You would not be laying here. All liability falls on us, the owner of the magnet” It is in their fine print.

Lisa, Thank you so much for all the information. I had no idea that some were MRI-safe or that there were differences between products to be considered. It’s not something I’d ever rush into, and I’ve heard folks who had very poor results or had to get them removed. I’m keeping an eye on vagus nerve stimulators, as I think this will be a helpful adjunct treatment someday. Not for pain, but for the problems that are peripheral to pain.

This is for HJ’s questions about spinal cord stimulators and MRI friendliness. Yes there are companies who manufacturer MRI friendly stimulators. Boston Scientific is supposed to be one of the best companies for stimulators and as of 3 years ago, they were diligently working on getting an MRI friendly to market. Also Medtronics has an MRI friendly version. I had a St. Jude stimulator which was not MRI friendly. At the time it was implanted, I did my research, spoke with other St. Jude recipients, looked at the BBB, looked up success rates, etc., but what I didn’t know was that I had a CHOICE of which company’s stimulator I could get. I believed in my doctor that he was giving me the best. I did fail the trial but the rep was insistent and called me every day for 4 months until I caved because my lumbar and leg pain was so unbearable I was desperate. Later, I found that the doctors get kick backs for getting these into patients and the sales people get large commissions. Another important fact that needs to be assured to the patient, if suffering from lumbar and sciatic pain, the paddle should be no higher than T10 to get the best stimulation results. Mine was implanted at T7. Stimulators can go bi-directional, so if you are suffering both cervical and lumbar you can get stimulators to go both ways. Beside the fact that I needed MRIs as my spine was getting worse not better, and the fact that we could not get the stimulation to be where it was needed, I had to have mine removed. When I went to meet with the Neurosurgeon to review having it removed he asked me an important question–Where do you feel the stimulation? I said I feel it on the inside of my legs, but I need it for the outside of my legs and they have been unable to get it there or into my spine. I would have to turn the stimulation up to it’s highest measure for the residual feeling to the outside. Low and behold, there’s a condition called a “U” in patients whose own nerve wirings to the brain are criss-crossed. Well, that was me! That’s why it never worked and though later I found St. Jude and all the other stimulator companies knew about this condition, they never said a word or posted it on their websites under any condition. The neurosurgeon also told me that I never should have had it implanted and am never a candidate for another. Even with all the newer technologies over the years when it comes to stimulators, I also failed with the Medtronics as my new PM wanted to just try once more. My spine surgeon still wants me to try it in my damaged cervical spine, and my new PM says NO WAY!!! I have way too much damage that he wouldn’t touch it with a ten foot poll, and the pain… Read more »

Pain does not exist under a bell shaped curve not unlike diabetes mellitus. Ever wonder why there are so many dosage strengths of practically all prescription medications? We are all not alike.
Most if not all physicians know this.
I am not sure but I believe some medical schools create a phobia about prescribing opioids.
I am a chemist. The new hires have a chemo phobia. Perhaps they should have chosen a different profession.
It appears to me that the DEA in it’s over reach plays the music and the physicians must dance to the beat that is being played.
In many cases where bone diseases have progressed in the elderly this could be considered elder abuse.
At one time there may have been an over prescribing epidemic but this has been slowed to a crawl with the careful screening of patients, UDC and pill counts. The system is working.
Choose your physician and specialist wisely. Once your relationship is compromised due to a disagreement it is time to move on to another physician or specialists.

Just discovered your site. What can we do? HAve had sever back disintergration for 17 years.
Now the latest cut in Morphine is going to make me bedridden. Not very good for my physicial health at all. I cannot, cannot tolerate this treatment, and do not know what to do or where to go. We MUST assemble ourselves in protests. We MUST get regular media coverage, as that is the only way in this country.

“Medications are just one of many ways to treat chronic pain” At that point I would have liked to ask then why are medications being withheld when they’ve been proven the
most effective for a patient if indeed they are one way to treat chronic pain. Doctors are all on the same popular bandwagon. They are career driven, led like cattle by the media. God bless my doctor who tries to get me off opiods but not denying them to me.

I am sorry but I feel like the Doctor sidestepped the VERY straightforward question about opiates. There are going to be patients recently referred to Pain management who WILL benefit from more than opiate treatment-I am benefiting from MORE than just opiate treatment- but no one is threatening the ability of my drs to continue to provide these additional services.
Dr Peaterson, we who are receiving appropriate multiple disciplinary pain services are having our opiates unrealistically cut and long standing combinations of medication denied (many thrown into crisis from developing issues related to the under management of pain) because our prescribers fear the guidelines.
Me Colghan in question one asked you about your opinion. I don’t know if you are ALSO afraid to go on record (understanding that you have a practice to protect) but for those who need opiates to remain a part of a treatment plan (established,verifiable, vetted-obviously contract oversight in place) what is then your opinion of the opiate crisis in availability to these patients?

Thank you.

i’ve been in very great pain,and now its gotten to where i just look forward to dieing,for over two years my pain doctor act like the cdc has been behind them,all the times i told them with medical proof that my pain was too much all the times they looked at my blood pressure and seen their was something wrong,way too high,funny thing before they started acting like the cdc was more right then me they had me on high level’s of opioid medicine,because after having two neck fusion and repair on side of neck where they drill holes to see if they could repair the great damage at c-7 which didn’t work because i can’t hold anything in my left arm anymore,they said well if all fails we could put you on high dose’s of opioid,which for the last two years they been lowering and lowering,i guess to them its like boiling a frog,they believe the frog,or anyone else won’t know they are beening killed if they do it slowing,well its called murder,torture because you took an oak to protect your patient,they stop my nerve medication,because they said patients that took it and opioids were dieing i’d taking it for over 14yrs with high level’s of opioid medicines watched over by 2 doctors,you know i looked at the worst problems in this country,drinking,smoking,and opioids weren’t even in the top 10 someone killing chronic pain patients its about time to look into this opioid lie,if you had someone die from opioids better look into it because they took every body who ever took opioid and if they took their opioid medicine right and had their opioid medicine in their system they were marking it down as od,also their patients like me who can’t even have an life as an disabled person because my opiod medicines don’t work for beening lower way too much,my doctor said i had another pain medication in my system so i had another doctor test me and took an lie detector test,got an lawer i’m tired of not having an life and all these lie,too many people are playing GOD with other peoples lifes,let me put it like this if my son died in a car wreck and i made those in power too believe cars are evil and they took them away from you,you never having a car wreck and worked all your life to have car wouldn’t you feel like you been picked on,this is dennis m lawson i know of an 1000 real pain patients could be more,just in my state who have killed themself because they opioid pain medication’s were taken away,they come to the point where they mind couldn’t take the very high level of pain and nothing else worked but high level’s of opioid but their doctor were told not to help them kept their medicine low,they just killed themself guess it stop the pain,but at what cost to their familes,you see its like the man who works on your… Read more »

There has to be more that we can do. Isn’t there an Attorney or somebody to help us and file a lawsuit? it’s against our civil rights these people making these decisions 99% of them have no medical background and to make this decision and group everybody the same is wrong Everybody’s medical issues and medical records have to be reviewed individually and that only could be done between the patient and the doctor. Our Rights as Citizens of the United States are being Violated and is there someone or a group to help us? I just can’t believe there’s nothing we can do..

Dr. Pearson please realize there are so many of us like Lisa Hess that have been through numerous treatments. In my case 1 year of trying: PT, TENS, NSAIDS, acupuncture, RF injections, biofeedback, chiropractic. I was NOT given opioids. When nothing helped I opted for spinal fusion and researched my choice of both orthopedic and neurosurgeons. I was told 85% success rate. I went into surgery with one type of pain and came out with a pain totally different and much worse- 24/7 nerve pain. After 4 subsequent surgeries to try to fix this I was told nothing could be done for me and have been prescribed Fentanyl patches ever since. They are a life saver in my opinion and allow me to have a better life. It’s been 15 years, with the same prescribed dosage for 13 years. Fentanyl works for my pain. I would welcome the opportunity to speak with the CDC and DEA about long-term opioid use. Even though it seems they have little to no research on this topic they do not seem to want to hear from myself or those like myself who are having success with long-term opioid therapy.

I also must add that I have nothing to do with opioid overdose deaths. I don’t understand why chronic pain patients opioid medications are reduced or curtailed when we have nothing to do with illegal drug use. Plus, as I read recently (MedpageToday 2.14.18 Why Do So Few Doctors Have Buprenorphine Waivers, comments) doctors do not want to be involved in Suboxone prescribing and addiction treatment. So what is there to offer chronic pain patients for pain and withdrawal when you strip away the only treatment that works for them? The US medical establishment is leaving chronic pain patients to suffer in agony. Why?

I hate commenting with the same comments regardless of the topic. All I read is what should be done, how wrong it is how the doctors are responding, how inaccurate the stats out there are, how chronic pain patients are suffering needlessly, it’s all information that we keep mulling over again and again and again. What we really need are lawyers to get involved and tell us what legal rights we have to receive quality treatment for our legitimate chronic pain. If we new what we should expect legally maybe we could fight back. I am sitting here feeling physically horrible, my pain level is a nine, I literally can’t do anything until I take 75% of my pain meds, so from 6:00 am to 2:00 o’clock I simply can’t function. Before they drastically reduced my pain meds I had them spaced out throughout day and my final pill was just before bed so I could get a good night’s sleep. I kept my pain level mostly at a four, which was totally fine and I was a high functioning person who participated in life with my friends and family, my wife works and I’m on disability so I was taking care of the house inside and out, along with cooking dinner and watching my 11 year old grandson. Now my days and nights are a living hell, I try and keep up and it is literally indescribable as far as pain goes, but what am I going to do, ask my wife to do it? Her engineering job is a very high stress job and she works a lot of hours and I want to make her home life as relaxing as I can, with no worries. My story is fairly typical for chronic pain patients and I could give you all a lot more details and horrors I go through on a daily basis but you are all living this nightmare. Back to my original thought, if there are any lawyers out there who could give us some advice, what can we legally do to get our pain meds prescribed in the amounts that we all know will help us. We are U.S. citizens, we pay our taxes, we vote, etc., and we must have some sort of a legal right to expect quality health care from our physicians. I would like to go into my doctor’s office and demand that he administers the proper amount of pain medication to address my symptoms. We must have some rights for God’s sake. We need some ammunition, so PLEASE if there are any lawyers out there who want to advocate for the thousands of legitimate chronic pain patients that suffer needlessly every single day. Please, we need to fight for our rights. My doctor says that the DEA is forcing him to reduce our pain meds, I don’t think the DEA can force a doctor to do anything, this is the kind of situation that we need answers for. Can… Read more »

Dr. Amy Pearson, what do you suggest to patients who have arachnoiditis and are definitily not candidates for any invasive treatments? Patients like myself were harmed by ESI, myelograms and even spine surgery. Now we are being abandoned by the medical community that caused harm in the first place!

We search for Pain Drs. who we need to understand this, are turned away only to move on to the next Dr. who may help us only to be turned down over and over. Then we are labled as drug seekers. There is a group of patients who’s only effective treatment is opioid medication. We have been stable on these doses which is the only option that gives us any quality of life. We are responsible with our medication because we know we have to be. Some Drs. are comitting extortion by telling patients that they will not receive pain medication if they don’t consent to these invasive procedures which only advance their disease, and lines the pockets of the Dr. What do you have to say to these patience who are suddenly dropped by Drs. without any consideration to withdrawl?

We did not have a choice in getting a disease. We did not do anything to cause it. Abusers have a choice to be cured. We do not! There is no hope for us! Please answer these questions Dr. Pearson. I will be anxiously awaiting your response.

Kathleen C Harrington

Let’s call this what it really was in the beginning….It is a HEROIN crisis. Why have cpp been the target in all this? Is it because we are the easiest of those taking opioids to get to? That is not right. The HEROIN addicts are still able to hit their dealers up for a fix, and my meds are cut or immediately taken away? It is a HEROIN CRISIS!! Stop the heroin from getting to the streets! Make all law enforcement, DEA and all the rest do their jobs! More money is not needed, just have them do their jobs. This thing is all screwed up. We get and take our meds responsibly. I am monitered by my state as to how many times I get a script filled and by whom. I am drug tested for street drugs and to make sure the rx’s I have been given are in my system. In addition to that I have blood levels drawn to really see if I am taking my meds as directed. There are some cpp who get their meds and sell them, nand there will always be a doctor that writes scripys without pain documentation. I feel like they were doing well in those areas trying to stop it. If every doctor would do the tests I mentioned we could get a handle on who is and is not taking their prescribed meds. But again, when did this turn from stopping the junkies from dying at stop lights with their kids in the car, to a responsible cpp that is taking meds to be able to work, raise our families and live a decent quality of life. I am ashamed to live in America at the present time. I am told I have to suffer in excruciating pain for no reason. Men in Government, and pharmacists who are not doctors are calling the shots and making the rules! If I have to live in this excruciating pain I will consider killing myself as I just cannot take the pain. Chronic Pain Patients did not ask for this life of pain.

MMJ isn’t the answer for everyone, either. We are not cookie-cutter patients, but we are treated this way.

As someone with spinal issues and whose mother has spinal issues, it seems to me that they’d work on neuromodulators or spinal cord stimulators that are MRI-safe.

I don’t like the idea of not being able to monitor what’s going on with my back. Is there something I’m missing? I assume that pain pumps are the same way — you can’t get an MRI with them, right?

Do batteries need to be replaced? I dunno. I think some things have to be worked out. I’ve heard some folks have a difficult experience with having these devices implanted. It’s hard to judge if that’s a lot of people or a few loud people (who have every right to be loud and ask for support, mind you!)

Do we need a card issued to verified true medical condition patients that require this treatment? I am treated at the pharmacy like an addict. The looks the pharmacy staff gives when presenting a precription is depressing. They can also be extremely mean at times.

The one question not asked and therefore not answered. There are patients who have tried every modality available and all have failed. That would include years and years of physical therapy, a failed spinal cord stimulator implanted and removed and an additional trial of a different stimulator that also failed, over 30 non-invasive procedures that did not help alleviate any pain throughout an entire spine that has endured 5 spine surgeries which included the placement and removal of the spinal cord stimulator. The patient who has several chronic auto-immune illnesses that cause pain such as, but not limited to, Fibro Myalgia, Late Stage Lyme Disease, RA, OA and Osteoporosis, severe Degenerative Disc Disease, Radiculopathy, several herniated discs throughout the spine. That is me and I have run out of alternatives so Opioids are the only thing that can help keep my pain under control when my pain levels are under an 8 which for over 2 months now has not occurred. There are thousands of people like me from all cultures with multiple pain causing illnesses that have tried everything and nothing works but medication. That is our fight that no one sees.

I get abused by Doctors and the Hospital!!! They KNOW NOTHING ABOUT CRPS RSD. DISEASE. And this happened me and others too!! My Regular M.D. studied and talked to world renown Dr.Chopra and a scientist to educated and helped me. He now has 3 CRPS patients he tells truth to too. From what he took time to help us. We all said the same abusive type stories. I should have sued one who his office girls had their ears to the door cause I was screaming in pain alone with him in the office. He put tiny needles in CRPS affected area every fraction of my body foot and calf..then put a longer needle in my groin told me I twist body. S screamed so loud almost passed out and yelled No more. …stop stop. He got mad and failed my test even though he already tested it all!! Those nurses ears at door and asked me if I needed anything? Should have saved him from hurting others!!!

There is nothing perceived about it. It is a crackdown and it has little to do with any individual patient. I am finding it ironic that opiates are killing a good number of careless and unhappy Americans so we are willing to ruin the lives of many legitimate pain patients while Guns kill far more and we wont do anything to alter their availability. For many Americans, especially older Americans, we are being charged, tried, convicted and sentenced for a social ill that is totally out of our control. And to top it off in many states it is actually illegal to commit suicide to escape the daily pain. No, I am not suicidal but I am frustrated that as i am being weaned off the medication that has allowed me to continue to work at something I loved i am facing the fact that I will have to give it up due to the actions of others. A Thank You to Dr Pearson for at least trying to figure out solutions.

Thank you for your article. But I don’t think you got to cross how this is a life and death issue for some. If they were going to impose the 100 200 m m e mandate like this then they should have at least given us some warning so we could get on someone schedule for a pain pump. Some have no other alternative