Pain Academy’s Response to Surgeon General’s Opioid Pledge: “Come to terms with chronic pain”

Pain Academy’s Response to Surgeon General’s Opioid Pledge: “Come to terms with chronic pain”

by Ed Coghlan

Since the CDC Guideline on Opioid Prescribing was released what has rankled many in the pain community—doctors, patients and advocacy organizations alike – was the lack of options to opioid prescribing.

The Academy of Integrative Pain Management added its voice this week in criticizing the Surgeon General’s Opioid Pledge.  It coincides with an op-ed published in USA Today from AIPM’s immediate past president, Dr. Robert Bonakdar.

Last week, the Academy of Integrative Pain Management (formerly the American Academy of Pain Management) held its 27th Annual Meeting, educating attendees on a broad range of non-pharmaceutical treatments they could use to effectively, safely, and sanely treat patients in pain. Given the national furor over opioid prescribing, the meeting provided timely alternatives for nearly a thousand participants.

Dr. Bonakdar is Director of Pain Management at Scripps Center for Integrative Medicine and Assistant Clinical Professor at UCSD School of Medicine. He addressed the evolution of alternative pain treatments used around the world and showed how they may inform and improve access to and quality of US pain care.

In the USA TODAY, Dr. Bonakdar wrote, while over-prescribing of opioids and lack of insurance coverage for non-pharmacological treatments are problems, what the Surgeon General really needs to address is more fundamental – in the US, we have difficulty dealing with chronic pain.

“Chronic pain is a complex scenario that not only affects the back or shoulder, but one that over time can shrink the brain while creating or worsening fatigue, insomnia, depression, anxiety, obesity and risk of suicide.  The pain transformation called for by the IOM and most recently the National Pain Strategy requires not just a campaign, but an integrative, patient-centered approach to support someone whose entire existence is affected.”

The Academy of Integrative Pain Management has been a leader in advocating this approach to pain care since 1988 by training and educating clinicians. In addition, it is the only organization with three staff working full time on policy and advocacy at the federal, state, and local level to assure patients have access to integrative care that is paid for by insurance companies.

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

newest oldest
Notify of

Dear Doc Anonymous,
You are either an especially gifted physician or you are a chronic pain sufferer…or both.


We have
Our own special
In heaven
Just waiting for us
And we will tell each other stories…
Ooohhh lawdy

Truth Seeker

Good luck finding an Attorney for this. I think probably an Attorney, who’s willing to file a class action lawsuit, on behalf of chronic pain patients being denied proper pain meds would have to be the one for this.
Perhaps CDC and all the rest of the Alphabet Org. should do a serious, honest, study/research on the amount of suicides, by chronic pain patients, who simply can’t take the pain any more!!!
I belong to seveal support groups, for Invisible illness, RA, MS, AS and more. Administrator of one. It’s sad whenever we lose another member, who wants to live life, like You and I. However, their quality of life, or existence depends on pain meds, to allow this. When they’ve been denied this and exist (not live) every day, with constant, grinding, nonstop, excruciating pain and NO ONE is giving them answers, or helping it becomes a vicious cycle. Sadly, some feel there’s no way out.
Someone, somewhere, alone, or collectively has to do something.
People are dying everyday, due to constant, or intractable pain
Tired of getting half truths, from the Alphabet soup.


Dear fellow “Pain Warrior”
I too belong to/Facilitate a Pain Support Group. I am sooo very very sorry to hear of your friend. It is heartbreaking and tragic..
And that’s exactly what I was indicating in my remark below. God help us and bless your friend’s wife and children. I send sympathy. Maureen

I am currently TRYING to find an ATTORNEY who still has a SOUL and that’s BRAVE ENOUGH to “sue” the FDA, CDC and DEA!!! Still HAVE NOT FOUND ONE out of the 53 attorneys I’ve contacted across the US! Lol! It’s COMICAL how NO ONE has BALLS ENOUGH to set PESIDENCE!! 😅 What a JOKE!
We’ve got Doctors practicing ONLY for a paycheck NOT HELPING their patients THEN when HAVE/NEED to go to get an attorney for HELP they’re ALL MORE CONCERNED about their BUSINESS and how the repercussions that may be entailed WOULD AFFECT THEM

Steve M


Thank you for saying what so many of us have gone hoarse and given up expressing. Ib know you don’t reply back to comments, but I hope you read this and know you’re not alone. My wife and I have both had chronic pain since early childhood and were unceremoniously discharged without cause. We also have a young daughter. Sometimes, we both struggle with the question off whether she’s better off with us as invalids for corpses.

If you decide to pursue a lawsuit against the DEA, surgeon general, and CDC for mistreatment for human rights violations and make it a class action, I know plenty of people who would be willing to be additional plaintiffs.

I sincerely pray that you people who are trying to strip us of our basic right to reasonable pain management end up with a severe chronic pain condition & I pray that when you disparately seek help from the doctors who are supposed to help you that they treat you like trash & either deny you medications and tell you to take Tylenol or that they under treat your pain by giving you just enough to get out of bed to walk to the bathroom. I’m so tired of living & I’m only 25 and have a 2 year old child that I can’t play with anymore because all doctors are making us cut back on our much needed medications that by the way I’ve been taking the same dose for 12 years & never had an issue yet people like myself are being punished in a monstrous way because of the selfish drug addicts who won’t ever stop looking for ways to get high. Why is our nation attacking the most vulnerable people who should be getting the most love and support? I think it’s basically like what the nazis wanted to do to the disabled or anybody they felt was not worthy of life. I feel that we are being targeted by our nation to try to make us die from complications from untreated pain which there’s plenty of evidence and research that demonstrates that udertreated pain can cause death in many ways and if nothing else many will choose suicide over a life sentence of torture. If America takes away the only thing that takes some of my severe pain away then America has killed me because I’ll choose death. I will make lots of you tube videos first though naming names and since my husband works at a tv station it won’t be hard getting it to ho viral if it ever gets to that point. I’d like to live and see my child grow up but not if I’m confined to my bed, in constant, uncontrollable pain which makes me less pleasant to be around and basically I’d feel like a burden no matter what anyone else says. For me, that’s not a life I can tolerate for another 60 years. Lets get real America! Drug addicts will find something to get high on no matter what. They’re hopeless unless THEY choose to change themselves which sadly is not common and America should offer free, long term drug treatment if we really cared about addiction. All these laws and restrictions on pain pills is only going to hurt innocent people who really need it and deserve to be treated with compassion and respect instead of making people feel like criminals. It’s ironic too since I’ve never even seen weed or any illegal drugs in my life and have played by the rules my whole life and worked hard and got my college degree and never got into debt, never even got a speeding ticket and… Read more »

WEEELLLL, I’ve come to “terms” with my pain, we’ve had some pretty heated discussions about “WHO’S TRULY IN CHARGE” of this body and guess what?!? PAIN said “HAHAHA I’M IN CHARGE NOW DUMB*SS!!” Then continued to say “I’M GOING TO DICTATE THE AMOUNT AND FREQUENCY OF PAIN YOUR IN FOR THE REST OF YOUR LIFEEDBACK AND YOUR TOO WEAK TO FIGHT ME HAHAHA!!!”👹👹👺😈👹👺
Sooo guess who WON?!?!


Pain Warrior

All I want to say at this time and I have a lot I could say iS our pain/diseaae support group lost another member to suicide, about 8 weeks ago.
He left behind a wife and 2 young children. REALITY CHECK! !!!
He could NOT take the pain anymore.
This ia what we’re going to see a lot more of, with pain patients being denied access to their pain medications.


To Adrienne: Yours aren’t “real medical issues”? – Lord help us. Maybe only diabetes and heart disease are these days. I completely understand your refusal to see doctors. Years ago, I started to realize that in many ways we need to be our own. I know a lot of it is the system, but not all.

One thing that is heartening to me is that there are several doctors who frequent this site whom I believe truly care. Most recently, a post by Dr. Kutzner made me kind of sad, as he expressed downright anger at the pain so many are in and actually felt the need to apologize for his colleagues. It is just a crying shame there aren’t so many more.


The Surgeon General is a pompous a**! First off the CDC didn’t release guidelines, they released recommendations that Doctors are now hiding behind because, as I was told recently, “They now have more time to spend on patients with real medical issues.” I have been from KC, Kansas to Wichita trying to get care for retrolisthesis, collapsed disc, moderate stenosis next cauda equina bundle, facet joint disease (L4-S1 totally gone) et al. I have heard three different procedures in which each God complexes doctor has said the last shouldn’t have recommended it. Wtf is that?! I know more about my back issues then most specialists. I NEED a two tier fusion with discectomy replacement because I have no height at all in the L4-S1. I’ve jumped through their hoops here for the last 5 years and finally was told I’m high risk for addiction with no explanation. I rarely even drink and I vomit if I take 10mg of Norco at once…really? I’ve dealt with my back for eleven years which started at age 29. I had an eight pack due to how physically fit and strong my core was.

I refuse to see any more doctors EVER! KS is refusing to pass MMJ which doesn’t work that well because if I take to much or smoke it I vomit for hours on end, in which I have already laid out a five year plan to get my affairs in order. I’m so goddamned tired of fighting and feeling useless while life happens around me. I wish to all those that haven’t experienced this type of pain to have it bestowed upon you or your loved ones and be denied proper management or to be told it’s in your head so just deal.

Cherryl Brenner

Doc Anonymous I agree.
I for one fought for 10 years to NOT use opioids, as a form of treatment for chronic pain. Finally I had to give in to have any type of physical capabilities. I’m trying to keep the ability to take care of myself, ie everyday living.
I don’t enjoy sitting in a lab @3 months, for liver panels, due to pain management. I’ve had so many other forms of treatment, since 1995, to ko avail. Nothing is any longer working, but the opiods and I’m still in a certain amount of pain with them.
I do find this article misleading in many ways. They are not honestly addressing the true chronic pain patients
This is not a “one size fix all” situation.
How about Doctors, who are also chronic pain patients their self have some input on these articles????

Tim Mason

My place kept trying to throw Cymbalta at me. I knew better because I had tried every SSRI there is. I took Paxil for three months and it finally got to where I could not even write my on name. One Cymbalta capsule threw me into a three day deep depression. I could not get my head out of my lap.
I got an odd call from a head pharmacist at the Walgreen headquarters. She asked me why I let someone prescribe me Cymbalta. I told her the docs kept saying its different, its different. I told her I asked the local Walgreen pharmacist about it and he acted “weird”. She said our records indicate that you should never, ever take an SSRI.


Don’t forget the violent,evil and psycho pot smokers.
In a way we as pain patients have asked for some of the treatment we have gotten by the medical community by accepting being forced to sign pain contracts, submit to piss tests and pill counts, being forced into painful and mostly useless procedures, being forced to see shrinks and not refusing this treatment. I am as much to blame as anyone because, like you, I was desperate for relief! Where has this submission gotten us? We are treated as less than human drug addicts! The real addicts will continue finding ways to get high and we will suffer or join their ranks. I fear there is no answer since it is quite obvious that the powers that be just plain don’t care! I have refused psychiatric intervention because I am neither crazy nor CLINICALLY DEPRESSED. What depression I do have comes directly from the lack of treatment I deal with and the fear that what little pain control I have! Talking about it and taking dangerous drugs that have terrible side effects isn’t going to change that! I can only pray that the tiger will change its stripes and this horrendous cr*p will end. It would be awesome for someone to come up with a miracle cure that wasn’t worse than the disease but am not going to hold my breath since I don’t look good in blue!

Bernie Stevens

It is embarrassing to hear the CDC, FDA & PCP’s mock us in Chronic Pain. But what bothers me the most is spreading this venom to Colleges, Pharmacies and any lay person that can’t help but to listen. A lot like the brainwashing of communities about the dangerous & creepy Tobacco user. Having people turn on each other is a sad state of affairs in this Country that demands Independence & individual choice. It is my choice to stay pain controlled or take my changes with new not yet proved remedies. You have no right to decide how much pain I can tolerate. You would not deny a patient oxygen, why deny them a decent life. Do not put the addicts life in front of mine.

Jo Anne Robarts

At my Doctors request, I cut my opiod use in half. Before this I was able to do volunteer work at our local St. Vincent de Paul store 15-20 hrs per week. Now I haven’t been able to do that.
16 yrs ago when the Fibro made me practically bed bound for 1 year, I refused to take opioids for fear of being addicted. Our University Hospital pain clinic convinced me that I needed to take them and there was a difference between being addicted and being dependent. So I gave in and my life became functional again. I have never abused them. I can’t understand how they can now take that away from us.
Will they “get it” when we all hide in our homes and start committing suicide?
I wish they could find a way to go after the abusers without penalizing those of us that need it.
Yes, spend one month living our lives. Only then should you have a say about this.

Prefer anonymity

There is also a point that nobody wants to acknowledge. Addiction or misuse of opiods seems to be among the biggest fears. Re : addiction. Some of us have questioned this about our own use, especially when being accused of it by most medical practioners, well meaning family and friends – not to mention employers. Truth is dependency, severe chronic pain, “acceptable meds” and unplanned withdrawal can all resemble addiction in how a person behaves. So then we are forced into agonizing withdrawal and it’s stigma along with our source of pain not having magically healed…..the addict label is reinforced. So we doctor shop (a red flag for addiction or misuse) because we are abruptly dropped from our current pain doctor. We beg and grovel for this truly life allowing medication. We lose friends who don’t want to be “enablers” We lose all credibility even with those who are close. Yet we read the truth in ourselves well. We don’t have cravings. We would love for any of these alternatives to provide the pain relief opiods do. We work constantly at being responsible opiod users. We lose friends, family looks at us much differently. We lose jobs and careers. We don’t even want to go to other doctors for the rest of our medical care because we have the knowledge that we will need to justify and defend our opiod use all over again (even risk them trying to persuade a competent, humane pain doctor like I am finally blessed with, to go down the “get them off opiods” road.) The really FUNNY thing I notice is when I have an appropriate stable medication regime, people start congratulating me on how well I am doing (in other words, ” you must be off opiods” Little do they know…..


@Doc Anonymous, ‘Thank you’ and bravo for your fine post on our behalf,
and of your own professional feelings.
It is always a heartfelt comfort when I see a Doctor, such as you, write with understanding and support of us. You are a brave soul to speak for us and I appreciate you very much.
Please continue your walk along side us….we need more of you and Doctors like you to support us.


Very few people who do not live with chronic pain can even begin to understand that this is not something that is going to go away no matter what! Living day to day with horrific pain and knowing there is no light at the end of the tunnel isn’t like having surgery or a broken bone that will heal in time! Those idiots who think they know everything wouldn’t even understand if they lived a week in our bodies because they would know that the pain will end at the end of that week. Most of us have tried everything else without success and the ONLY thing that gives us any resemblance of a life are opiates! Some of us, God forbid, require large doses in order to survive. The only thing I can do is to hope that those opioid Nazis someday face what we do and because of their stupidity can’t get the ONLY relief that opiates give us! I find it hard to understand how they can be so blind and deaf to the evidence of what thousands of people in pain are trying to tell them!

Hyaden Hamby Jr.

After two back surgeries which I was advised by the orthpedic surgeon would reduce my pain level by 70%, I am in chronic pain. If it were not for pain management facilities I would probably not exist. I am in pain standing, lying, in a recliner, or even with water therapy ( suspended weight). I have been in business for 38 years which I could not have done without medication. I have been through ALL alternative therapies and I do mean all. Maybe opiate derivatives are not the best way to control all pain, but it has been a lifesaver for me. I ask the authorities to place more confidence in the doctors who are in pain management. I realize that not one size fits all so to speak, so the across the board reduction in the dispersment of pain mediation is not the answer. In a perfect wotld no one would be in pain, but 100 million or so …….are in pain in the U.S.A. on a daily basis and wish nothing more than to be an active part of their family, an opportunity to work without the stigma assocaited with pain management patients. However one thing at a time. If the authorities insist on reducing or even removing the medications that are helping those of us in non repairable or non curable pain it simply will open up more problems. Drugs to control pain have been here in the form of natural or herbal pain relievers forever. To remove or reduce medication from chronic pain patients will reduce the possibility for a person to actively pursue gainful employment, to possibly defend themselves, to rise and vote, to pursue a role in politics, and reduce or negate the pursuit of hapiness just to name a few things people take for granted. Oppression?, from the authorities to those who have no criminal record, worked and were good citizens all their lives unless they wer born with a disease that caused pain from the inception of life? I do believe that the only ones who truly understand folks in chronic pain are those in chronic pain.


Angel, your post sums things up well, in my opinion. “It’s terribly depressing.”

Daniel Hartsgrove

AIPM is gadget pumps therapy ect. They have no use for essential narcotic pain meds. Again we see someone “anonymous ” posting here with cancer. Don’t let the “guidelines ” fool you. All cancer suffering are included in the “guidelines “. It just saddens me that this person would post anonymous. I too suffer from stage 4 along with many of my fellow warriors this shows these “guidelines ” are being misused to the fullest. True legitimate chronic pain should not be compared to each other. We need to put a name and face on cancer patients in order to correct this huge failed inhumane barbaric war.

Anonymous sufferer

I have stage 3 metastatic malignant melanoma with no primary source. Yes it is skin cancer,but with no primary source it means it started on the inside somewhere. It is the rarest form & quickest spreading of all the skin cancers. I have a lot of pain,most days are 10+ on the pain scale. I already have a difficult time getting the opioid pain meds due to the everyday limit already being cut. I used to get 6 a day,now I get 4. They have tried adding non-opioid meds to the opioids but they didnt help & 2 of them I had a severe allergic reaction to. I have tried everything but only the opioids help,well as best they can. If more are taken from my daily regimen I wont even be able to get up & walk in my home or out in my yard. People who have never had excruciating pain on a daily basis do not know nor understand that taking the meds from us they are harming us,not helping us. Isnt the 1st line on the doctors hypocratic oath “to do no harm?” If they do this to us they will be harming us.


More of the same. Those healthy individuals addressing what should be done for those of us living with chronic pain and disease. At a certain point I think we all know we will be unable to get our medication we will be condemed to an existence in agony trapped in our beds and homes. If alternative treatments worked I would not be on opioid therapy I would’ve preferred to not ever have known a diseased life suffering silently while everyone dictates what should be done with the likes of me. It’s terribly depressing.

I’ve ran the GAMUT with taking narcotics these past 7 years. From the onset of this “dysfunction/disease” NOT KNOWING what was wrong with me doctors kept prescriding MORE AND MORE narcotics to combat the pain! This poor body has ABSORBED and BUILT A RESISTANCE to MAJORITY of pain meds! NOT BY MY CHOICE but NO-ONE LISTENS to people that are on Pain Management!
When a person signs papers for pain management they SIGN AWAY EVERY RIGHT AFFORDED TO THEM BY THE AMERICAN CONSTITUTION!! The GOVERNMENT OWNS YOU NOW AND THERE’S NOTHING YOU/I CAN DO ABOUT IT! The SYMPATHY/EMPATHY care you once received from your DOCTOR turns into SUSPICION/CONDEMNATION!!! NOMG longer does the”Hypocratic oathe” ALL DOCTORS TAKE of “FIRST DO NO HARM” Takes on a whole new meaning! Now ‘first do no harm” centers around the DOCTORS CARRERS (do no harm to MY CARRER by staying under the GOVERNMENTS radar!!)
WELL THANK YOU!! (Extremely sarcastically stated) When will our GOVERNMENT OFFICIALS get it thru their THICK SKULLS that THEY DON’T HAVE THE MIDAS TOUCH! EVERYTHING they stick their NOSES in and “TRY” to fix only CREATES A CLUSTER F@&%!! Now sooooooooooooooooooooo many people are left SUFFERING!
Here’s a HEADS UP for you, PAIN DICTATES/OVERRULES a person’s LOGICAL THINKING!! The ONLY thing they want is to RELIEVE PAIN and ONE WAY or ANOTHER they’re going to either search for pain medication ILLEGALLY (creating a different EPIDEMIC) or COMMIT SUICIDE (also creating a different/bigger EPIDEMIC) SO your the ONLY thing your ACTUALLY doing is CREATING MORE EPIDEMICS!!!


Tim Mason

At my age I am considered Geriatric Patient. NSAIDs are not advised for this group of people. 49% of this group have diagnosed arthritis. 41% have hypertension 31% heart disease Any cancer 22% Diabetes 18%
This group is getting larger every day. I think 10,000 people turn 65 every day. The results of inadequate Analgesia are:
Reduced quality of life
Decreased appetite, poor nutrition
Impaired sleep
Mood disorders, particularly depression
Risk of disability, inability to perform ordinary activities

Denial of pain treatment, including medications for pain can be considered a form of “Elder Abuse”
reference Pergolizzi, et al. Pain Practice June 2008


Why are there 3 positions for integrative care advocacy and noone advocating for appropriateness of opioid therapy? (A rhetorical question..answer: follow the money”) “Appropriate” is subjective. My “appropriate” is the ability to be off the couch, able to perform activities of daily living. I don’t want to snow ski. I want to take a shower without severe pain. I have had 2 failed back surgeries and many steroid injections. I’m the patient noone wants. I am, thankfully, prescribed enough opioid medication to handle the baseline pain that never leaves me. However, there was no increase in my pain meds, despite using and having used all of the integrative therapies you can name, for my most recent flare of arachnoiditis. So I remain on the couch with 9/10 pain and hope that the flare passes and that living on the couch, in severe pain, is not my new normal. God help me if it is.


I’m sorry but…really?! ‘can shrink the brain’?! and…just ‘three’ staff working full time?!
That’s all we are worth to them folks! Over 100 million people in Chronic pain!
When will they entertain the thought of ‘talking with and learning’ from us, the suffering chronic pain community?!
I understand that this whole issue is extremely complicated for them given the issue of the abusers but still…. I just don’t get it.
When will they come to understand that most of us have already been through all the integrative approaches?!
There is no going back, it doesn’t work for folks like us!
Just last night…as I was lying in bed in heightened pain, I could not emotionally let go of the negative effects that all of that this has on me.
I’m so tired of dealing with the pharmacy and the doctor, monthly. Being treating wrongly and having the fear of having no medication.
I could not fall asleep, I could not shut my mind off. I hate being in this situation.
I grieved for the perfect pain management that I used to have for many years.
But, overall…. I want to be whom I used to be…without constant pain.
Yet, I know that without my medication, I could not live in that horrific pain.
As I see the movement of rallies and marches beginning… I continue to hold on to HOPE, we can still have hope. Keep strong warriors, and don’t back down!

Stephen M

What do people who don’t respond to those treatments do? Most of us tried these gimmicks, but opioids work and these don’t for many of us.

How can you publish such an informed article? It appears that no one thought it might be informative to explain that these treatments, regardless of insurance coverage, are nearly useless.

So many of us fought opioid prescriptions for years, back when the pain wasn’t completely debilitating. We’ve tried all of these supposed alternatives. They aren’t FDA approved and opioids are.

Doc Anonymous

I agree that the Surgeon General’s letter is misleading at best and serves to suppress needed treatment of people already tortured by incurable chronic pain. But Dr. Bonakdar also ignores the real CHRONIC nature of incurable pain. His editorial states that there is no evidence that opioids have added any benefit. But that is because the studies have measured the wrong thing. People who have OPIOID RESPONSIVE CHRONIC PAIN do not get “cured”. They do gain the ability to participate in more of life’s simple activities that non-chronic-pain people take for granted: Simple things like going shopping for necessities for an hour, being able to attend family events, maybe go to a movie, and for some even the ability to work! And the use of opioids may also contribute to decreased activity induced flare of pain that can be caused by these activities.

Those are the gains that opioids give to the opioid responsive chronic pain patient, but they are not the gains mentioned in Dr. Bonakdar’s Op-Ed. And the Surgeon General is oblivious to these aspects of chronic pain management, and thus he is really not qualified to be the Surgeon General of ALL the people.

I do agree with Dr. Bonakdar that we have a problem in the US with managing chronic pain but we have a more serious problem with understanding the true nature of chronic pain. And all resources seem to be going into a “NO OPIOID” campaign. From my 25 years of treating chronic pain patients, virtually all tried and/or used some form of alternative or “integrative” treatment. We do not need to reinvent that issue for the patients. We do need to reinvent it for those in power to control the treatment of people in chronic pain.