Denying chronic pain, and therefore minimizing the nation’s pain problem, has become a preoccupation of the Anti-Analgesia Cartel, which now includes the CDC.
It is time to Stand Up and Be Counted for those who live with daily intractable pain.
Many of our readers may know that in 2011 a prestigious medical think-tank, the Institute of Medicine (IOM), published Relieving Pain in America: A Blueprint for Transforming, Prevention, Care, Education, and Research.
It says about 100 million experience chronic pain, a condition that costs the nation between $560 billion and $635 billion every year.
This statement points out a medical problem without precedent. Never before have we dealt with a pandemic involving 100 Million adults. That number is almost unimaginable.
The U.S. is the third-most populous country in the world. Look around you. One in every three of the people you see live with a daily pain that interferes with their quality of life. Maybe that person is you?
Americans spend as much as $635 billion annually seeking the treatment of pain which is more than the cost of treating heart disease, cancer, and diabetes, combined. Relieving Pain in America asks the questions – what can we do about this, and how will pain impact medical costs in the future?
Our national response to date has been to deny pain, to remove people from essential treatments, to persecute the physicians who dare to treat pain with effective medication, to shame those in pain by calling them “addicts”, and to ignore the human consequences of daily, disabling pain.
This story examines some of the factors behind our deplorable response to these facts, and asks all Americans who live with daily pain to speak up and be counted.
What is the Institute of Medicine?
Our number one medical treatment for pain involves the use of medications called opioid analgesics, known colloquially (and legally) as “narcotics.”
The IOM statement calls for more treatment of pain. It is unfortunate that to some, this makes them sound like a group of hyped-up narcotics addicts, calling for greater addiction rates, criminal behavior, and deaths.
Is calling for the use of more and better pain treatment inflammatory, dangerous, and destructive propaganda, hell-bent on destroying all we hold near and dear? Well then we need to get the children in the house and call the police. Our enemies are at the gate advocating the destruction of our American way of life.
I’ve identified this radical group, and it feel that it is my duty to out them here and now. I’ve discovered that:
“The Institute of Medicine (IOM) is a division of the National Academies of Sciences, Engineering, and Medicine. The Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions related to science, technology, and medicine. The Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. <emphasis: author>
Now we know who is behind this radical faction of narcotic pushers – Abraham Lincoln.
Yet, there are groups of trained medical professionals and others who strongly disagree with the IOM conclusions.
The National Pain Report has followed the controversy over the numbers of people living in pain in America since our infancy. We’ve titled those stories: The Numbers Game. While you can search for them on our site, I’ve listed them at the bottom of this commentary for your convenience. Consult them later for your information. For now, please, I want your attention.
The Numbers Game – Redux
This group that denies the IOM numbers claim that they are inflated, and frankly, absurd. Included in that group is our nation’s stalwart edifice against the spread of disease, the Center for Disease Control, known as the CDC.
This group – I call them: The Anti-Analgesia Cartel – is led by addictionologists, in other words, doctors who treat addiction, pharmacists – those men and women who are the gatekeepers of our controlled substance inventory, parents of children who have died of drug overdose – as a parent, they have my sympathy, but not my empathy. Also included are some neurologists, some interventional pain doctors, some orthopedic surgeons, and others whose net profit is reduced by the medical treatment of pain, or who wish to control “drugs” and eradicate their influence from the face of the Earth.
Perhaps there are some counted among this group who simply do not understand the suffering and disability millions of Americans must face every day of their lives. I’d like to believe that.
Let me say this: anyone I’ve known who fears the use of opioid analgesics for the treatment of non-terminal chronic pain, and who has then experienced chronic pain personally, or in a loved one, has come to understand that these medications restore lives. This new understanding changes their attitudes about the use of these medications in the treatment of pain and suffering that does not end.
Why do I use the word, cartel – is it hyperbole?
There’s so much more money in treating pain. Americans spend a half-trillion dollars more seeking treatment for pain than they do seeking treatment for addiction each year. Any business person would understand that there is a tremendous potential for the addiction business here, and hey – isn’t it great to have money?
I suspect that the strategy behind the numbers game of minimizing the number of people who live with daily pain is ploy of this “Cartel” to gain a larger market share of the annual American medical expenditure. In other words:
They want a larger slice of the pie.
The riches at stake are enough to cause a grumpy addictionologist to break into song …
As I walk along the Bois de Boulogne
With an independent air
You can hear the girls declare
“He must be a Millionaire.”
You can hear them sigh and wish to die,
You can see them wink the other eye
At the man who broke the bank at Monte Carlo. ***
There’s money to be made in converting our pain population to anti-abuse formulations of inexpensive medications, like the conversion of oxycodone to OxyContin, hydromorphone to Exalgo, and now, the transfer of all people in pain from medications known as opioid agonists (like morphine, oxycodone, fentanyl), to the partial opioid agonists (like the active drug in Subutex and Suboxone), that treat addiction problems.
An agency of the federal government, the Drug Enforcement Agency, requires a special license to prescribe these partial agonists for addiction, and in general, addictionologists possess this license, while your PCP and pain doctor probably do not.
So, is the use of the word Cartel, unfair? Look it up.
That’s the numbers game – minimizing the number of people who live with daily pain.
An Example of Cartel Strategy
The Cartel is clever and there is much at stake. In 2014, they challenged the IOM numbers in the respected journal of the American Pain Society (APS), Journal of Pain. Their challenge attempted to obfuscate the medical evidence presented in the IOM document, and further supports their assertion – pain is overestimated and over treated in America.
Their argument goes something like this:
How can there be millions in pain? Where are they? Why don’t we see them in our treatment centers? Why aren’t more people writing letters to the New York Times about inadequate pain care?
You see how they do it?
While these are valid questions, they’re not being addressed. However, the Cartel is “busy, busy, busy.”
In their last effort, the Cartel brought the 100 million figure down to a mere 35 million – as if 35 million Americans in who suffer daily pain that’s severe enough to seek medical attention, is a trivial event hardly worthy of our attention.
The IOM defends its research, including its numbers. The vast majority of pain experts, and their professional organizations, the American Academy of Pain Medicine (AAPM), and the APS, also agree with the IOM.
Enter the Center for Disease Control
The CDC in Atlanta, GA is our stalwart defense against infectious disease in America. We call them the CDC, and that name is held in high esteem in medical circles. But Atlanta has a PR problem, and it’s been the cause of changes in leadership, recommitment, and I imagine, greater thought to improving public relations.
The CDC has missed some major events in the prevention of infectious disease in America during the past 30 years.
- They stalled on effectively dealing with the AIDS crisis.
- They thoroughly bungled the fungal meningitis outbreak.
- They shipped live anthrax to Korea (oops).
- They failed in instituting protocols for keeping Ebola from our shores.
Their job is to defend against disease, and they’ve been embarrassingly incompetent of late.
In the early 1980s, when other countries like Australia were heat-treating blood products to kill HIV and other blood-borne diseases like hepatitis C to protect their citizens from disease America’s stalwart defender against disease met in conference and traded memoranda – for years. We played political patty-cake while we lost one-third of our gay male population and one-half of our hemophiliacs to AIDS and other HIV-related mortality.
I take that personally. One friend and coworker, a compassionate dialysis nurse named Jeff, whose story is told in a 1980 back-issue of the San Francisco Chronicle, died of HIV.
Here’s the other reason CDC bureaucratic tomfoolery angers me: I am a hemophiliac.
Severe hemophiliacs need regular infusions of blood products called “clotting factors” because they are deficient in these essential proteins because of a genetic disorder.
My condition is mild – my body can make only 20% of the amount of one (of 13) clotting factors required in the “coagulation cascade.” While I am fortunate that I don’t require regular infusions that severe hemophiliacs require, had I needed a blood product in during the years 1979 to 1984 in America, the odds are that I too would have succumbed to HIV.
Sources of further information on the hemophiliac/AIDS connection are supplied at the end of this document.
The other CDC bungles listed above are from more recent history and you are invited to read about them in the back pages of major newspapers on your browser.
In the mid-1990s, the beginning of the period known as the Decade of Pain, physicians came to their senses and treated more people with daily intractable pain using our best weapon against moderate to severe pain, opioid analgesics.
At the beginning of this decade, the CDC began to notice an alarming rise in deaths due to “opioid-induced mortality.” They documented this trend in a paper titled Vital Reports, published in 2008, that noted a 400% rise in opioid-related mortality during the period 1999 to 2008. They have been publishing annually on this issue ever since, and have made it a major focus of their mission.
Last year over 16,000 Americans died with an opioid in their blood stream.
Increasing Death Rates
Another statistic the CDC noticed is that opioid prescriptions rose at a similar rate during this period. They came to understand that together, the rate of opioid prescribing and opioid-related deaths rose, in tandem, and came to a shocking conclusion:
The rise in opioid prescriptions is causing a subsequent rise in the death rate.
This conclusion became known as “the Opioid Epidemic.”
In a country committed to a “War on Drugs”, the CDC appeared to have been getting it right. They found an effect, and discovered an associated cause. Doctors around the country were alarmed to this deadly result, and the Decade of Pain came to an abrupt conclusion.
Treatment of long-lasting pain, so-called “chronic pain” with opioids, has deadly consequences.
The medical world reacted, and as a result, people in pain began to receive less analgesic medications containing opioids. Doctors who treat pain with pain pills were blamed for addiction and death, and were stigmatized. Vicodin and Norco, a prescription medication containing acetaminophen and hydrocodone (a medication once labeled to treat mild to moderate pain), was branded as a “deadly” or “dangerous” drug by the media, and in 2014, the FDA rescheduled this medication in the same class as morphine, hydromorphone, and the most powerful opioid medications in our arsenal against pain.
But very few “investigative” journalists questioned the medical industry’s reactionary move away from the safe and effective treatment of pain, and hardly anyone questioned the CDC conclusions.
Epidemic or Logical Fallacy?
The CDC claims that the rise in opioid prescriptions written for the treatment of chronic pain conditions has caused an increase of opioid-related deaths.
In logical terms, they claim that a rise in rate A, associated with a corresponding rise in rate B, means that A causes B.
Claiming causality between these two statistical sets may seem logical to many, but this is not science.
There is no evidence that the two statistical sets are related. Their only close relation is the word “opioid”, and a particular window of time.
Given these two corresponding data sets and the graph labeled Figure 2 in the CDC’s Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999—2008, November 4, 2011, this conclusion appears, to many, to be conclusive evidence.
Again, you’ll find a link to all documents used to support my argument following this story, in the section labeled Notes.
My training is in engineering and computer science. In my way of thinking, the CDC’s conclusion is invalid. They’ve fallen victim to an error in reasoning known as a logical fallacy. This particular fallacy has a name – a post hoc fallacy.
The data presented by the CDC appear to be related, but on closer examination, one cannot make the conclusion that “a rise in rate A, associated with a corresponding rise in rate B, means that A causes B.”
This is not how one reaches a scientific conclusion. Perhaps this point requires scientific training to understand my point, but we must base our medicine, and our legislation around medicine, on science. The Henny Penny declaration that the sky is falling due to the increase in the compassionate and medically-proven, safe and effective treatment of chronic pain with opioid analgesics is irresponsible.
I’m not the one voice in the wilderness who says so.
In reference to a Twitter discussion of this fallacy, a clever (and formidable) medical journalist wrote:
Absence of evidence is not evidence of absence.
Simply put, there is little evidence that a rise in treating pain with opioid analgesics has caused a rise in opioid-related deaths. Yet, the CDC has sounded a warning bell, and medicine is listening. Government is listening. The American people, thanks to incomplete reports like the one on 60 Minutes last Sunday night, and biased sensationalism in papers like the New York Times, they are also listening.
If you are interested in logical fallacy, Google will provide you with a host of examples. The study of logic is a lost art in our technological society where we depend on “experts” to do our thinking for us. Perhaps it should again become part of a public education, as it was when we were a great nation?
A respected rehabilitation and mental health specialist familiar to readers of the National Pain Report, Dr. Terri A. Lewis, PhD., characterizes the CDC’s conclusion as “a systematic error.”
She reminds us that not all states and counties have laws in place regarding death statistics. For example, where I live and in many other places in America the office of coroner is a political position and election to coroner does not require a medical degree or special training as a pathologist. Medical examiner opinion and autopsy are not required to report death statistics. The circumstances surrounding each death are unknown.
Instead, the system relies heavily on the OPINION of the certifying official or physician. If I were to die tomorrow of a lightning strike, I could be counted as an opioid-related death because I’m prescribed chronic opioid therapy for pain.
The system of reporting death in America lacks reliability and veracity. How can we rely on this method of reporting to make pronouncements on medical treatments, or pass legislation, Kentucky? ~~~
This is a tempest-in-a-teapot epidemic. The fact remains that more people die every year of NSAID poisoning. ^^^
The opioid-induced mortality figures need further investigation.
Dr. Bob Twillman, PhD, FAPM, and Executive Director of the American Academy of Pain Medicine (AAPM), in 2012 wrote a careful analysis and proposed a few reasoned arguments why the increase in mortality may not be related to the increase in compassionate treatment of pain and suffering. His paper is referenced at the end of this article for the scientifically inclined.
To date, further investigation has proven no connection between the two sets of statistics. In fact, there is additional evidence, some published as recently as the October 28, 2015 edition of the New England Journal of Medicine that demonstrates the recent five-year “crack down” on opioid prescribing has caused a large increase in the number of people using street Heroin.
Put that in your pipe and smoke it for sixty minutes.
Enter the Anti-Analgesic Cartel
The CDC has hired “experts” from the Anti-Analgesia Cartel to advise them on how to handle this “epidemic” of 16,000 deaths a year. Members of this Cartel belong to a group that believes opioid analgesics should be used for short-term care only. A few years ago, they tried to get the FDA to relabel opioids analgesics but failed. The Wayback Machine will give you an idea of the goals of this organization. If they had their way:
Poof – there went our strongest class of medication for treating chronic pain.
The legal prescription for the treatment of long-lasting pain with an opioid analgesic might become outlawed in the land of the free and the home of the brave, just like it is in today in state of Kentucky, by decree of a legislature of non-medical politicians. Their decision depended on the advice of “experts.”
How many of you are getting less “opioid-induced analgesia” today than you were five or ten years ago, and what has it done to the quality of your life?
Is there a hidden agenda here?
That’s a pretty cynical question?
But then I have had the unique pleasure of watching these people for many years. My perspective and experience with their message warns me to be skeptical of this group’s motives. They don’t give two hoots for the fact that I live with severe chronic pain.
So, imagine the transfer of wealth from the pain world’s $600 billion a year, to the addiction world’s $18 billion a year, more or less, if there were no opioid analgesic pain management medical treatments available in America.
Where would you be without your medication?
Just imagine the boom in treatment centers across this land. Where else would you go? Can you function without our pain medication? Is your opioid tolerance, like mine, so high that withdrawal would threaten your life?
Of course, if you’re an addiction mogul, like the non-profit Phoenix House, the concept can make your mouth water. Imagine the resources you’d control with a potential 35 million new patients.
Profits, not compassion for people in pain will drive standards of medical practice, backed up by the law of the land. Will Abe Lincoln rest more easily in his tomb, knowing that those “drug pushing doctors” are now out of business?
How can they do this?
If there are more addicts and less people with a legitimate need for pain medicine, they can and will take our medications away.
If they can insist that the rise in opioid prescriptions for people who live in daily pain causes the horrors of that psychological condition known as opiate addiction, in major media outlets like 60 Minutes and the New York Times, then America will believe that this is a fact.
The president will sign the End Heroin Addiction Act and go down in history as our greatest hero as a savior of all Americans from the ravages of addiction – prisons, institutions, and death.
Do we need this kind of savior?
Why it’s important to Stand Up and Be Counted – NOW!
Without my medication, I couldn’t sit here and write to you like this. I couldn’t shop for food, cook a meal for my family, or run the vacuum cleaner. I couldn’t play my piano, or play with my grandchildren. I would be in constant, unmitigated misery.
Hell, without my medication, I wouldn’t be here today – after 35 years of living with pain, and moderate to severe spinal stenosis in my cervical and lumbar regions that cause pain with every movement, an un-operable condition due to hemophilia, I’d be doomed to this life.
Do you think I’d want to hang around for much more of this torture?
That’s why we need to be counted. It’s a numbers game.
How You Can Fight Back
Now, more than ever, America needs to hear from its tired, broken, suffering people who live with daily intractable pain and require strong pain medication to function.
We don’t need the meds because we’re addicts, but because we hurt.
We don’t need the meds because we crave the high, but because we need the analgesia.
We can’t let their new guidelines or their new initiative forget about us.
We are millions of Americans who need to speak with one voice.
That voice should echo a resounding NO across this land, while we are still free.
We are not lotus eaters. We are people who live with daily, overwhelming pain, and without our treatment modalities, we could not function.
Time to Stand Up and Be Counted, folks.
It’s Not A Hopeless Cause
So many of us are defeated before we’re started. You’ve lost your doctors, you’ve lost your medication. You’re already beaten.
It’s easy to click a link. I’ve provided the link to CBS news below. (Don’t forget to select the 60 Minutes show from the pulldown.)
You’re not going to be interviewed on 60 Minutes. Your email may be ignored. Your letter may go in the trash. No one will thank you, but me.
Do it. Keep doing it. Make noise, for crying out loud.
Make a nuisance of yourself and be heard.
Here’s an idea:
Persist to exist.
Here’s a template:
I am an American who lives with severe daily intractable pain from a chronic illness. I need the pain medicines that my doctor prescribes to live my life. These are not “Heroin Pills” and do not contribute to any Heroin Epidemic. They are too few and too precious to sell or share, because they help me do the things in life that most people take for granted, like feed my family, bath my child, or fill in the blank…
How’s that? Can you copy, paste, add your own idea at the end about what your medicine lets you do, and mail it to CBS? How about to the other media outlets? Can you mail it to the White House? Your state representatives?
How much can you help yourself?
By the way, feedback to CBS news is: http://audienceservices.cbs.com/feedback/feedback.htm.
Don’t forget to select 60 Minutes as the show you watch above the comment box.
I think we can all do it. I believe that we must all do it.
Meet Your Ally — Social Media
Social media is a great equalizer. If you can, get on Twitter, and get on Facebook, and the other online places where people like us meet. The energy of fellow people in pain, whether their illness is obvious or invisible, is contagious. It fills me up. It lights my fire.
If we can see you there – we’ll see you there.
Twitter uses index words, or key words called “hashtags.” These words start with the hash mark or pound sign that looks like this:
I use the hashtag #chronicpain in almost all of my posts to Twitter. If you want to learn about chronic pain, search for that hashtag.
Another hashtag invented by a woman in daily pain is #chroniclife. I believe that we all know what that means. If we live in chronic pain, then we have a chronic life.
In Twitter, hashtags bind us.
There’s a hashtag for us: #NatPainReport.
Online, you’ll develop friends and people that you admire, via addresses. A Twitter address begins with the “at sign”, @ and looks like this:
That is my twitter address. Use it. Tell me – I’m here.
Hi @kwgmatthies. I have #chronicpain and I agree. We need to Stand Up and Be Counted. #NatPainReport
That Tweet contains my address, the hashtag #chronicpain, and the hashtag for the National Pain Report. Copy and Paste.
Ed Coghlan is the very good man who edits this publication. His address is @edCoghlan.
When you open a (free) Twitter account, open a new tweet and say:
Hi @edCoghlan –I live with #chronicpain and read the #NatPainReport. Thank you.
That’s a tweet. Ed would love to hear from you. So would I, and so would the other people who feel as you do.
You doctors out there:
Hi @kwgmatthies. I treat #chronicpain with #opioids. Cochrane says they are safe and effective when ppl take as directed. #NatPainReport
I would be honored if you “follow me.” That means you subscribe to my musings on Twitter.
View a Twitter tutorial video – You’ll quickly understand what I mean and how to get started.
Social Media can bind us together, and help us to speak with one voice.
Let us know you’re out here.
Say: I am a person in pain, and couldn’t function without my pain medication. Don’t take it away!
Right now, if you want to count, and if you want to keep your prescription pain medicine, or you want it back, Stand Up and Be Counted.
You have a right to adequate, effective, safe, and medically proven pain control.
But today, you have to fight for that right.
It’s a mean, ignorant, and greedy world out there for people who suffer with daily pain.
United we can defeat those who call us addicts and would take our medicine away.
The Numbers Game and The Numbers Game, II:
For the Story of Hemophilia, AIDS, and the CDC (1982-1985):
Kuhn, Dana, PhD, The Trail of Aids in the Hemophilia Community, Committee of Ten Thousand.
Leveton, Lauren B. (Ed), Sox, Harold C. (Ed), Stoto, Michael A. (Ed), HIV and the Blood Supply, An Analysis of Crisis Decisionmaking, IOM, National Academy Press, Washington, D.C., 1995.
CDC Vital Reports
Dr. Bob Twillman’s: What’s Really Driving Opioid-Related Death Rates? (2012):
From the New England Journal of Medicine: October 29, 2015
Shifting Patterns of Prescription Opioid and Heroin Abuse in the United States, N Engl J Med 2015; 373:1789-179 DOI: 10.1056/NEJMc1505541
The Wayback Machine:
Medical Education in Pain
Our medical schools are negligent educating physicians in the most common complaint seen by primary care providers – the neurophysiology and treatment of pain. As Judy Forman described, in her excellent book A Nation In Pain (2014), the average veterinarian receive more training in pain treatment, about two weeks, than the average physicians, who receives eight hours of training in a four-year medical curriculum.
*** From Gilbert (and Sullivan) – The Man who Broke the Bank and Monte Carlo.
~~~ From private correspondence with Dr. Terri A. Lewis, PhD. Thank you Terri, for generously sharing your special knowledge of mortality rates, specifications for standards of death, and other information essential to the facts presented in this story.
^^^ Data follows from the American Chiropractic Association website. http://www.acatoday.org/content_css.cfm?CID=2428
“A more recent study published in The New England Journal of Medicine estimated that at least 103,000 patients are hospitalized per year in the United States for serious gastrointestinal complications due to NSAID use. At an estimated cost of $15,000 to $20,000 per hospitalization, the annual direct costs of such complications exceed $2 billion. This study estimated that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States. This figure is similar to the annual number of deaths from AIDS and considerably greater than the number of deaths from asthma, cervical cancer or Hodgkin’s disease. If deaths from gastrointestinal toxic effects of NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the US.”
Special thanks to all who reviewed and offered suggestions on this project. I couldn’t have done it without your careful attention to detail through multiple revisions. I am humbled by your generosity. You have my greatest respect and affection – Kurt.
The opinions expressed in this commentary are those of Kurt W.G. Matthies.
Copyright © 2015 by Kurt W.G. Matthies and National Pain Report