The National Pain Strategy Doesn’t Go Far Enough

The National Pain Strategy Doesn’t Go Far Enough

David Becker is a social worker, patient advocate and political activist, residing in New York City, who believes the needs and concerns of pain sufferers are not adequately addressed by the National Pain Strategy. He comments often on National Pain Report stories and we asked him to share his thoughts expressing his views which we thought are interesting, provocative and worth sharing.

David Becker

David Becker

The U.S. should encourage diverse and independent thought in pain care and help to build capacity of all Americans in a way that is other-regarding. Building capacity doesn’t mean the average Joe will think just like someone from the American Academy of Pain Medicine (AAPM) about pain care. To the contrary, Americans need to be much more fluid and flexible in their thinking than members of the AAPM could imagine.

Too many Americans in pain have been marginalized, disenfranchised, and left to suffer from a pain care system that for too long has been one rough beast. Yet, remarkably, politicians believe more of the same biomedical research – the cures initiative or precision medicine will work.

People like myself,  who have seen the failures of the decade of the brain, (where Dr. Judd in the 1990’s claimed we would “largely conquer mental illness by the year 2000”) and the last decade of pain research and control, are ignored because we are doubtful “a new and improved” biomedical pain care will make a difference. And so the government and the experts turn their heads when they are faced with opinions that are vastly different then their own. When you look at pain care in the last decade, new and improved drugs and treatments have done little to lower the prevalence of pain or the satisfaction of pain sufferers.

A new and much more sophisticated model needs to be developed – and there is no recognition of such from the power elite. They neurotically believe the same old deference to powerful special interest groups is the answer to everything as they see those groups as a well sharpened Swiss Army Knife that can be used for any problem. The only trouble is we aren’t lowering the costs or prevalence of pain – not to mention those special interest groups don’t even care about such.

Think about this for a moment – over 12,000 RCT’s have been done on opioids. Last year a report sponsored by NIH indicated they lack evidence for chronic non-cancer pain – so what is the government planning to do? More research on opioids. Why not do more research on anti-convulsants or lasers or ultrasound for pain, instead? Why not give a fair and full chance to other treatments for pain? From where I sit, it’s clear to see our government isn’t about helping the many people in pain – they wish to help the health care industry grow regardless of how Americans are hurt or helped.

And so discursive imperialism from the AAPM or the American Pain Society or those “professional voices”  is just another reflection of their failure to get it right when it comes to pain care. And so, from where I sit, it is plain to see that pain care in America is not about Americans suffering from pain – it is about managerialism and social darwinism. People in pain will remain an underclass due to the longstanding indifference and managerialism of power elites who don’t engage in reflective practice. And that magic “soma” dream they have will only drain the financial resources of our Nation.

Since inquiry is not obligated to the words of authorities, so I will continue to fully and freely explore our pain care system.

Let us hear from those at the margin, let us have the benefit of independent and diverse thought about pain – that’s what a vibrant democracy is about – and that is the best way to remedy those in government and industry who would make all Americans ripe for their ill-conceived designs.


Editor’s Note: The deadline for public comment is May 20th. You can leave your comments online. Here’s the link.

Authored by: David Becker

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Stephen M

Kurt W.G. Matthies, please stay out of my head! Just kidding, but seriously your comments perfectly mimick my thoughts.


Kurt- the person in pain should be given the sole right to decide what treatment they receive. It shouldn’t be up to a doctors, the DEA, the government, etc.After all it is not the doctors pain or the dea’s pain.
Infantilizing people in pain will not build their capacity to make decisions that work for them.
UDT is a moral outrage- it is outrageous to force people to such- given how unreliable the tests are and the dire consequences the test can have on peoples lives.
Kurt I hope you will let the powers that be know, that people in pain are a disenfranchised underclass that should be given a front seat with the NPS and any program that deals with pain. Until people in pain have a front seat at the table- more of the same poor pain care will continue to thrive at the expense of individuals in pain.


Agreed 100% opiates have worked for me for 15 yrs now there’s studies that support both sides of the efficiency of long term NMCP i think it depends on the individual and if it works for said individual then it should be left alone there should be a UDT done on initial start of treatment and unless there is reason to be to believe that abuse or diversion is present then only then should chronic pain suffers be treated like they have done something wrong not every month we should be considered innocent until proven and documented otherwise it sucks to be treated like someone on felony parole or worse with being called in for pill counts smaller cut off rates forced to sign contracts that have us give up our privacy rites just for a medical treatment that is the only thing that works for alot of us

Kurt W.G. Matthies

David, I have to agree. There are so many ways that patient concerns have not been addressed.

We’re still hearing propaganda almost daily — statements like “Now we know that opioids don’t treat chronic pain effectively.”

Yet, mllions of patients who are able climb out of bed and maintain a job, only because they are prescribed daily opioid medication, know that a statement like that is just plain nonsense.

We place so much importance on peer-review in medicine, yet papers like:

Portenoy RK, Bennett DS, et. al., Prevalence and characteristics of breakthrough pain in opioid-treated patients with chronic noncancer pain, J Pain. 2006 Aug;7(8):583-91.


Simon S, Bennett DS, et, al., Breakthrough pain in opioid-treated patients with neuropathic pain, J Opioid Manag. 2006 Nov-Dec;2(6):347-52.

are conveniently ignored.


Because studies like these, that recognize the efficacy of chronic opioid treatment in these cases of chronic intractable pain in non-terminal patients, fly in the face of efforts to minimize the importance of this important treatment option for the suffering millions.

Maximum morphine equivalent daily dose recommendations fly in the face of basic research on opioid tolerance and dosage requirements for long-time opioid tolerant pain patients.

Monthly UDT protocols drive up costs of care, and when used in combination with controlled substance agreements provide a “trapdoor” mechanism for releasing patients from a practice, too often without proper weaning or detox.

How many physicians using UDT understand the pharmacokinetics of opioid metabolism? The thousands of chronic pain patients who have been released due to false positives or false negatives in UDTs have been traumatized and lost at sea when it comes to further pain treatment, too often without cause. They didn’t break the rules; their physician didn’t understand the results of the test.

Is it ethical to bill for a diagnostic test that you don’t know how to interpret and in turn provide scientific feedback regarding results?

Is it ethical to release a patient from a prescribed treatment that causes dangerous withdrawal symptoms, especially in our growing elderly population, without providing for medical management of those symptoms?

Until issues like these are addressed in our treatment strategy for chronic pain, patients’ interests are not fully represented, and therefore the public health is being poorly served.


Well,,with as much respect I have for the author,,,my own thoughts as a chronic physical pain person is,,,most of us have been forced to try all kinds of ,”ways” other then what works,,which is a medicine called opiates.,,Someone once said to me,”maybe you don’t want to try something else,”??Well I have tried many other things,forced biofeedback,forced shrink,which stopped as soon as they found my tumors,,forced electricity currents,ie,”tens unit,,forced nuerotin,forced fentanyl,forced hydrocodone,,to list a few,,Now at any time if I said ,”NO”, I would not of gotten to the pain medicine that works,,ie a opiate medicine.Same dosage for 10 years now,,,,It took 5 years to get to that point,,to get the right amount and right combo that works,,,So if someone is going to ask me to try something else,,why??? So I can suffer in pain again??why would I do that to myself after working sooo hard and long to finally find what works??? The self evident truth is,`10-12 years ago pain management was no-where near as bad as it is now a days..No forced pee in this cup,,no forced contracts nor spending your money u don’t have,or no medicine,,The self evident truths are,10-12 years ago,,,”our” government was NOT in our private medical issues,,Once they illegally gain access to our private medical issues,,they sought to control us,our medicines and our Doctors,and literally started to kill the sick,with all the hoops they make people go thru now a days,and inturn forcing people to endure their physical pain more,,and that simply isn’t possible,”the more”,,so people started ending their physical pain by death,,The government got involved with our private medical issues,,thats why pain management is a mess right now,plan and simple!!!!”Our” government is soo busy coming after the sick,the old,the doctors that treat us,,that they don’t pay attention to things like over 1 million pain killers being stolen in Baltimore pharmacies,,,but that’s ok,to them,,they just took down this Doctor Ibsen,,soo its good!!!Our government involvement into our medicines is ass backwards,their NOT doctors and it shows,,Their rules,regulations are because they have blurred the lines between terrible street drugs,and our MEDICINES,,which is why their not doctors,and have no business playing doctor..Conscentrate on the true criminals, like thieves in Baltimore who stoled over 1 million pain medicines in those riots or any other pharmacies being robbed..Stay out of my household and my private medical issues…. When anyone forces another human being to endure physical pain by definition that is torture,,and torture has no place in our so-called civilized world,,What I really would like to know is why does anyone think they have that right to project torture onto another human being??Why does a so-called professional,ie doctors,e.r. staff,medical personel think its their right to allow another humanbeing to suffer in physical pain when they have the means to lessen that physical pain???..i could never stand by and watch someone in agony,,how&why do others think they have that right to make someone suffer???J.m.o.,,3 things have killed more people then any pill,bullet,,or bomb,,,Arrogance+ ignorance+poisen pens of propaganda,,,have killed more people,,,and will… Read more »


America is a Oligarchy a recent study at Princeton University has proven not a vibrant democracy (we were supposed to be a democratic republic) so us poor disabled people are at the mercy of the government (or lack there of) state and federal to take what we get from Dr’s that go by there guidelines and laws at the time as they change
The problem is that the government is our private medical care if they would leave it up to Dr’s and paitens make the best decisions for individual paitens and what works best for the individual is how I would like to be treated government should have no say in how my doctor treats my pain only me and my doctor need know that private information unless it directly harms another then it should become a law enforcement problem between victim and patient

Since I’ve gone to my 4th or 5th doctor at the Lexington VA Hospital since 2013, I thinking I’ll do a sampling of just how incompetent one of the largest government powers that be are. I had been on pain med for 15 yrs instead of repairing the problems with my knees and back. I found out I had hep C at the VA. They have done one thing right I think? I took a 12 week course of the new meds they have out. Now I have a gallbladder that’s full of stones and a comprised liver. I can not have the gallstones removed because of some issue with the connecting blood vessels. My visit today was a complete waste of time. When I spoke of my problems. The internest as she “call herself” told me I had no problems with my knees or legs and if I would loose 50 pounds I would feel better! Easy for her to say when I can barely walk or move without constant severe pain. I can’t tell which would be better a bottle of booze to kill the pain. The VA has hooked me on PAIN Medicine and now when I try some other alt. substance (Pot) for pain relieve, I’m slammed. I was concerned about the amount of pain med and all the things that go with the long term effects. And so now I can get no doctor to give me even the smallest about of meds because they are afraid of loosing their licence to mal-practice with the VA system. Everybody is afraid of the DEA. Well here is One person that is not!!!! Who made them over doctors with years of training (supposedly). I would have never served my country, nor it’s civil service system had I known what I know now. I would have no contact with any of the alleged medical profession, who are more worried about their licence, then improving lives. All I said was I want to go back to WORK and have a meaningful life with what’s left of it. It this seems like a rant to you than it is!!!!