Opioids Blamed for Consequences of Chronic Pain

Opioids Blamed for Consequences of Chronic Pain

By Angelika Byczkowski

I’ve noticed a trend in the proliferating numbers of studies ostensibly investigating the damaging effects of opioid therapy: whatever the negative outcome, researchers correlate or attribute it to the opioid medications instead of the underlying pain.

Angelika Byczkowski

That’s like stating that people who take Dilantin (antiepileptic) have seizures. Technically that’s correct, but it doesn’t address the reason people are using Dilantin in the first place, which is that they have epilepsy. This is the real source of their seizures, not the medication they take to control the seizures.

Yet this is exactly how recent studies evaluate opioid medication. They start by selecting a group of patients taking opioids and compare them to patients who don’t take them or take much less. Even if both groups have pain, they never consider varying levels of pain to be the legitimate reason for this disparity.

The particular study that made me question this type of design was the following:

“Patients on higher doses of opioids tend to have worse pain, worse function, and higher healthcare utilization when compared with patients on lower doses of opioids, according to a study designed to examine the relationships between prescription opioid dose and self-reported pain intensity, function, quality of life, and mental health. Results from this study were recently published in the Journal of Pain.”  (http://www.clinicalpainadvisor.com/opioid-addiction/high-opioid-doses-lead-to-poor-outcomes-for-patients/article/633829/)

This can be rewritten and make more sense as: “Patients with higher levels of pain tend to have worse pain, worse function, and higher healthcare utilization when compared with patients with lower levels of pain.”

Those who take opioids generally have more serious or consistent pain than those that don’t or take less, so the comparison is actually between people with serious pain and people with slight or no pain.

Here’s an example to show how such studies mislead:

Theoretical study on the detrimental effects of Dilantin

  1. Study headline: People who take Dilantin have seizures

  2. Study reality: Dilantin is correlated with seizures (seizures are correlated with Dilantin)

  3. Media headline: Dilantin causes seizures

  4. Reality: People who have epilepsy have seizures

Actual study on the detrimental effects of opioid medication

  1. Study headline: People who take opioids get depressed

  2. Study reality: Opioids are correlated with depression (depression is correlated with opioids)

  3. Media headline: Opioids cause depression

  4. Reality: People who have pain get depressed

This problem is evident in most of the recent studies of opioids. The researchers claim to be studying the effects of opioids when they are really studying the effects of chronic pain. They blame any and all negative outcomes, like depression or a sedentary lifestyle, on the opioids instead of proceeding to the root cause, which is pain.

How can we compare opioid therapy to non-opioid-therapy without accounting for the fact that people are taking opioids because of their otherwise unmanageable pain? Opioid dosages are determined by pain levels and a pain patient’s drug tolerance over time, so pain level and opioid dosage usually change in tandem.

However, pain patients are always warned that opioids will not remove all our pain, so many of us still have to cope with considerable, and sometimes disabling, amounts of pain and its damaging effect on our bodies and minds.

Yet these studies seem to be trying to link the opioid-reduced remains of our full pain to the opioids we take to relieve our pain. Nowhere mentioned is the fact that opioids are prescribed to treat the pain symptoms that they claim are caused by those very same opioids.

Many studies seem structured to support the currently popular (and funded) anti-opioid campaign. Simply by measuring opioid dosages instead of pain levels, such studies can produce the desired conclusions.

No other health conditions are studied like this, using the amount of medication rather than the severity of the condition as an indicator. It seems an almost deliberate deception to shift the cause of troubling symptoms from the pain itself to the medication we take to ease the pain.

Another example:

In the 1970’s, a study came out claiming that oat bran reduced cholesterol. What was not taken into account is that people eating oat bran so long ago were also unusually health-conscious and active. That’s what was lowering their cholesterol, not eating oat bran.

Eating “health food” was only one of many obscure factors correlated with general good health (like owning running shoes, paying attention to weather reports, not watching TV, or knowing your pulse rate).

In science, such misbegotten studies are common before the underlying causes of the issue being studied are known (like knowing that bacterial infection causes ulcers, not the foods we eat), but this can hardly be said about opioids.

So, why are the negative consequences of opioid therapy being studied, but not the consequences of pain or the ability of opioids to ease it?

Pain has so much variety in its location, amount, and character that it can only be vaguely estimated from self-reports. Opioid dosages, on the other hand, can be controlled and measured. So, much like the drunk looking for his keys under a streetlight instead of where he lost them because that’s where he can see, researchers are designing studies that use opioid doses as though they were independent of pain levels because that’s what can be measured.

Chronic pain negatively impacts our health in so many ways that these studies are finding all kinds of ill effects. But all the studies are designed to attribute these detrimental effects to the opioids we take to relieve our pain instead of the chronic pain itself.

In this way, even medical science has been corrupted by anti-opioid bias due to the persistent cultural meme that “opioids cause addiction”, which has even come to be regarded as common knowledge.

In this way, even medical science has been corrupted by anti-opioid bias due to the persistent, though untrue, cultural meme that “opioids cause addiction”. This myth has been repeated so often that it has come to be regarded as common knowledge.

And that makes it the most effective propaganda of all.


I have been scientifically inclined since childhood and believe there’s always a reason for how scientific studies are designed, but in this case I’m flummoxed. I hope someone with a better understanding of current research protocols can explain away this apparent design flaw I’ve detailed and restore my faith in the NIH and its research.

Until she was disabled by progressive pain and fatigue from Ehlers-Danlos Syndrome and Fibromyalgia, Angelika was a high tech IT maven at Apple and Yahoo, and a competitive endurance athlete. She lives in a rustic cabin in the redwood forests of the Santa Cruz Mountains just up the hill from Silicon Valley with her husband and various 4-legged kids.

When her pain allows, she spends her limited energy researching, writing, and blogging about Chronic Pain, EDS, and Fibromyalgia at http://EDSinfo.wordpress.com and writes poetry to sustain her sanity.

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Authored by: Angelika Byczkowski

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Tim Mason

Justification of opioid use for acute pain straight from the CDC guideline. Jean is right.
Experts agreed that when opioids are needed for acute pain, clinicians should prescribe opioids at the lowest effective dose and for no longer than the expected duration of pain severe enough to require opioids to minimize unintentional initiation of long-term opioid use. The lowest effective dose can be determined using product labeling as a starting point with calibration as needed based on the severity of pain and on other clinical factors such as renal or hepatic insufficiency (see Recommendation 8). Experts thought, based on clinical experience regarding anticipated duration of pain severe enough to require an opioid, that in most cases of acute pain not related to surgery or trauma, a ≤3 days’ supply of opioids will be sufficient. For example, in one study of the course of acute low back pain (not associated with malignancies, infections, spondylarthropathies, fractures, or neurological signs) in a primary care setting, there was a large decrease in pain until the fourth day after treatment with paracetamol, with smaller decreases thereafter ( 1 9 8 ). Some experts thought that because some types of acute pain might require more than 3 days of opioid treatment, it would be appropriate to recommend a range of ≤3–5 days or ≤3–7 days when opioids are needed. Some experts thought that a range including 7 days was too long given the expected course of severe acute pain for most acute pain syndromes seen in primary care.
Acute pain can often be managed without opioids. It is important to evaluate the patient for reversible causes of pain, for underlying etiologies with potentially serious sequelae, and to determine appropriate treatment. When the diagnosis and severity of nontraumatic, nonsurgical acute pain are reasonably assumed to warrant the use of opioids, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids, often 3 days or less, unless circumstances clearly warrant additional opioid therapy. More than 7 days will rarely be needed. Opioid treatment for post-surgical pain is outside the scope of this guideline but has been addressed elsewhere ( 3 0 ). Clinicians should not prescribe additional opioids to patients “just in case” pain continues longer than expected. Clinicians should re-evaluate the subset of patients who experience severe acute pain that continues longer than the expected duration to confirm or revise the initial diagnosis and to adjust management accordingly. Given longer half-lives and longer duration of effects (e.g., respiratory depression) with ER/LA opioids such as methadone, fentanyl patches, or extended release versions of opioids such as oxycodone, oxymorphone, or morphine, clinicians should not prescribe ER/LA opioids for the treatment of acute pain.

Jean Price

James, I seriously do apologize if my comment has upset you. That was not my intention at all, nor was “using you” as any kind of “scapegoat, for my own input! My main goal was actually to just inform you…and perhaps any others who might not know…that opioids ARE indeed appropriate for short term pain, as well as chronic pain. And also that from what I’ve read and seen, there are very few who are prescribed opiods for acute pain who then end up addicted! It seemed to me just from your comment that you may not have known this…and I merely wanted to ADD to your knowledge from my own experience…and NOT take away anything from your comment or from you!! (I suppose that is the “teacher”value I have…and as I said, I’m truly sorry it didn’t come across this way to you.) I do realize you said you have taken Tramadol for years, (which is a synthetic opioid-like medication, because it works on the same receptors). I really was just trying to add some insight about all the opioids now under harsh scrutiny. And I think Tramadol is also prescribed a lot less now than it used to be, when it first came out and wasn’t considered to even be a narcotic of sorts, and was marketed that way. (I think there may even still be some discussion about where it fits in the whole scope of opioid medications.). I’m really glad it helps you, for sure!! You know, James, I guess I could have left my original comment at that…just stating my thoughts to meet my goal of informing very simply…and not telling you WHY I thought differently than you seemed to. Yet I figured you would want to know my reasoning behind saying this. So, I went on to explain why, from a nursing standpoint (as well as being a patient who has both types of pain!). Perhaps because I do think of this comment section as rather a forum, where we CAN offer our opinions and insights, and also support each other…by our comment discussions on the articles…as well as on each other’s comments, sharing both our personal experiences and histories and additional knowledge. You may not realize I (and others here) often address our comments to a person in particular…especially if what we have to say either agrees or has a little more information to offer them. So I wonder if for THIS reason you may have felt singled out. Again, NOT AT ALL my intention! And I can honestly say you were NOT used as the “reason” for my comment…since right now, I think any and all information we share is helpful to us all…in further understanding what is happening with pain care! So I do routinely share a lot of what I think and know and have myself experienced, just for that purpose alone! So, please accept my apology, and once again I offer you the explanation behind my response here!! (You’ve… Read more »


My heart goes out to the family of Johnna. The only blessing is that one less person is suffering from the stupidity of the powers that be 🙁

James Watkins

Jean Price
I’m very concerned you are using my comment as a scapegoat for your input – Where do i state most of you made up accusations of comment (if you even read, or comprehended) as a person who has dealt with pain for decades, has been a patient of pain clinics/specialists for decades and has taken Ultram / Tramadol for a for many tears, PLEASE DO NOT USE ME AS A REASON POST YOUR COMMENT – NOT ACCEPTABLE!

Laura P Schulman, M.D.

Unfortunately, I just received confirmation that Johnna of painkills2 has died. Another true heart killed by pain.

Cause of death is still unclear to us, her friends. I have reason to believe that she died of “natural causes.” At least she is no longer suffering.


I left out a huge part of a sentence on my previous post, my apologies. There is one of us who I am seriously concerned about since I know she’s on ac fragile thread. I haven’t seen hide nor hair of her on either of the forums where I usually see her.
Hopefully this clears up the incomplete sentence in my previous post lol


(((Hugs))) to Laura. I haven’t seen hide nor hair of on a while. Knowing that she’s been holding on by a very thin thread has me terribly worried. This torture is so wrong that there needs to be a new word coined for it! Torture seems to tame! I fear we will be trying to survive much worse before the pendulum of treating pain returns to something close to reasonable!


I had noticed this design flaw myself, and prior to my disabling pain, I was a cognitive scientist conducting experimental studies. Thanks for taking the time to point this out to people.

Laura P Schulman, M.D.

I don’t worry about being nice when so many people are being literally tortured. Another one of our pain bloggers has died. Her long, long battle with horrible chronic pain contributed to her death. I actively curse those miserable sadists who sentence our people to a life that becomes a burden to us. I curse them that they should live in pain and that they should have to live with their own “rules.” As they sow, so shall they reap.


Even though I could see the writing on the wall for many years I never truly believed just how bad the treatment of pain would become nor how quickly it would happen. People in pain are treated as subhuman by the nonfeeling robots of the system. I can only hope that karma will get each and every one of them and get them hard and soon! I realize that isn’t nice but I don’t feel very charitable while I sit here trying to decide whether to tear up my stomach some more with nsaids for minimal relief or take one of my precious few dilauded and get a little more relief since my meds have been reduced by 80% and still going down 🙁

Tim Mason

That article is still applicable today. So we must ask ourselves this question. “What has changed?”
The answer is that people changed. The mindset of professionals under 35 are opioidophibic. These Nuevo experts are only regurgitating what they have been told. They have no practical experience with pain or with people that suffer from it.
They won’t get it until they themselves succumb to a chronic painful condition.
TV media is just regurgitated misinformation.
Things are about to change for the better.
please take a look at this Dr. Schulman.


Almost everything you read on the subject of chronic pain says you need to see a specialist. I have tried many pain specialist over the years and personally have never gotten anything from them but poor treatment as a person and zero treatment for pain!

Laura P Schulman, M.D.

Hi Tim, when I read through your link I actually cried because the author of that article just…gets it!

So I headed to the Hospital for Special Surgery home page, did a search for “Pain Medicine,” and got this 180 degree turn around.

Tim Mason


I reposted the link above. It is still applicable today. The only difference is that millennial thinking is taking over education and medicine.
Pain is inherently a fact of getting old. One day they will just ask us to “Look at the Flowers” and our pain will go away.

do gfs

So very well written. And accurate. I mean while my doctor and myself understands pain,thank god. Im able to get meds that truly help. I feel terrible about patients who live the hell on earth because of being not able to fill a legitimate rx.I wonder how is it a legit prescription cant get filled baffles me to no end.
Thanks for a on point response.

Tim Mason

Very well said Jean. You really do have your thoughts organized. Concerning the malfeasance in journalism about the made up opioid epidemic (its an opiate epidemic-Heroin) and millennial thought process.
I biggest pet peeve is an article about opiate epidemic and the article shows an open bottle of Percocet, a lump of powder and an insulin syringe containing a brown liquid.
Heroin (an opiate) is not prescribed by any physician. Heroin has nothing to do with doctors writing prescriptions for pain. I do know that it is easy to convert morphine sulfate to heroin by using acetic anhydride or vinegar.
With this being said, I would like to recall the recent arrest of John Gotti who sold large quantities of prescription pain medication to undercover officers to the sum of approx. $50,000.
This is diversion on a grand scale. The missing link from the CDC statistics.
These same journalist now blame doctors for Heroin cut with crudely synthesized Fentanyl and the same photo mentioned above is shown.
Pain Management facilities practices are working and the program they use are costly and there is a tremendous amount of paperwork to demonstrate that you, as a physician, are preventing diversion of narcotics.
Last year two granddaughters brought “granny” into a pain management office for her pain. Granny’s initial drug screen showed that granny was using three drugs w/o prescriptions and also using methamphetamine and crack cocaine.
A GC/MS/MS with an ion trap detector and an LC with a mass spec detector will tell you if a patient is drinking with his narcotics, converting his or her morphine sulfate to heroin and using it. The amounts of drugs are quantified to determine if you have been taking your medicine for a period of time or just took some the day before you go for an appointment.
So, People with pain go to a pain management doctor that uses forensic chemistry instruments and techniques to separate the Good, the Bad and the Ugly.
Then there is the hair test-

Laura P Schulman, M.D.

Great response!


As I was doing some research in the pain journals, I found this letter that gives more evidence that those who take opioids for chronic pain don’t get the high that recreational users do – a hospice worker with kidney stones got morphine for intense pain – no high. A while later, got same dose but the pain had already eased – and then he felt the high… it’s a good letter, in which he calls for more study into this phenomenon.


Jean Price

James, I’m concerned you may have some MISUNDERSTANDINGS OF opioids being successfully used for years, and also that they are still truly appropriate and used today for many types of both acute and chronic pain. Perhaps this is based on your own experience of not having them prescribed to you for one reason or another!! Yet I wanted to tell you of my knowledge of all this as a nurse, and also as a long time patient. I was in nursing from about 1967 until 1993, and I have been a patient with both acute and chronic pain throughout my lifetime, plus I also know many nurses and doctors who still work who would agree with me and say…opioids ARE used to treat BOTH ACUTE and CHRONIC pain. Opioids most definitely DO help patients with short term pain, like acute pain….AND pain continuing over many months, years, decades, and a whole lifetime…like chronic pain, also. Opioids in various forms have been used this way literally for decades upon decades…if not centuries!! With good results and fewer side effects than many other medications! Opioids for medical use consist of both natural and synthetic preparations, in tablets or liquids for taking by mouth, types to use as intramuscular injections, or to be administered IV. Plus now we have some topical opioids in patches. They are used both prior to surgery and following most surgeries! AND for anyone in the hospital having moderate to severe pain from any number of conditions, whether they are acute…like pancreatitis….or chronic, like angina from cardiac issues! They are also prescribed for use at home, in doctors offices and hospitals. I’ve even given tablets or injections of Demerol, Morphine or Dilaudid…to those in the ER who came in with uncontrollable headache pain from a severe migraine…and also those with chronic pain from a number of conditions who were unable to get their pain under control during a severe flare. (This was of course some years ago…since most ERs are reluctant now to treat ANY pain!! And especially chronic pain! Yet, this is because of the CDCs erroneous mindset, and NOT because it doesn’t help OR because it isn’t appropriate!! Opioids as an adjunct therapy would still be a sound medical practice and could be widely used as such…if it weren’t for the current publicity that opioids are bad! Which they are not!!). I have also given opioid medications for any number of acute pain issues…like kidney stones, heart attacks, traumas from accidents—including automobile accidents, burns, miscarriages, appendicitis, dislocated joints, and severe muscle spasm or broken bones. It is also routine to dispense or prescribe PRN opioid pain medication for those who had severe falls, been in auto accidents, had broken bones or sprained ligaments, burns, even severe cuts or road burn. So yes, opioids WERE AND STILL ARE used for both acute and chronic conditions resulting in pain! Sadly…not as often now as needed! For either! As far as your concern and your statement that those who receive… Read more »

Tim Mason

Where did John get all these pills to sell. He did not get them from a Pain Doctor.
This is the REAL STORY. Diversion of major proportions.

James Watkins

Sally Forth, There are many other medications that for years have been prescribed after surgeries other then opiod medications – I know because I have taken them after many surgeries for the TEMPORARY pain control.. Opioids are prescribed for those with chronic pain, which is not – short term pain control. By opioids being used for short term pain control – how many people have been put on the path of addiction after taking a medication they should not of been prescribed?
Tim Mason, I totally agree the issue is heroin, which opiods has been lumped into this mess, or used as a excuse for heron addiction, or overdoses.

Sally Forth

James Watkins, what you have written, in my mind, makes you nearly as guilty as the CDC themselves! “Temporary pain control, which is not the purpose of prescription opioids.” What then, do you suppose is the primary source of pain relief after surgery? Also, you appear to be saying that the government should have started “playing doctor” long ago. Your logic is flawed, and I am angered by your post.

Tim Mason

James the real issue is heroin. Or people not being able to get heroin so they get and RX for oxycontin and trade it for heroin. It’s about diversion. They poor statisticians group heroin users with chronic pain patients getting legit prescriptions. Heroin use is up 283%. You can’t get dollars from a heroin addict so they go after the gray haired MD treating his elderly patients. The elderly physician can keep up with the red tape of regulations so he gives up.
The average age of the person overdosing is 25 years old. Guess what? 25 year olds drink a lot of alcohol. These kids and friends of kids get into mothers purse or grandpaw’s medicine cabinet and steal the medication.
Believe none of what you read and believe only the things that you see that you understand.
Think of Yahoo as the tabloid at your local supermarket. Anyone that buys ad space on there can write a news article. It does not have to be true or peer reviewed.

James Watkins

As someone who has lived with constant chronic pain for many years, I have been taking Tramadol (opioid) at high dosage for a few years. With numerous medications I take daily for a diverse medical conditions, I take medication like clockwork, to be responsible in the dosages, and out of respect for the purpose each medication has been prescribed. Over the last couple of years, prescription opioids have been controversial, with the federal government issuing stronger oversight. The medical profession has over-prescribed opiods for years, in some cases for temporary pain control, which is not the purpose of prescription opiods. The insurance industry encouraged this as prescription opiods prices fell to a all time low due to extreme numbers of the medication being produced. The government ignored the situation, as the government does on many issues, till there are issues. But at the end of the day, for people with chronic pain that do take prescription opiods, and are able to improve their quality of life with the pain control that is achieved – have been the victims of a witch hunt due to irresponsibility of the medical profession for prescribing opiods in a un-professional manner, the insurance industry that encouraged the practice, and the lack oversight of the government till a epidemic of people becoming addicted to a prescription drug that in may cases should not of been prescribed to start with, also individuals who took the medications for their own purpose, and the lack of control and oversight by the medical profession and the federal government. – Its time to stop harassing people who live with chronic pain, that take medications in a responsible manner, and are able to have a improved quality of life with proper pain control.

Jean Price

Virtually every single medication and even every medical treatment or surgery CAN PRODUCE THE EXACT SAME EFFECTS as it is supposed to treat!! For instance, radiation to treat cancer can cause cancers!! Antidepressant medications can cause depression!! Surgery to resolve a bowel obstruction can creat bowel obstructions!! XRays to detect stomach and bowel issues can cause stomach and bowel issues due to the contrast medium used!! Nausea medications can produce nausea! Anti-seizure medications can cause seizures!! Sleep medications can produce sleeplessness! Antibiotics can cause overwhelming infections from other sources! Muscle relaxants can cause muscle pain!! Steroids given for pain from inflammation can produce more pain from muscular and joint issues! Or given for life threatening reactions and conditions can produce life threatening responses! And the list goes on and on and on! So when someone tries to say opioid pain medications can produce more pain…and more problems, there can be little doubt they may have some potential! Yet for those with physical pain…any increased pain is likely due to increased functioning, since pain is relieved for several hours and the person can do more in that time than before!! How is this a problem?! Especially when increasing function can help healing plus prevent other health issues, both physical and mental!! So it’s a non issue, really!! There will always be those who take medication inappropriately for other purposes than it was intended! However, the incidence of this is extremely rare with people in pain who are legally prescribed opioid pain medication to help them be more comfortable while functioning! All these many attempts we see now to make opioids into some kind of “moral monster” that harms all who touch it are perverted, misleading, themselves immoral, and grossly unscientific!! Articles like this one expose further layers of this witch hunt and we must all fight against this stigma whenever, however, and wherever we can! Armed with our personal experiences and information like this well written article!! We seem to be the only ones who know the truth here…or are interested in it! If we fail to keep holding this up, not only will we spend our lives in unnecessary pain…yet so will others to come! Until this is stopped and sanity returns to the age old issues of caring for pain, we are likely to be assailed with more lies and more restrictions! Sad but true…and we are now outcasts and beggars in our society, asking for help from people who seem to walk by unaffected in the least by our struggles! Plus we are hassled by law agencies and our government for even asking for help! And judged as unworthy and deficient!! You could say a society’s worth is measured by the numbers and causes of their needy. If we look at those in need medically regarding physical pain…and for all other reasons in this country people aren’t able to live out their Constitutional rights… INCLUDING our well deserving veterans who are treated so abominably…our society is so far… Read more »

Carla Cheshire

This logic is just plain stupid. If opioids are the cause of chronic pain and depression I suppose that drug addicts are craving them because they love the pain and love to be depressed! And to think I thought they were doing opioids to get high and feel good, silly me.

Ben Aiken Longfellow

A little off the subject but, people who blame those of us in chronic pain “for” our chronic pain or say our medication is assisting our level of pain are badly misguided in their opinions. There are also hypocrites because none of us know for sure what we would do in any given, particular situation such a non cancer chronic pain. I KNOW for a fact that if someone, anyone, fighting daily with severe, continuous pain WILL take prescribed opioid medication to ease their pain if no other treatment helps ease their pain! What can I say? The word for these folks, good intentions, or bad toward we chronic pain patients is……..hypocrite.

Until Chronic Pain is studied as a disease that requires medication to cope with the symptoms we are going to live in fear. Pain medications allowed me to keep my career for an additional 15 years and allow me to get up and enjoy a movie with my family. I went years without adequate pain control and it was a nightmare wherein every moment was consumed by pain; whereas with medication I can have a semblance of a normal life. What I find so frustrating is I have had worse reactions & developed more negative side effects from all these so-called new miracle drugs.. Lyrica caused such severe swelling that I developed ruptured blood vessels on both legs.& now I have constant burning pain in my legs. Many of the over the counter medications made me sick to my stomach whereas the pain medicines do one thing – help me to manage my pain & be more productive. I tried all the natural, alternative methods for years, including acupuncture, biofeedback, endless painful procedures, surgeries including a complete hysterectomy – but the pain continued. I developed severe continuous pelvic / bladder pain from years of endometriosis, ruptured cysts and interstitial cystitis. The pain makes it difficult to stand or walk and I feel as though I am in labor 24/7. Since I gave birth to 9 & 10 pound babies naturally – I know what real pain feels like – the difference was once I had the baby the pain was gone, whereas for the past 23 years I have had non stop intense pelvic wall pain. I have been on the same dosage of medications for over 15 years and I will admit I am on a high dosage. There are days where the pain is worse than others, but without the pain medication I would not be able to keep on living – unless a cure for the pain is developed. I have ruptured disks in my low back that I keep under control with exercise & essential oils, but thus far the only thing that helps my pelvic pain is hot baths & pain medications. I am disappointed that most doctors simply dropped their pain patients instead of supporting their patients by standing up together against the CDC & their highly skewed statistics. I was told years ago that there is a way to simulate contractions & pain to give people an idea of what pain is like and I wish it could be used to give people an idea of what we live and cope with day in and day out year after year. The thought that I will not be able to get my medications is so stressful and I am angry that we are being put in the same category as heroin & cocaine addicts. It is ridiculous – I do not get high, and unlike addicts I do not steal, lie or abuse my medication. I am sorry there are those that have lost… Read more »


Hello. I’ve been on pain meds (mostly on) since 2009 for herniations and other back/neck issues. Recently the pain got worse. I remember Dr. Drew Pinsky talking about Opiod-induced hyperalgesia (see below). I put it to the test and recently backed off my pain medicine. Surprise…I feel better. I have less aches/pains than prior. So, is this true for everyone? No. Is it a peculiar phenomenon that actually exists? Yes.

Opioid-induced hyperalgesia (OIH) is defined as a state of nociceptive sensitization caused by exposure to opioids. The condition is characterized by a paradoxical response whereby a patient receiving opioids for the treatment of pain could actually become more sensitive to certain painful stimuli.

As an aside….

Regarding “accidental” deaths related to opioids. It seems to me that if I eat extra cookies I’m going to gain weight. If I take a respiratory-restricting medication (i.e. opioids) as prescribed – no problem. If I take twice or three times the prescribed dosage, well, it’s not an accident when death occurs. I’m puzzled why discussion about patient responsibility is not the focus of opioid treatment. It’s not about cutting back to avoid accidental death. It’s about taking your medicine as prescribed. More is rarely better in any facet of life. Just sayin.

Off topic but: https://petitions.whitehouse.gov/petition/stop-dea-and-cdc-taking-pain-patients-opiates-away-change-cdc-guidelines

The website above was found on Twitter and the 30 days is up March 7th. I was the 89th signature & 100,000 is needed. Not looking good. There are lots of reasons for the poor response I’m sure, but only 89 signatures, what’s the reason if millions are suffering ?

I’ve said this many times: we complain to each other ( most of us ). If there are 10 to 12 million Chronic Pain Patients that were using opiates every day for pain and the CDC guidelines have caused at least half or 5 million patients to be weaned off of opiates and forced to suffer quietly, 100,000 signatures should be a one day event if done properly.

Myself, over the last 3 months my IR medication has gone from 180 mg to 40 mg. I’m told once I’m weaned off completely the ER is next. My activity level is down 80 to 90% and I now have trouble just bathing and dressing myself. I am a burden to my family and to myself and often I think – now I know why some use suicide. I’m a fighter so suicide is not a route I will take and I would prefer to keep fighting until change is made. I thank god I have a family and spouse that will help me keep fighting.

I’m starting to believe the Trump ” Fake News ” allegations. The media has changed the way America thinks about Opiates and we need to affect more change, the truth.


John S

Tim Mason

Dr Debra Houry is 44 years old. She is close in age to millennial thinking (35) but is obvious brain washed by their thinking I attended a seminar today held by Fred Pryor Seminars: Title: “Dealing with Difficult People” The recurring theme of this webinar was the vast numbers of this age group that are becoming professionals with degrees, some of which are advanced degreed MS, PhDs.
For what it’s worth, it was stated that this age group of people are difficult to get along with and cannot or will not be argued with. (Not tolerated).
There were many professionals in attendance of the 6 hour webinar. Nurses, some with advance degrees, engineers of all sorts, chemists like myself, etc.
The instructor himself was 53 but had bought into the logic obviously to keep a salary and food on the table for his family.
I am not saying that all millennia’s are of this mindset and those professionals in the audience, 30-35 did not exhibit the millennial logic.
The majority of the medical audience that expressed frustration with working with younger medical professionals was told, like all of us, use the tool set we have set fort to get along with the younger generation or be prepared to leave or change careers.
It is my opinion that many young medical professionals (not all) are relying on regurgitated bad statistics.
The CDC and FDA and possibly the DEA hire the millennial because they are technically savvy and they cater to their flex schedule demands


Thank you for this insightful and excellent report.
I live with the chronic, intractable pain of Adhesive Arachnoidtitis, a debilitating disease of the spinal cord. Prior to the procedure (an Epidural Steriod Injection) that caused this, I was very active in my community with The Master Gardeners Association, along with spending time in my own yard. I was a new grandmother to a precious little boy and was looking forward to doing all the things with him that my grandparents had done with me. My youngest of two daughters was in college and my husband and I were looking forward to traveling as we were newly empty nesting. Life was good, seemed full of new adventures ahead. Besides the occasional case of the blues, I had nothing to be depressed about.
My life took an unexpected turn when I was suddenly forced into the world of chronic pain. I was no longer that person that could hit the floor running. Everything changed. My life became a never ending sea of Dr appointments, a constant struggle to get through each day, hoping for a few hours of sleep to escape the blinding pain. Depression was part of the package, how could it not be?
Anyone living with Arachnoidtitis, or any disease that causes chronic, intractable pain, knows that it is the pain that causes depression. Grieving the loss of one’s former self, troubled relationships, financial burdens, worries about the future, and the list goes on, is the cause. Not the life saving medications that allow us a quality of life.
Follow the money trail and any study will state what the intended outcome is before it ever begins.

Thank you again, I look forward to following your blog.

Laura P Schulman, M.D.

In their backwards reading of cause and effect, eating oat bran causes high cholesterol.

It’s misleading fallacious assertions like these that dupe the public into continuing to misunderstand & misinterpret “studies” regarding opioids. I’m so tired of this kind of blind so-called science.

Jesika Edith

Not all pains are the same , no all studies are meant to really get dip into the real problem … Chronic pain is a real concern up growing…
Focusing only on a group whose purpose isn’t heal pain but get high isn’t helping us at all instead is making us part of the addiction problem which we are not , we are in pain and suffering . JE #VAUEMC

Bob Schubring

THANKS VERY MUCH for picking up on this.

Obama’s hand-picked hatchet-swinger, Dr Debra Houry, created from thin air, an Accidental Deaths office at the CDC, which previously had been a federal agency tasked with preventing infectious diseases from being spread. Houry’s initial goal was to prohibit most uses of firearms. When she failed, Obama re-tasked her to attack pain patients and our doctors. She utilized identically the same junk-science methods but with great success. America’s activist gun owners joined Gun Owners of America and counter-attacked. America’s pain patients were too busy surviving, to notice we were under attack until it was too late.

Houry’s deliberate application of junk science, works thusly:

1. A pain patient commits suicide.
2. The dead corpse of the pain patient contains opioids.
3. The pain patient’s suicide note, states that his doctor is afraid to prescribe more opioids to the patient because government agents will arrest the doctor, or insurance corporations will punish the doctor, or any of a variety of reasons we’ve all encountered.
4. The pain patient’s suicide note states that Dr Houry’s CDC Guidelines are the reason she took her own life.
5. Dr Houry disregards 3 and 4 as irrelevant.
6. Dr Houry combines the fact that the dead patient has died of suicide, with the fact that the dead patient’s body contains a minute trace of opioids, to conclude that minute traces of opioids carry a risk of suicide.
7. On the basis of 6, Dr Houry prepares her remarks to Congress, seeking further research funding, to “improve” the CDC guidelines further, so as to prevent the suicides that her CDC guidelines just caused.
8. Since Dr Houry refuses to admit that her CDC guidelines caused the suicide, and instead blames the suicides on the opioid drugs she took away from the patients, any research work Dr Houry directs, will only make the problem worse.

This is an utter and total scam. Dr Houry needs to explain to a judge, why she should be allowed to hold a license to practice medicine, because what she’s practicing, is not medicine. Her actions have the appearance, that she is engaging in a pattern of genocide, contrary to 18 USC §1191, aimed at making life impossible for the race of humans who share the common characteristic of chronic pain.

Isn’t that like saying the horses got out of the corral because the gate has never been shut ?

Borders on stupidity!

John S


Nih,is only interested in negitive aspects. I believe it really has no other option,other then to report the negitive. Its actually also is written in its own protocol to like i said ,focus on the negative. Its really quite f–ked . Dont quote me ,but i believe like when they study pot,no matter how they look at it,any study will only report the negative,and when they find a positive it wont be included.
So it seems to focus on propaganda in one way or another.
I hope that babble made some sense.

Thank you all for your responses. Specifically…

Richard Oberg M.D: thank you for your compliments about me being a critical thinker and “smarter than” physicians explaining correlation vs. causation. I hope this is NOT true because physicians should know a lot more about pain than I do. Unfortunately for us, this doesn’t seem to be true.

Chritina: Yes, the differences in opioid metabolism are great and the CDC’s and other’s guidelines ignore that. I’m appalled how unscientific the government “science” agencies are.

JHaber: People simply do not believe in pain that cannot be cured, that all the highly touted “alternative medicine” treatments cannot help. I’m not sure I did either before it happened to me.

CathyM: That bibliography is full or articles on studies doing exactly what I mentioned: blaming opioids for the consequences of pain.

Kim: Common sense (real, not media-sourced) is in very short supply these days. Sadly, this seems to be true even in academia and scientific research.

Connie: It’s hard to believe that doctors can’t understand the concept that constant pain is the cause of all these problems. They simply accept the propaganda saying that opioids are causing them.

Danny: You have a good doctor if he can see past the hype and understand that chronic pain is what causes the depression. If opioids weren’t involved in any of this, research would be quite different and come to very different conclusions.

Jean: You and other readers are what gives me the motivation to work on this research and write my blog. You make me feel useful, which is a feeling difficult to achieve with chronic pain.

Marty: Yes, I am also coming to believe these researchers are not looking for real answers, but rather to show allegiance to our culture’s wrongheaded beliefs. Also, there is much more funding for these kinds of stories than the ones exposing the complexity and ambiguity of pain treatment.

Cheri Furr

This is ridiculous. They are designing the stufy to result in their desired outcome, one that would support the bew guidelines on opiods by the CDC and FDA.

Even a not-so-good doctor usually asks you what your level of pain is on a scale from 1-10. There is a lot of difference for a chronic pain patient with CRPS, for example, and s mild headache. A simple headache may be at a one, but CRPS pain is usually 10+. Until studies are designed to include the level of pain a patient is experiencing, these studies are useless. Thank you for writing this. I hope the US Pain Foundation will point this out to the designer of the study and to the medical jounal which published it!

Lynn Marie

With severe spinal stenosis and L3, 4 and 5 badly herniated, I’d be unable to be on my feet more than 3 minutes without the drugs that I rotate, so as not to become addicted or immuned. Drs over prescribe.
I take half or less of what they say. Most days I take 50 mg of Tramadol. Pain Dr says take 2 or 3 if one isn’t enough.
If I don’t take Tramadol I take
1/2 of a 325/5 mg Norco. Never take together. Or will supplement with 3 Advil.
I try to mix it up. Icing low back helps. DEPRESSION doesn’t cause Stenosis or Herniation. As once a very physical person, sadness and frustration results from being sedentary. Likely racing jet skis and fast horse riding and various falls are the cause of my condition. Stretching and swimming in warm water gives relief. Chronic pain seems
to affect thinking and organizational skills. I was an Adv. Exec at L A TIMES.
Now must write every little thing down and remember to look at it. I’m worn out so may look into Neuro surgery or hope to find non invasive surgery that’s not a scam.
Living alone is hard. Having support would help. At times I am so mentally and physically tired of struggling, I’d rather not live. Then my 4 yr old grandson calls me. Unable to take care of him.

Richard Oberg M.D.

Angelika – very well said and great post from a critical thinker….. if only the people looking at this issue were. I’ve said this before here – I’m a physician with 24 years now of bad psoriatic arthritis and myriad complications. Yanking my pain meds due to the CDC and hospital hysteria (our state regs are just fine and say no such thing – we’ve spoken with them) cost me my profession as a 30 year senior staff pathologist. I was 60 and had 5 years to go before retirement and I’d ‘only’ been on opioids for 18 years without which I’d have had to retire decades earlier – that’s how effective they are when everything else ceases to work. I’ve only been on the upper end of ‘low dose’ yet it doesn’t seem to matter anymore. Chronic pain and fatigue are consequences of my disease which any idiot can look up on any reputable psoriatic arthritis site (there are many). I don’t have Phil Mikkelson’s version of this though Enbel did help as did other biologics and systemic meds – until they didn’t. Then I needed palliative care type management meaning opioid pain meds that WORK. Whenever some study says ‘some’, ‘might’, ‘tend to’ then it should be questioned as to validity of what it’s trying to establish or it doesn’t establish anything. Physicians are being passive-aggressive about this issue and are mostly just fine with it going away – faster thru put of patients ($$$) and fewer headaches vetting patients. Many have no empathy and could care less – if you think your physician seems to have empathy because he says so then you really have no idea. Subspecialty organizations could have stepped in and stopped this yet they didn’t – why? They stop everything else physicians don’t like such as reduced reimbursements from Medicare. I’ve mostly stopped posting anything about this because I don’t feel well and it’s a waste of time – patients aren’t the ones who can speak for themselves and won’t ever get this fixed – only physicians can and they WON’T. Throw patients under the bus and claim everyone’s picking on you despite the fact that the fast majority of physicians aren’t being picked on by anyone – and again that’s what subspecialty organizations (rheumatology, oncology, medicine, etc. etc. – they all have group representation) are for. The AMA used to be the ‘go to’ but membership’s down around 20% of all physicians now and who’s voice is weak – and changed their position to anti-opioid also when the CDC physician poll came out. Our frikkin’ physician state reg people told us no one’s stopping any physician from scripting according to state regs (over 120mme’s need pain consultation) and said ‘anyone physician who wouldn’t script you for your opioids isn’t a very good physician’. So why won’t they? Patients can’t change this – only physicians can and they’re playing stupid about all of it when they aren’t. And why this talk about high… Read more »


They also need to do a studie on how patient to patient metabolism. We are not all black and white.
Nobody wants to be in pain. Depression will come with pain because a person can no longer do the little things and have to except it and for busy brains this its devastating..
This is becoming inhuman to torture patients with their own body.


So well said! Thank you so much! I have been crying this out for 2+ years when the opioid regs changed in 2014. Fibromyalgia here, (all day every day widespread chronic pain) since 1998. I was pretty successfully on opioid therapy for 12 years. I took the same low dose (5mg) 2x daily for 12 years. Perhaps I am the rare oddity but I did not develop a tolerance, they always helped me the same.

I took myself off them in Oct. 2014 because I could not bear the emotional turmoil and stress of what I might go through (what I had seen and heard many others going through) at the prospect of being sent to pain management (plus no insurance and no extra money to go through a trail and error of other Drs). Opioids allowed me to function somewhat normally, to get through most of a work day without being in misery, to do a little gardening on the weekend, go on a few activities with family. I try to manage now with a few supplements but it’s not going well. My quality of life has been drastically reduced to working and when I’m not doing the bare minimum to try and keep my pain levels down, gone are the days of gardening or outside weekend activities with family. I am not able to take any NSAID due to severe stomach distress and with no insurance for the past 9 years, alternative treatment attempts are not an option.

All through this I have always said, everyone thinks opioids should not be prescribed but what are people like me who are in pain every single day supposed to do for the pain they were taking the opioids for in the first place?

Cathy M

Thank you for this post!! Yes, I’ve seen the same bias, the same unfathomable confusion between the observed symptoms and the supposed cause. I had a huge fight over on another blog with someone who didn’t ID themselves (til the end – says he’s med. dir. for unit working with disabled workers… he gave me this biblio to “prove” opioids CAUSE increased pain. I hope this list will help with your investigations. What I find is that they quote each other in a circular fashion and their studies – as you mention – conflate co-incidence and cause, even though that is a BASIC taboo in science 101. We need to keep digging, not take their word for it, and pressure them on repeatability and study design! 1: Mitra S. Opioid-induced hyperalgesia: pathophysiology and clinical implications. J Opioid Manag. 2008 May-Jun;4(3):123-30. Review. PubMed PMID: 18717507. 2: Silverman SM. Opioid induced hyperalgesia: clinical implications for the pain practitioner. Pain Physician. 2009 May-Jun;12(3):679-84. Review. PubMed PMID: 19461836. 3: Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011 Mar-Apr;14(2):145-61. Review. PubMed PMID: 21412369. 4: Belgrade M, Hall S. Dexmedetomidine infusion for the management of opioid-induced hyperalgesia. Pain Med. 2010 Dec;11(12):1819-26. doi: 10.1111/j.1526-4637.2010.00973.x. PubMed PMID: 21040434. 5: Sørensen J, Sjøgren P. [The clinical relevance of opioid-induced hyperalgesia remains unresolved]. Ugeskr Laeger. 2011 Mar 28;173(13):965-8. Danish. PubMed PMID: 21453637. 6: Bannister K, Dickenson AH. Opioid hyperalgesia. Curr Opin Support Palliat Care. 2010 Mar;4(1):1-5. doi: 10.1097/SPC.0b013e328335ddfe. Review. PubMed PMID: 20019618. 7: Raffa RB, Pergolizzi JV Jr. Multi-mechanistic analgesia for opioid-induced hyperalgesia. J Clin Pharm Ther. 2012 Apr;37(2):125-7. doi: 10.1111/j.1365-2710.2011.01264.x. PubMed PMID: 21501205. 8: Holtman JR Jr, Wala EP. Characterization of the antinociceptive and pronociceptive effects of methadone in rats. Anesthesiology. 2007 Mar;106(3):563-71. PubMed PMID: 17325516. 9: Ramasubbu C, Gupta A. Pharmacological treatment of opioid-induced hyperalgesia: a review of the evidence. J Pain Palliat Care Pharmacother. 2011;25(3):219-30. doi: 10.3109/15360288.2011.589490. Review. PubMed PMID: 21834699. 10: Koppert W. [Opioid-induced hyperalgesia. Pathophysiology and clinical relevance]. Anaesthesist. 2004 May;53(5):455-66. Review. German. PubMed PMID: 15034638. 11: Low Y, Clarke CF, Huh BK. Opioid-induced hyperalgesia: a review of epidemiology, mechanisms and management. Singapore Med J. 2012 May;53(5):357-60. Review. PubMed PMID: 22584979. 12: Laulin JP, Célèrier E, Larcher A, Le Moal M, Simonnet G. Opiate tolerance to daily heroin administration: an apparent phenomenon associated with enhanced pain sensitivity. Neuroscience. 1999 Mar;89(3):631-6. PubMed PMID: 10199599. 13: Aley KO, Levine JD. Multiple receptors involved in peripheral alpha 2, mu, and A1 antinociception, tolerance, and withdrawal. J Neurosci. 1997 Jan 15;17(2):735-44. PubMed PMID: 8987795. 14: Wala EP, Sloan PA, Holtman JR Jr. Effect of prior treatment with ultra-low-dose morphine on opioid- and nerve injury-induced hyperalgesia in rats. J Opioid Manag. 2011 Sep-Oct;7(5):377-89. PubMed PMID: 22165037. 15: Yi P, Pryzbylkowski P. Opioid Induced Hyperalgesia. Pain Med. 2015 Oct;16 Suppl 1:S32-6. doi: 10.1111/pme.12914. Review. PubMed PMID: 26461074. 16: Ram KC, Eisenberg E, Haddad M, Pud D. Oral opioid use alters DNIC but not cold pain perception in patients with chronic… Read more »


Great article, obswrvations and points! After understanding the absurdity of it all, one can only wonder… Your examples reminded me of another expensive stupid study I read about… The team ‘studied’ whther anesthesia before a nerve block injection affected the long term efficacy of the injection… Fools! That is not the point of the anesthesia… I have had the injections with and without anesthesia so I should know. The point of the anesthesia is getting the patient through the injection process. The lead-in to the injection study talked about how the anesthesia really increases the cost of the procedure .. so their motivation was clear and their premise preconceived .. if we can show no long term efficacy from the anesthesia, then we stop paying for it as a part of the procedure because it doesn’t positively affect the long term outcome. Fools! If they dont do anesthesia to help with the crazy pain of the procedure, they wil have no repeat customers and another avenue of pain relief for some will be closed. I think all ‘study’ teams should include a minimum of 1 person affected by what is being studied, so at least one person on the team will have common sense about what is being “studied”, and resulting recommendations that will affect people who got no input on the study.


I have several degenerative diseases that cause pain and have been using opiates for pain relief off and on for fifteen years. Recently a doctor (one I wasn’t seeing for pain control) informed me that the medication was making my pain worse. I couldn’t believe my ears! Are doctors really believing this crap? If so they need to take a hard look at disease and the meaning of the word “degenerative”!


What an excellent article! I, too, have struggled with the “which came first: the chicken or the egg?” conundrum of the studies purporting to show that “depression plays an important role in the development of chronic pain”. At the time, when I first learned of one of these studies, I had been suffering from chronic, intractable pain for about 8 years. Upon reading of the study, my instant reaction was that the chronic pain caused depression, not the other way around. My doctor agrees.

I am fortunate to have a Neuro-Psychiatrist who specializes in, among other things, pain management. While I have had exposure to many pain management doctors and clinics during the 12 years before I found my current doctor, I cannot truthfully express an opinion on the quality of the majority of pain management doctors throughout the US. I honestly believe, however, that my doctor must be among the best around. He’s very informed and concerned about the current atmosphere concerning pain treatment and he’s often hired as an expert in the neuropsychiatric field to participate in civil and criminal trials.

His take on the chronic pain condition, depression and the effective treatments available are of the common sense variety. Those of us who have dealt with chronic pain for many years (26 years for me) mostly agree that there are common sensical approaches that include opiates as well as any other holistic- or non-medicinal treatments that offer relief, based upon the individual’s experience. My pain is a result of an electrical accident – I knew that I had found “my” doctor when I learned that his first undergraduate degree was in Electrical Engineering. While it didn’t necessarily make him an “expert” in electrical injuries, it did give him a basic understanding of electricity which, combined with his degrees in Neurology and Psychiatry, made him better informed about the affects of electrical injury on the brain/body than the previous 26 neurologists and other doctors I had seen in the previous 12 years.

Thank you for this article. I hope that others will benefit from it.


Thanks for this insightful post. So true, keep up the good fight. not all people in chronic pain have the energy to fight against giant entities.