The Opioid Abuse Crisis; an Opportunity for Those with Chronic Pain

The Opioid Abuse Crisis; an Opportunity for Those with Chronic Pain

by David Nagel, MD

author, “Needless Suffering, How Society Fails Those with Chronic Pain”

Those are rare who fall without becoming degraded; there is a point, moreover, at which the unfortunate and the infamous are associated and confounded in a single word, a fatal word, Les Misérables.

– From Les Misérables, Vol III, Book VIII, Chapter V

Jean Valjean is one of the great characters of literature.  As the protagonist of Victor Hugo’s Les Miserables, he finds a way to triumph over the evil of his fellow man. He becomes a true hero, one who takes the gifts he has been born with, develops them, then uses to them to help all those around him to make the world a better place.  His journey starts in poverty.  He is desperate and he is hungry, as is his widowed sister’s family he struggles to support.  One day, tired of his hunger and theirs, he commits the unthinkable crime of stealing a loaf of bread.   Unfortunately for him, his sister, and her seven children, he ends up in jail.  His punishment for his crime and his multiple attempts to escape is 19 years in prison.  We are left to imagine what happens to his sister’s family.  The gross injustice of a system merciless to the poor destroys 8 lives.  It almost destroyed a 9th.  Jean leaves prison a changed man, a mere animal only existing to survive, oblivious to the cares and needs of those around him.  He is a creation of that system, and the system is oblivious to its sins.  The remainder of the story is a running battle between two sinners, Jean, a sinner soon to be turned saint, and the system, represented by Javert who would rather die than repent.  It would appear that Jean is headed for no good, but then it happens.  After stealing from a kindly bishop, he is offered a gift, one that confounds him.  The gift is the bishop’s mercy.  A simple act of kindness in an unfriendly world changes our sinner into a hero, one who spends the rest of his life paying forward this gift to all those he comes in contact with.

There is nothing abstract about this story.   It happens in our country every day.  In 1862 Victor Hugo wrote:  “So long as there shall exist, by reason of law and custom, a social condemnation which, in the midst of civilization, artificially creates a hell on earth…so long as ignorance and misery remain on earth, there should be a need for books such as this.”

I love my country.  However, we are not without sin.  We lament our past injustices to Native Americans, African Americans, women, homosexuals, Jews, and others.  We seek to fix the sins of the past.  Yet, I would argue there are others who remain persecuted.  I would argue that our social policies over the last 100 years have made an unnecessary living hell for both those who suffer from chronic pain and from addiction.  Currently, 35-40 million Americans suffer from what has been referred to as “high impact” chronic pain.  2.5 million Americans suffer from some form of “opioid abuse disorder.”  For most of the past century they have all been treated like criminals, imprisoned by an ignorant system lacking in mercy.  For those addicted, hope is on the horizon.  The social policies designed to help those addicted only harm those in pain.  What is needed is a change in perception, a cultural transformation, to de-stigmatize the stigmatized.  This modern day Jean Valjean seeks mercy.  It is my contention despite all the mistakes being made in public policy to combat the “opioid abuse crisis,” there is hope for those in pain.  In writing Needless Suffering, How Society Fails Those with Chronic Pain, it was my hope to bring attention to the needs of those who suffer, too often needlessly, and to suggest meaningful public policy to bring hope to the hopeless.  Too often we trivialize pain management as merely medication management.  It needs to be so much more than that and it can be so.  It is my hope in writing this book that I can help effect that change.  As I have written and talked to so many people about this issue, I am struck by how ignorant most people are about this problem, how myopic they are about the potential solutions, and how oblivious they are as to how we got here in the first place.  As George Santayana has said, “Those who cannot remember the past are condemned to repeat it.” To create a better future, let’s take a moment to look at the past.

The Beginnings of Opioid and Cannabinoid Policy in America

The late 1800’s and early 1900’s were a very different time for drug policy.  In a sense, one could have thought of it as the wild west.  There was no strong regulatory oversight, and snake oil salesman abounded.  Medical theories at the time suggested that disease was the result of too little or too much stimulus, and opium had the ability to effect this.  As a result, opium was the most prescribed drug by physicians, and could be prescribed for all sorts of ailments.  Parallel to this medical use was a growing problem with non-medical use.  Opioid addiction, iatrogenic and not, became a growing problem.  Some in the country viewed the problem as a security threat because those most commonly involved were males between the ages of 25 and 45, those of fighting age.  During this time, it was recognized that the treatment of opioid addiction was the regular administration of opioids, ie maintenance therapy.

Both home and abroad, both in administrative circles, it was felt that something needed to be done to control the opioid problem.  Physicians were losing faith in the power of opioids to treat, well, everything, and policy makers increasing looked as opioids as a scourge.  Prior to 1904, control of medication was largely relegated to the states.  That changed with the Federal Exclusion Act of 1904, which made importation of opium illegal for any but medicinal purposes.  The most notorious federal legislation was the Harrison Act of 1914 and subsequent related judicial actions which placed great penalties on doctors who prescribed indiscriminately.  Similar legislation in the 1930’s championed by prohibitionists and corporate interests competing against hemp presented to a largely dis-interested Congress resulted in a similar prohibition of cannabis.   The results were predictable and unfortunate.  Addiction became a crime punishable by sometimes absurd prison time.  All but the most courageous physicians were afraid to prescribe opioids for anything but acute pain.  Those complaining of chronic pain had a character flaw, a psychological diagnosis not worthy of respect.  The reaction of patients and addicts was predictable.  Those seeking help from their suffering took to the streets to get it, creating millions of “Jean Valjean” criminals, their only crime seeking relief from their suffering.

Those attitudes were clearly taught when I was in medical school, and, to a large extent it is my observation they still exist today.  While I do not work with those addicted, my pain patients struggle to find someone willing to care for them, their struggles aggravated by an increasingly bottom line driven, fragmented health care system the doesn’t have the time to care and a medical education system that doesn’t see chronic pain as a problem worthy of research or treatment.

The Tide is Changing

            By the 1960’s, it became apparent to some, that legislation on opioid addiction was not working and that addiction was not a crime or a personal weakness, but a medical condition worthy of compassion and treatment.  A  White House Conference on the issue was convened in 1962, and that led to a change in how addicts were treated.  Those in pain would have to wait a while.  In 1985, Kathleen Foley published an article advocating the use of opioids for end of life care, and 1986, Dr. Foley and Dr. Russell Portenoy, both from Sloane-Kettering, followed with a similar article demonstrating efficacy of sustained opioids for those who suffer from chronic, non-malignant pain.  In a sense, these articles served to open a flood gate for legislative action.  In 1998, the Federation of State Medical Boards published its guidelines for opioid prescribing which were subsequently accepted by all states as rules or guidelines.  In 1999, Congress passed the Pain Relief Promotion Act which encouraged prescribers to compassionately treat pain.  The decade of 20001 – 2010 was designated as the Decade of Pain Control and Research.  While I would argue that these actions largely fell under the radar of most people, they served as an important foundation for what followed and what is yet to come.  In 2009, the Pain Care Policy Act was passed as part of the Patient Protection/Affordable Care Act.  This directed the Institute of Medicine to study the issue of pain in America and make formal recommendations for social change in managing this issue.  Released in 2011 and entitled: “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research,” the report directed the department of Health and Human Services to create a National Pain Strategy, which was released in 2016.

Simultaneous to these developments, though was what has been called a growing opioid crisis.  I would prefer to call this as an opioid abuse epidemic as I would argue we simultaneously have problems with over and under prescribing combined with a shifting of preferred drugs of addiction to more dangerous forms of opioids.  To help combat this crisis, many states passed feel-good legislation which has had the unfortunate effect of harming those suffering from chronic pain.  Such legislation has not helped addicts in the past either.  The net effect remains to be seen for either group.  At the federal level, though, the Federation of State Medical Boards passed updated guidelines in 2013 and the Center for Disease Control Passed opioid prescribing guidelines also in 2016.

Where is the silver lining?

The recent behavior of state and federal authorities towards opioids has harmed many pain patients.  I see the results every day in my office.  The reality is that our options for treating pain are limited, and opioids are an important tool in this battle.  So, the question needs to be posed to these authorities, if you are limiting access to opioids, what steps are you willing to take to help develop other options for care?  This is not a new question, and perhaps it will receive greater emphasis as a result of the opioid crisis.  It has been my observation that in colloquial terms, pain management and opioid prescription are too often viewed inter-changeably.  It is also troublesome the needs of treating and preventing opioid abuse supersedes that of those who suffer from chronic pain, even though the ratio of those who suffer from high impact chronic pain to those who abuse prescription and non-prescription opioids approaches 20 : 1. For example, recently President Obama provided $100 million of federal funds to address the opioid abuse crisis.  At the same time, pain researchers are literally begging for money.  That needs to stop, and statements within the FSMB guidelines, the CDC guidelines, and the National Pain Strategy all call for this to happen.  All include similar statements that acknowledge the conflicts that occur between public policy for addiction and chronic pain, but demand a balance between those policies.  The FSMB guidelines outline two important issues:

  1. Undertreatment of pain is recognized as a serious public health problem that compromises patients’ functional status and quality of life.  A myriad of psychological, social, economic, political, legal, and educational factors—including inconsistencies and restrictions in state pain policies—can either facilitate or impede the ability and willingness of physicians to manage patients with pain
  2. While acknowledging that under treatment of pain exists, it must be understood that chronic pain often is intractable, that the current state of medical knowledge and medical therapies, including opioid analgesics, does not provide for complete elimination of chronic pain in most cases, and that the existence of persistent and disabling pain does not in and of itself constitute evidence of under treatment.

In short, there is no universal understanding of or treatment for chronic pain.  Chronic pain is its own disease state that results in substantial bio-psycho-social disability which is aggravated unnecessarily by an ignorant and or un-caring social hierarchy.

The National Pain Strategy is an extraordinary document which seeks to correct these problems.  It acknowledges the problems with opioid abuse, it points out the deficiencies in our ability to care for those who suffer, and it offers a 6 point strategy for remedying these deficiencies by addressing:  1) population research,  2) prevention and care of chronic pain, 3) disparities, 4) service delivery and payment, 5) professional education and training, and 6) public education and communication.

What is also exciting is that for the first time in my career, patient advocate groups are standing up for their rights.  The Chronic Pain Advocacy Task Force has outlined four core beliefs which are being accepted by other groups including the National Pain Strategy:

  • Chronic pain is a real and complex disease that may exist by itself or be linked with other medical conditions.
  • Chronic pain is both an under-recognized and under-resourced public health crisis with devastating personal and economic impact.
  • Effective chronic pain care requires access to a wide range of treatment options, including biomedical, behavioral health and complementary treatment.
  • Denying appropriate care to people with chronic pain is unethical and can lead to unnecessary suffering, depression, disability and even suicide.

Please note that these beliefs, created by individuals who suffer from chronic pain, are calling for a much wider number of care options including self-management programs.  While they recognize that opioids will always be an important treatment option, and the process to receive them should not be egregious (as it is in too many states now), the word opioid is never mentioned in these core beliefs.

Another exciting development has been the creation of state policies for medical cannabis, directly challenging federal authority.  Cannabis and cannabinoids have great potential as therapeutic agents for pain, and at least 15 percent of pain sufferers risk government reprisal by illegally obtaining them for self-medication.  Federal policy about cannabinoids has never made any sense, and has unnecessarily harmed millions of individuals.  The head in the sand attitude of the federal government is being challenged by consumer advocacy groups, state legislatures, and medical groups such as the AMA.

Much is happening, but much needs to happen.  Pain patients are treated as pariahs by doctors, who often refuse to care for them.  They are treated like criminals in a court system which views them as guilty until proven innocent.  They are discriminated against in a workplace which views them as cost and risk averse.  They are the targets of unsavory snake oil salesmen both in the medical and non-medical settings.  And so on.  These things also need to change.  In Needless Suffering I outline 16 social institutions and how the behavior of each adversely affects the lives of those who suffer from chronic pain.  More importantly, I offer solutions for the problems created.  My goal is to broaden the social discussion on chronic pain beyond opioids and bring a sense of dignity to those who suffer.  In promoting this discussion, I would like to see an end to the legion of Valjean’s who suffer needlessly and a destruction of the Javert of ignorance.  In doing so, I hope, like Valjean’s bishop savior, to provide mercy to the need and a sense of hope to the hopeless.  I welcome you to join this journey.

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Authored by: David Nagel, MD

There are 49 comments for this article
  1. Tim Mason at 10:41 pm

    Sandra, we could, send letters to major media when they run a lopsided story about “Opioid Crisis” with their mal statistics. Boycott them and any product they advertise. When you see an article in a news paper or editorial, WRITE BACK. I do this all the time.
    Get your facts down with references and write back. In your spare time you could write your own letter and send it in. You know that old saying; “The Pen is mightier than the Sword”. There is a lot of truth in that. Take Matt Lauer for instance. He just repeats a story written for him and reads it with emphasis like it is absolute fact. These people cannot not respond to an intelligent question. The people the interview are carefully selected. Take Newt Gingrich for example. He is banned from Fox news for the way he shut down Megan Kelley this week.
    These figures tell lies and have people swear to them. I have an article here from a women’s magazine. It was written by a very bright socioeconomic researcher about how the biggest risk for addiction is youth and how practically no chronic pain patient (1% maybe) is addicted to their medication. I put a link to it in one of these threads this year. I think people are beginning to wake up and realize that much of what they see and hear on TV is a half truth and not factual. One celebrity overdose on booze, OxyContin and wow, all of a sudden anyone that has ever see a table is subject to addiction. These shows are entertainment, much like the tabloid at your grocery store checkout line.

  2. Tim Mason at 6:36 pm

    I think, but I am not sure, each pain management place is allotted (allowed) so much MSContin, Percs, Hydro, Fentanyl ect each month. Perhaps they watch for an increase. What I am suggesting it this: They can’t or won’t move someone from Percocet to OxyContin until an OxyContin patient leaves on his/her own or via an exit strategy.
    Look up Exit Strategies in Pain Management.

  3. Sandra G at 3:16 pm

    Ok we have all got our stories. We have been treated badly. Now what do we do. .?
    Each one of us has to stay on track. Hard to do with pain. We have hire an attorney. Each one must be able to put in a small amount even ten dollars.
    We can’t keep telling our stories. Well maybe we do have to talk to each other we have no one but our selves. That’s good. But please we ne Ed a attorney a good one to fight for us or this will never be over with. We will lay in pain until we die.
    Please we need help getting this organized. I don’t see any other way. Please input ..do you have another idea.

  4. Sandra G at 4:26 pm

    I wish we could put the state everyone comes from.

  5. Sandra G at 4:24 pm

    I live in Washington state, Olympia. Please don’t com here if you have chronic pain. You are treated so ugly if you have chronic pain.im in my late 60 ,s . I have been in pain for over ten years. About a year ago my doctor stated I needed to increase my pain medication. With same doctor for long time. Six months after that she said can’t give you pain medication, done. You need to go to Pain Cente. In this state they want nothing but money. These people are real monsters.
    That brings me to additional issues. Please look up Guildlines for Palliative Care. I went to a local Palliative care place . They follow no Guildlines for Palliative Care. They make up want ever they want to do to you. You have to go once a month in a room with five or six people drilling you. Chaplin , Dr, nurse. Social worker, pharmacist they have way more than this each month. Both of these places are about 8 or 9 thousand a month. This was told to mr by another patient in the waiting room. Also others have mentioned this.
    Well to top it off they let you stay in pain. What the h–! Uncaring people. The doctor I have says some things to me that I consider rude and does this with a smile. So you hurt ,hurt, hurt with no one to help you. If one person knows one doctor I can go to that treats me like a human being please let me know. I get so sick sometimes. I don’t know what to do.
    Sandra
    Washington

  6. Kristine at 12:17 pm

    I think you hit the nail on the head when you said,

    “Denying appropriate care to people with chronic pain is unethical and can lead to unnecessary suffering, depression, disability and even suicide.”

    I’ve been living with chronic pain for 16 years. I am active in a few online support groups, which help some I guess.
    The unnecessary suffering and depression are with all of us.

    Since the pain specialists and doctors have their hands tied and can’t prescribe the correct medications for chronic pain patients, there is talk and thoughts of suicide in almost each one of us.

    My thought is that is this the governments way of killing off a huge group of people. Maybe they think it will better our healthcare system if there were less chronic pain patients.

    It is absolutely unethical in letting us suffer daily. It’s also unethical to have our loved ones and caretakers suffer while bring helpless in their efforts of trying to help us be more comfortable, and watching us suffer.

    This is all very sad.

  7. Catherine Rusk at 9:14 pm

    Marijuana and Kratom are both needed to be available for chronic pain suffers. There is medicinal value to both. We need these natural herbs. They work

  8. Tim Mason at 6:32 pm

    Perhaps the Government will round us all up like they did the Five Civilized Tribes and put us on a Reservation in Southwest Colorado. Free land, housing, free cannabis, Sweat lodges, hot springs, etc.

  9. Deborah Dollard at 10:09 am

    On top of everything else, the DEA is trying to place kratom tea as a schedule I controlled substance which will effectively ban it. So many chronic pain patients have already lost access to good doctors and the pain medication they need to have a life that they’ve been forced to look for other options. Kratom should be kept legal so that chronic pain patients have somewhere to turn when their doctors won’t (or can’t) help them. We deserve the right to have our pain treated, one way or another – safely and legally.

  10. Maureen at 6:34 am

    Dr. Nagel, It is wonderful to see you here again. I’m loving reading your book…your words, information, teachings and compassion are all very welcoming and educational.
    I’m halfway through your book and am learning so much.
    But, most of all… just to know that there is a doctor such as you out there knowing and understanding us and our Chronic Pain helps me a lot emotionally.

    It is amazing to read the comments on this page…and find that so many people know my own sufferings. It’s almost surreal to me that so many of us suffer in many of the same/simalar ways. How could the government ignore us?!!

    Pam, you have basically told my story also. I am you. I’ve experienced all of that you have, and still do daily. Hang in there.
    Keep strong and if possible for anyone… go to the rally in DC on 10/22.
    I’m unable to travel but I sure wish I could be part of the movement!! I will be there in spirit and praying for all!

  11. Pam at 4:14 am

    Hi Tim, In re-reading your comment, by high risk, you mean to have my blood monitored, i thought you meant about suicide, Funny you say that, last December I also wrote my neurologist a letter with everything I go thru, and how well aware I am of what the CDC, DEA and government are doing, I also had suggested to him that I should be tested for that genetics test to determine if how I metabolize meds. It fell on deaf ears. Just trying to get into a “pain clinic” is next to impossible. I have been searching on internet for intractable pain drs in NJ, only found a handful and what I don’t understand is why they only take cash, no insurance. Im disabled and cant even keep up with rent and utilities, i surely cant pay out of pocket for a dr monthly plus the treatments they do like prolotherapy which is not covered as well. I did see a pain dr in NYC in December to see about taking over, but I decided I couldn’t do it as the commute into the city was to much for me and I worried if it were bad weather and I couldn’t get there, etc, I can’t drive very far, after about 15/20 mins my back locks up and the electric shocks shoot down my right leg, my right foot feels as if its going numb with pain and to much to lift the foot from gas to brake, I don’t have anyone to help me either. Again, thank you for taking the time and responding, Have a nice day!

  12. Pam at 2:04 am

    Tim, Thank you for even reading my long rant. Not sure what you mean by high risk? Just so you know I woukd never hurt myself, My kids are my world and I would never hurt them that way. My daughter is married, my son a teenager and I am all he has. I can’t tell you how many drs I have called thruout NJ and continue to hear the same things, “not taking pts”, ” don’t treat with meds”, ” go to detox”, and so on. That spinal cord stim thing, Won’t be going in my back anytime soon. I’ve heard more negative than positive about it. My brother had it done. did nothing, He actuaally had another back surgery in Dec and winded up with MRSA and apparently it came from the SCS, so the surgeon says. It’s very upsetting when we have years of medical records, have tried everything our bodies could take, I am thousands and thousands of dollars in medical debt from insurance not paying for alternative therapies. I try not to overwhelm myself b/c it causes the pain to rise,Most times I don’t even know where my sons next meal is coming from, cant keep up with rent, the ship is sinking fast. When I exlain to my dr what’s going on, how I do not sleep/eat due to overbearing pain and the stress of everything else, im told that can’t have pain medication and anxiety meds together, have to make a choice. Our healthcare is a huge shameful disgrace.

  13. Tim Mason at 4:29 pm

    Pam,
    Sounds like you need a pain management professional that specializes in “high risk” patients. I don’t mean that in a negative way. You are one of those whose blood levels need to be monitored until you are sufficiently comfortable. You need to look for some one “Board Certified”. Ask around. Ask your GP to help you locate such a doctor and go interview him or her first.
    I am on my third Pain Management doc and he is ok. Most of them you have to let them feel like the boss and make the calls. Mine pushes the Spinal stimulators but my leg pain is tolerable with medication. Those devices are the method of last resort.
    Hope you find someone…soon.

  14. Pam at 10:53 am

    I have reached my breaking point. I suffer from CRPS/RSD, sciatica, severe stenosis, three herniated discs which I will not allow any surgeon to ever cut me open again, ive had two failed spinal fusions that left me with severe nerve damage, never again, neuropathy, radiculopathy, osteoarthritis, fibro, DDD, cervical disc degeneration, migraines, anxiety, depression just to name a few. Ten very long years I followed all the rules, did everything I was told to do by the medical community. When my fusions failed, ill never forget the look on my surgeons face when I expressed to him the amount of pain I was still in, worse even then before surgery. That arrogant jerk treated me like I was lying, pushed me off to pain management again and started all the dam alternative therapies all over again. Over two years of PT, massage, chiro, accupuncture, water therapy, epidurals, all kimds of bs meds that did not work, OTC and nsaids that tore ky liver and stomach up, over the past four years i had well over 175 very painful facet injections, trigger point injections, si joint injections that intensify the pain, do not work but in order to get the low dose meds they must be done. Years ago when I was with the most compassionate pain dr ever, he had me on the correct doses of meds that worked and finally i was able to function, never painfree, the pain was tolerable, I enjoyed life. I enjoyed doing things with my kids, cooking for them, walking my dog, showering daily, sleeping in my bed which is on the second floor. Then the DEA targeted him, took everything from him, left his patients with nowhere to turn. I had panic attacks daily as i could not find a dr to take over. I was treated like a drug addict, awful things were said to me over the phone by the many drs i called, from people who never saw me or my long history of debilitating incurable conditions. I literally was ready to run my car over a bridge. I finally found a dr who I am with today. Upon the first visit my meds were cut back. But what was I to do, noone would take me and I had lost all hope. I was on the same stable dose for many years, the pain was tolerable and most importantly I had a QUALITY OF LIFE. Over a year ago my meds were lowered even more, muscle relaxers were taken away, and I have been in a torturous hell ever since. My dr has made degrading statements to me. Last December I could not take it anymore and pleaded to be put back on the mg’s that worked, Of course his nasty comments came, telling me i was bargaining to get pills. Made me sick. He finally agreed to the mg’s that worked but no more than three a day! I cannot go eight hrs to take a pill. Ive tried many times, like yesterday, by seven hrs i was doubled over in pain, i could not walk, the burning pins and needles in my right foot was excruciating, my back felt as if it were being crushed by a burning concrete slab with burning pins pressing into my back. Last dr visit i had he gladly injected my right knee and I was unable to walk for nearly two weeks. Every time I would my knee felt like it was snapping. Our government is killing us!! If I didn’t have my kids I would take my life without a doubt, but id make sure i left letters so my death would not be labeled an OD. but a death due to inadequate pain relief!! The damage the DEA, CDC, FDA, PROP and our corrupt government has caused to millions of legitimate pain pts is unacceptable. Then of course when a pt is stripped of thier lifesaving pain medication, forced into severe withdrawal, they are treated like drug addicts, disgusting! I feel all these corrupt officials should have to make their pharmacy and dr records public for themselves and loved ones, There is no way in hell that none of them depend on opiods for a quality of life, no way. They all have thier private drs/pharmacies right in their back pockets. They don’t jump thru hoops or get degraded or Discriminated against. All they do is make a call, get whatever it is they need and continue to lead a functioning life. I really hope the whistleblowers will come forward and expose them all. Clinton for instance takes thyroid and allergy meds, wonder what would happen if she were denied those meds!? I read heartbreaking stories daily from fellow intractable pain sufferers and it makes me sick that many are being forced to the streets for relief or worse suicide. This past week I have heard of ten pain sufferers who took thier life b/c of the actions by the government, DEA, CDC, FDA and prop. DENIED LIFESAVING pain medication, forced to exist in excruciating pain. I am physically, mentally and emotionally exhausted. I get maybe two hrs of sleep , I have lost so much weight as I never have an appetite and trying to cook anything only intensifies the pain. My teenage son is lucky if I am able to make him a homemade meal once or twice a week, he eats alot of frozen foods that go right in the microwave or oven, he never complains, but me, the guilt of not being the mom he needs me to be is tearing me up. ENOUGH IS ENOUGH! I urge all of you to get as many people as you can to get to the rally in DC on Oct 22 @ 10am. For registration. and details go to rallyagainstpain.com. Our voices and faces must be seen and heard, If you are u able to go, please sned your story to the website to be read at the rally. SHAME ON OUR GOVERNMENT AND THIER SIDEKICKS! May karma get a hold of them all, may they know what suffering in severe pain 24/7 is like and get nothing for relief !! May they all get abused, neglected, degraded, mistreated, discriminated against and forced to suffer til they die.

  15. Moira at 6:50 am

    Many Traumas based causing relentless chronic nerve pain is trivialised, yet it is ignored. I have been told that it is a non life treating illness.
    So, so wrong.
    When you are not acknowledged and told you just have to live with it by so called professionals.
    Wrong
    It is not liveable

  16. Anomyous at 1:48 am

    Steve,
    Doctors tried me on SSRI several times. I took Paxil the longest 1 month. I became so shaky I could not check out of a hotel or drive myself home. Recently, my PM-PA said all he could offer me for anxiety from pain was Cymbalta. I declined it. Choose me a new GP within a month and he prescribed it for me. One capsule and my weekend was shot. I went back with my medication list from my neurologist and he re-prescribed Valium for me. My new doctor poured over my records and said, “I wish I had seen this earlier”-“This is what you need”
    Ironically, I got a call from a corporate Walgreens Pharmacist and asked me about the Cymbalta and I told her my reaction. They must have been a flag in my records for SSRI’s and I got a feeling that something major is about to happen to this drug.

  17. Barb H at 7:48 am

    I’m so tired of not being able to live my life. 3 years ago I was taken narcotics and muscles relaxers for back surgery, I also have migraines, fibromyalgia, bilateral knee replacements. I was living life at a pain level of about a 3 on a daily basis. But now that the government has put its nose in my Dr office I’m now on a 1/3 of the medication I was on and now my quality of life sucks. Im at a level 7 on a daily basis and treated like an addict by doctors, ER physcians, and even pharmacist. People that are cruel to animals go to jail. But licenced Dr. can treat me like this and get away with it, then wonder why suicide is on the rise.

  18. Steve at 7:45 am

    One point I think I would like to add to this forum. It sure appears to me that they have absolutely no trouble offering, and in many casing forcing or trying to force people into other kinds of more dangerous drugs. There are a whole lot of connections between a bunch of mass murders and other evil things with ssri’s and certain classes of mind altering drugs. They insisted over and over that I take them and Dave is right, they could care less about any of us or what we must endure. They don’t have to live in solitary confinement in the pain prison so who cares!
    The only reason they have been jumping on this band wagon against us is because the mothers of the dead and others don’t hesitate to run to the politicians and really apply their time and effort to demonize these medicines, when it was their offspring,most likely, just thought if you take them by the handful you can stay high not understanding how this stuff works. I’ve been taking these 44 years, since they were kind enough not to care much about people getting killed in war, and I never thought about adding too much of these and everything else risking death. Maybe I’m wrong here but I’ve known so many who did things in front of me that defied reason showing and even telling that they were just trying to get wasted. The real pain patients don’t seem to want to fight for their rights or it is just a small portion. I have told a few I know to stop venting out to me and either call or write someone involved. To this day they never ever have.

  19. Thomas at 7:02 am

    Not to mention , Drive Through Beverage Stores where the Beer is cold and the soda is warm, this is an attack on the citizens plain and simple. They are claiming they are concerned about the heroin epidemic but far more people die from alcohol , so what is really going on. ? They take a substance like Kratom and make that illegal, while also taking away pain patients opiates , of course pot also works for pain but i certainly could not take that unless it was in a pill form and didnt make you feel high. I hate feeling high. Its bizarre they seem to be forcing people to the streets? they are creating a new crisis and adding to a crisis , but really what is going to happen is Suicide. How cruel it is to think someone can function on a few little pills to get them to work, to get them out in the yard to play with their kid but the government will take this away and make them a cripple . God this country is a mess and absolute mess. Every avenue a man or woman has to get pain relief is being taken away, what do they think is going to happen? We need the Chronic Pain Patient Protection Act written into law now.

  20. Dave at 5:37 pm

    @ Tim Mason- Youve made some great points. Its remarkable how we are treated as stray planets in our own world. Were strangers in a strange land where the powers that be are so self centered and selfish they are forcing the life force out of us It seems whenever someone in pain pens their mouth- a doctor, a politician, a lawyer, etc is sure to have problem with providing a respectful hearing to our cncerns and needs. As Anais Nin wrote we dont see the world as it is- we see the world as we are. And so our institutions can only see people in pain as some thing that must reflect their version of the world and their needs- and not the needs of people in pain.
    We need to breathe fresh air and reverse the absurdities and cruelties that the powers that be have created for people in pain.

  21. Tim Mason at 4:33 pm

    It is common that if you have to explain anything scientific to a politician you need to keep it on a fifth grade level.
    Even drug courts laugh at our words like methyl ethyl ketone, or para-aminophenol, esters, phenyl acetic acid, etc. But we laugh not as such words as tort or sid pro bono.

  22. Pingback: Great Post re: Opioids & Pain Patients | Painfully Positive
  23. Dave at 5:30 am

    If options for treating pain are limited- its interesting that the author fails to consider that doctors and medicines failure to develop and utilize many treatments is the cause. Even John Bonica said that between 1800- 1960 there was little conceptual progress in pain care. Did government or anyone else prevent medicine from developing more treatments for pain? This was medicines fault- not governments. In 2009 the Texas State Pain Alliance indicated there is a massive failure to assess and treat pain. Government is not forcing doctors not to assess and treat pain. And just a few months ago Senator Gillibrand wrote a letter to the Secretary of DHHS calling for research on objective evidence for pain- for she and other Senators know doctors failure to assess and treat pain is due to an old prejudice called the medical gaze. So its clear medicine has been tragically neglectful of pain. Dr Nagel doesnt wish to pin the blame on doctors for prejudiced careless and cruel pain care that exists today-after all he’s a doctor and its clear to me he is more concerned about protecting medicine than prooting the good of people in pain. He has no vision and just like his colleagues who wrote the NPS- it was yours truly and one ther citizen whoo called for lowering the prevaelnce of all painful conditions.
    He wishes us to believe pain care problems are due to “the system” and not due to any medical organization or individual doctors. He doesnt want to talk about the fact that even with free education on opioids- promoted by the FDA- most doctors refused the free education. He doesnt want to talk about the fact most doctors have little or no education in pain care. He doesnt want to talk about the fact that doctors stigmatize people in pain, wite prescriptions that insurers dont pay for , call people in pain catastrophizers, malingerers, drug seekers, hypochondriacs, menopausaland now they refuse to provide opioids- though no law requires such. And if they cared so much about opioid based pain relief- how come the AMA has sided with the CDC guidelines- has government forced them to not oppose such. How bout the APS -where is there opposition ot the guidelines- will they be at the rally against pain next month- think again. Doctors are go along to get along and dont wish to be inconvenienced by the needs of people in pain. Nagel hasnt called for stiff penalties for discrimination in pain care. He hasnt called for people in pain to be board members of the AMA or AAPM or APS. He hasnt called for people in pain to be on advisory committees at NIH or FDA or DEA. Dr Nagel- like s many in medicine wish to be held blameless- they dont like admitting their profession made serious mistakes.
    Thats why doctors are still part of the problem in pain care- they are too proud too certain to admit their role in the opioid mess. Go to KEVINMD and see the piece on opioids by Dr Juurlink- see the comments doctors have made on how problems with opioids and pain care arent their fault- they of course had noting to do with it.
    Its shameful that Nagel instead of advocating his profession develop much more effective treatments and much greater variety- instead wishes to condemn government for their opioid policies. And unlike Dr Nagel- I have financially supported the rallyagainst pain and been asked to speak on eliminating the restrictive opioid policies. So i am against restrictions on opioids= but unlike Dr Nagel i see the problem as the moral and mental laziness of medicine toward people in pain. Proof of such can be seen in the National PAin Strategy- which missed the boat on childrens pain, elderly pain, multimorbidity in pain care- to name a few of its short comings. I didnt see any cmments on the NPS made during the comments period.
    Talk is cheap in pain care, Doctors will tell us how important pain care is-but when it comes to walking the walk- well its clear they not only have failed Americans in the past- but they dont intend on picking up the pace to improve pain care anytime soon. They continue to snore with the most profound security despite a ruinous pain care system.

  24. Tim Mason at 5:07 am

    Universities now graduate Chemistry majors with Chemophobia as a mindset and Medical Schools Graduate MD with opioidophibia mindset. I have witnessed it.
    The American Chemical Society (ACS) hosted a webinar a few weeks ago on Chemophobia- Why we have it, where did it come form and what to do about it.
    You could honestly replace the work Chemophobia with Opioidphopia..
    25% of the problem is with education 25% of the problem is with ignorance and 50% of the problem is with all forms of media.

  25. Tim Mason at 4:51 am

    Interesting note here about DEA-Kratom and Illegal substances. If the DEA really was serious about stopping illegal drug use, and saving lives don’t you think they would seize the glass meth, crack and speed pipes that are displayed in convenience stores???
    If someone gets pulled over by the law with one of those is that not considered “paraphernalia”- residue or no residue.
    This just does not make sense.

  26. Steven R. Sideleau at 12:16 am

    Dear Doctor
    And all the beautifully written replys,
    Doc, may GOD BLESS YOU and all pain patients. Everyone of you are right and it is a travesty of the highest degree and unconscionable what they have done to us all and now are doing. I live in Massachusetts where the governor Charlie Baker has led the attack on opioids without the slightest care for chronic pain patients. I have been through 4 near fatal incidents that have severely damaged me from head to toe, one was caused by a person filling my right ear with cigarette lighter fluid while I was sleeping burning all kinds of nerves in my head. One left me with Trigeminal neuralgia, nicknamed the suicide nerve, yet these crusaders of insanity and dictators care more about anything else than people in chronic severe pain. My only suggestion to all of you is to place a petition before GOD to help us people get the medications and help we need. The bible clearly states that GOD himself placed the things needed on this planet for us to use and doctors to help us. The government has crossed it’s designated assigned place and we the people own this country, not the government. They work for us!! I’ve got a perpetual prayer on behalf of us all before GOD! I trust him and he will never abandon us!!! Please add your prayers. If two or more ask me for anything, it shall be done for them.

  27. Robin at 6:55 pm

    Why is the basic assumption that pain patients want to live completely pain-free. As lovely as that would be, we realize that is not going to happen. Most of us would be happy with being able to control our pain enough to be able to live relatively normal lives – not zero pain, but managed pain. Unfortunately, even that is becoming more and more of a pipe dream.

    Even if you have something like a broken leg (like I did recently), doctors are reluctant to prescribe pain medication. Pharmacists treat you like an addict, even if you make a five day supply last two weeks. My break didn’t heal so I had to keep getting pain meds. It got to the point that I was ready to hang copies of my x-rays around my neck every time I went to the pharmacy. Fortunately, during my 12 days in the hospital and rehab, my pain was well controlled. It got a bit more difficult after I got out of the hospital. Fortunately, my orthopedist was very understanding.

    On the other hand, the doctor who treats my autoimmune disease flat out told me that doctors are scared to prescribe pain medications unless you have cancer or something that shows up easily (like a broken bone). Most insurance does not cover any pain management other than pills, so those of us with proven, but less visible conditions, have to pay the price for a misguided understanding of addiction.

  28. Chris Meisenbacher at 3:40 pm

    It has probably been said, however, both answers come from nature. All true help for those in Chronic Pain have come from, plants and weeds. Since Pain was those plants and weeds were used. In the last 100 years, those in power seem to have “Delusions of Grandeur.” Or, just bored, so they pull the strings as if we were puppets. Politicians have NO PLACE IN THE MEDICAL WORLD. Should not be between, the DRs, and us! If, these plants have worked since time then, how puffed up are you to think you could know better now?

  29. Kristin at 2:32 pm

    Yes, I too am tired of the way I am treated. Maine now has one of the strictest opiate laws in the states. I have been a model patient. My records all indicate this. My pain has been successfully controlled with opiates for over ten years. If my pain is under a 3, then to me that’s a success.
    Now they say no it’s not the answer. They blackmailed me into taking a $8000 mindfulness course twice a week for 12 weeks! If I didn’t agree then I would not be prescribed opiates. So I did. I found that it was not helpful. I myself do not like to think of my pain. I, after 16 years, do better if I don’t think about it. The pain lets me know it’s still there! While taking this course the pain doctor, who is also on the committee making recommendations to the state, told me that I could of course argue palliative care, since there was no cure for my back pain. That he liked hearing patients opinions. This helped him when he went to Augusta. He told me he would not let anyone suffer in pain. I felt he was finally listening to me, not just talking at me. Until the classes ended..
    Then it was “we are weaning you off everything in 4 months. You will be given a shot of narcan to have at your house in case of overdose”. Are you kidding me?!!!
    No you cannot argue palliative care and any doctor who does will be in trouble. I asked him what I was suppose to do and he said I feel that you will be better without the opiates. I reminded him that this already had happened for over a month when my doctor retired when nobody would take me because of chronic pain. His response was talk to the governor. It’s the law.
    So this is where I am at. I’ve been taking less, therefore I have to carefully pick and choose what to do and what not to do. I have written letters and made phone calls. I’ve never had depression, but like I told the doctor last Wednesday you guys are sure trying to push me into one. I feel sooo alone. I cry all the time. Then I am mad. Mad as hell. I’m gonna fight. I didn’t ask for this. Depends on the day. As you all know the pain alone is tiring. Emotionally, physically, mentally.
    Really makes ya think though. Never in my life have I seen a group more discriminated against. I have few options. Live with pain and be couch bound, street drugs or suicide. Nobody seems to care.
    Thanks Dr Nagal. At least someone is in our side

  30. Sara B at 1:12 pm

    Thank you Dr. Nagel! 99.9% of doctors, pharmacists, insurers, legislators, etc have used this “Opioid Epidemic” to wash their hands of their pain patients. As a chronic pain patient who just lost both of my doctors (they are leaving their practices), I am terrified to see a new doctor and “hope” they keep prescribing my very low dose of opioids. Pretty much everyone I know in pain has had their opioids stopped or dramatically decreased. Migraine patients who were prescribed two 5 mg norco tablets per month have had them stopped. 10 mg a month? The CDC guidelines are concerned with 90+ mg per day. Talk about misuse – the FDA & CDC “guidelines” have been severely misused by the medical industry, because they just don’t know what to do with pain patients. At the same time, money has been put into the DEA to intimidate doctors and money has been put into addiction programs, but funding at the NIH for pain patients has been flat (the funding levels are extremely low to begin with). Pain patients want better solutions to their pain than opioids! We know these drugs are less than perfect. But can’t we leave them on the table until better treatments become available? People are becoming disabled by their untreated pain. My disability increased greatly when injectable opioids were taken off the table for everyone at my clinic. Now opioids have been taken off the table for all migraine patients period. A very imperfect solution to a very complicated problem. I know I’m preaching to the choir, but pain patients and their advocates must speak up! Whenever I talk to Joe and Judy Public about this issue, they have NO IDEA what these policies are doing to pain patients. Even our legislators don’t know. Make an appointment today with your legislators’ staff or with them directly. Tell your story. Do it today before the problem gets worse.

  31. MichaelL at 1:06 pm

    Suffering from chronic neuropathy, from a damaged cauda equina after a fall and explosive vertebral body fracture of L-2, I am almost in tears reading these responses. I am suffering because the gabapentin is not controlling my pain. I have been having some side effects that scare me, too. I have been diagnosed with a bradycardia, I have awakened with a “loopy” feeling in my head. I took my pulse, in my left radial artery, and I found that it was barely palpable. I worry that the dose of gabapentin is killing me. I have tried to reduce the dose. So far it has only left me in severe discomfort, for days at a time, unable to sleep. If I were not well educated, maybe I would not be scared. I am a graduate school educated, past board certified general surgeon, with a certificate in Pain Studies from the University of the Pacific in Stockton. When, I read about the abuse of pain patients, I especially feel disgusted living in the same state that admonished me, three different times, for trying to, compassionately, treat people in chronic pain. The only thing they have accomplished in this state, is making sure that they treat us chronic pain sufferers worse than they would animals! Most doctors are afraid to use opiates in this state, now. My pain doctor wrote Medicare saying that I had exhausted all forms of therapy and need a dorsal column stimulator. Funny thing is, that was the first visit I had with him! He tried no other form of therapy. He was willing to risk my getting another MRSA infection, before trying ANY OTHER FORM OF THERAPY! No ultrasound, no micro-stimulation, no TENS, nothing else was suggested by this “wonderful” pain doctor. He lied to pad his wallet! He cared nothing for any risk that it would entail for me. He, also, bragged that none of his neuropathy patients were on opiates.

    The chilling effect, of the “expert” lawyer and non-pain specialty trained physicians, is torturing people like me. The only thing I can hope for, now, is that there is something in “karma” and those people responsible may contract a severe chronic pain problem for which they cannot be adequately treated! Right now, I am torn between wishing for a few more years of life vs relief of the pain through death. It is no way to live. I certainly believe I deserve better treatment than they would promote for animals in pain. It is so disconcerting! I pray to God that someone figures out that we deserve being treated better than this! God help us all! Your presentation is nice. But, unlike the others, my cynicism is so severe that I don’t have much hope for my future!

  32. Zyp Czyk at 12:27 pm

    Thank you, Dr. Nagel, for your efforts to educate the ignorant. But because we are all (pain patients and addicts and those that campaign for them) in our own “Media Bubble”, I suspect only those of us who already know these things are reading your book.

    I’ve read that providing contradictory facts to people on the other side of an argument only makes them dig in their heels more, so all the facts on our side seem to make little difference.

    How can we get the public to open their minds to our side of the issue?

    The extremely profitable addiction/recovery industry grabbed control of the media storyline before we knew what was happening and now have the public firmly on their side.

    There is an incredible amount of money to be made from their addiction categorization that anyone using opioids regularly for over 90 days for any reason is an addict, period. This fantasy has been accepted uncritically by many people who know better, perhaps because their minds are clouded by money.

    How can we fight the monetization of addiction?

    The cherry picked, unscientific, and biased “studies” and “data” used to create opioid prescribing restrictions remain unchallenged by our government representatives and other scientific people in positions of leadership. Instead, they lay the blame on pain patients and their doctors for prescribing and using the effective pain relief of opioids.

    How can chronic pain patients actively resist this persecution when they are using all their energy just to survive a life of constant torment?

    We need more people like you, with experience and credentials of expertise, to do battle for us and our cause.

  33. Martha Arntson at 10:50 am

    I have been a victim of the War On Pain Patients this very year. Since the CDC guidelines were adopted into my Pain Management Clinic I have been taken off ALL opiates, even the smallest dose I was on for many months (10 mg. Percocet 3 x day). Abruptly discontinued with a swipe of a pen I was labeled “NO NARCOTIC PRESCRIPTIONS TO BE WRITTEN” for patient. Accused of “overusing” my 28 day supply of 90 in a random pill count. The facts behind why I was a few short fell on deaf ears at my next appointment the following week. I was literally in tears when I left the office that day after being basically shreeked at by my P.A. and “how disappointed she was in me”, (shame), that I was “short a few pills” and “that should NEVER HAPPEN FOR ANY REASON”, was the words she used.
    Despite my explanation (which was totally left out of the conversation), she was adamant.
    Now, I find out the P.M. doctor overseeing this Clinic, has billed my insurance company for over $23,000.00 for “lab” work. Last I knew a urine test was between $700-1,500.00.
    I have yet to get an explanation of benefits for these so-called tests they supposedly gave me and better yet, these “tests” were done in Texas at 2 different hospitals that I have never heard of, nor been to, ever. Period.
    I am pursuing avenues of obtaining my Pharmacy records from the Prescription Drug Management Database in Kansas as well as informing my insurance company to further investigate these outrageous charges and ordered them to NOT PAY A SINGLE ONE!
    I am outraged, to say the least.
    I have chronic pain, I have done everything I have been asked to do. Injections, P.T., acupuncture, acupressure, homeopathic medicine, all the drugs, i.e., Lyrica, Gabapentin, etc. To no avail. I have offered to do MORE to help my condition, including more MRI tests which I have an order for but now have no doctor to send the results to.
    I am taking on a huge huge conglomerate of Physicians, N.P.’s, Pain Management Clinic, etc., along with the Insurance Company who recommended I investigate on my own some of the under handed billings of the P.M. Facility I was in.
    Thanks for your post, it’s enlightening to read that others also know the history of Opiates, our Country and how we have dealt with this problem since the 1800’s and on.
    The War is now on Patients in pain, not the drugs coming across the border States that are intentionally laced with dangerous substances, all in the name of “$”.

  34. kathy a overcast at 10:18 am

    I live with sever chronic pain and have for 18 years. I have multiple disorders including Fibromyalgia, Lupus, CFS,Spinal stenosis, degenerative spinal arthritis, and spinal stenosis. Over the years I have been on multiple medications including every kind of opioid available, and due to tolerance the medications just do not work all that well any longer.I do not abuse the medications, I hate the medications! a year ago I found and herb Kratom, that helped me tremendously it actually reduced the pain more than all the medications I was on and did it without making me walk around in a zombie state of mind. As of Sept. 30, the DEA has called for and emergency ban on Kratom and will list it as a schedule 1 drug. No medical use and high potential for abuse. This herb is no more addictive than coffee, no danger of respiratory depression, if a person overdoses on it the worst thing that will happen is they will throw up and feel like crap for a while. On Sept 13, a large amount of the kratom community marched on Washington D.C. trying to get this ban overturned. Many people use kratom for chronic pain, PTSD, depression, to get off of heroin and other addictive substances. The dea is claiming that it is dangerous and has absolutely no therapeutic value and they are lying. If you research it. the alkaloids in kratom have had patents from different pharmaceutical companies placed on them for research for pain relieving medication. Basicly what this whole thing is about is big pharma wants to capitalize on this plant and make money so they are taking away our right to use and hepb of God so they can profit on it. If in fact it had NO THERAPEUTIC VALUE, they wouldn’t be patenting the alkaloids in it. it contains NO OPIUM, but has the ability to work off the opioid receptors AND PROVIDE PAIN RELIEF without making a person high. This alone tells you it doesn’t have a high potential for abuse because most people will abuse things that get them high!!! Man many people will suffer from the DEA’s actions here! Many people will go back to using heroin, and being addicted to opioid medications thereby the death toll from overdoses will surly rise, when they are already over the roof. It sucks that big pharma could care less how many people die or become addicted, all in the name of big profits for them. The DEA and FDA are in cahoots with each other all in the name of big profits, not because they care about those of us who suffer with chronic debilitating pain 24/7. They can’t capitalize on a substance that people could grow in their backyards. The ONLY REASON MORE AND MORE STATES ARE EASING UP ON MARIJUANA IS BECAUSE THEY (BIG PHARMA AND THE GOVERNMENT) have figured out they can still make plenty of money even if the legalize it. And yet marijuana does in fact get a person high and alter their ability to think clearly…KRATOM DOES NOT, A PERSON CAN DRIVE FINE AND FUNCTION FINE ON KRATOM WITHOUT THE RISK OF HURTING THEMSELVES OR OTHERS, it by no means is a dangerous herb!!!!…I am so devastated that I have to go back to using all the prescription drugs i did in the past and living a life of a zombie. In the past my quality of life was so bad I could have cared less if i died, and now I have that to look forward to again!!!! Thank you DEA and FDA for your overwhelming concern of my well being!!!

  35. julie contos at 9:39 am

    Thank-you for this article. It gave me the gift of hope.

  36. Thomas at 9:24 am

    I am outraged by how Chronic Pain patients are treated due to Heroin addicts. We know addicts are born , not made so the government in an effort to ignore where the problem is really coming from attacks pain doctors and their patients. We need a law that protects Chronic Pain patients , the Chronic Pain Patient protection act that protects our rights under the constitution to be treated however we see fit under the guidance of a doctor and when indications of pain are present without the fear of being prosecuted or persecuted. Under ROE V WADE we state a woman has a right to do what she wants with her body , but then when a Chronic Pain Patient decides with their doctor they are best treated by long term pain management using opiates suddenly the government wants to cry addict , pill mill , drug dealer!! . I have been in pain management for 12 years and my pain started after a surgery that was supposed to cure me. Sure I can stand up now , but without the medications I can not function, a true cripple . During those 12 years I have produces roughly 1 million two hundred thousand dollars of taxable income . Without the medications I would have produced 0 and been on disability . I live under the fer that my medications will be taken away everyday , I cringe when I hear countless times on the news how the government has once again made a law regulating how I can take and use my medications all while making Chronic Pain Patients synonymous with Heroin addicts . ENOUGH!!! Stay out of my Doctors office and my Medicine cabinet, you are the government , you are supposed to be protecting us from the Heroin coming across our border not Vicodin from my doctor. Addicts in pain management are found out very quickly , and when that happens they still deserve pain relief , they just need to be more closely watched . My VET does not hesitate to prescribe pain medications to my dog when there are indications of pain , so are are we allowing human beings to suffer? It is disgusting. Also what about KRATOM? Kratom is a herbal alkaloid that truly works for pain , does not get you high , although the DEA says it does so they are making it Schedule I . An absolute joke they would take a perfectly safe extract from the coffee plant that is proven by millions of people who have tried it , including me , to work on pain without being addictive and make it illegal while at the same time making it almost impossible to get pain relief that really works from a doctor . THE WAR ON CHRONIC PAIN PATIENTS must end . In Great Britain you can walk into any Pharmacy and get a codeine based pain reliever over the counter lol . What the heck is going on in America where we do not have the right to pain relief because of a small number of abusers ? 88,000 THOUSAND people die of Alcohol related issues every year and yet the hysteria is about Opiates ? Sick and tired of this nonsense . Where are the advocates for PAIN PATIENTS? IT IS TIME TO FIGHT.

  37. Angela at 9:07 am

    Thank you so much for this! It’s very well thought out and it’s a great directory almost, to other literature that people may not have known about prior to reading this. I love that you covered our history in the US as far as pain control is concerned and that you tie it all together with the hopeful changes being made, as well as the many more that need to be made. I hope this article will be shared far and wide. I can’t say thank you enough – for this piece as well as for your courage as a physician, to speak up for those being horribly bullied in this country right now. Thank you, thank you, thank you!

  38. Tim Mason at 8:35 am

    What we are seeing is a third world Dystopia in pain care. We have been on a fast track to HELL for about 8 years now. The modern snake oil salesman are those that peddle the (Editor’s Note: Product Name Deleted) decompression device, the (Editor’s Note: Technology Category Deleted) is the new “Heroin”. These devices are the merchandise of the “Medical Charlatans”.
    As someone already pointed out the levels stress and anxiety associated with the bimonthly PM visits and the PA or NP that feel as though they an apostle of Jesus Christ.
    My relationship with my NP has been compromised by his unprofessional behavior and my next visit is with the MD.
    I feel as though I on a dead course with Medusa Gorgon, therefore I go armed with the gauntlet consisting of the latest scientific reports of efficacy of all treatments all peer reviewed, NIH related and FDA reports.
    I am an excellent listener I just wish the same could be said for the gods of pain medicine.
    When all else fails, Visit your nearest Sioux Indian Sweat Lodge during the next full moon.

  39. Angel at 8:05 am

    Excellent! Thank you for your advocacy your willingness to question the status quo! As someone who’s been through medical school and failed to ever use my MD due to a myriad of issues including a leukemia (CML) diagnosis, I’m highly interested in the medical community’s response to the pain crisis. I regularly read KevinMD.com. Seeing the attitudes of doctors posting in anonymity to the pain crisis is sickening. Their callous disregard for patients, their disdain for pain physicians it’s all too much. It’s open season on pain patients and their providers and the attitudes are both cruel and ignorant. It’s a scary time to be a patient in need of pain care or their doctor.
    http://www.kevinmd.com/blog/2016/09/must-face-unpleasant-truths-opioids.html

  40. Renée Hernandez at 7:50 am

    Thank you for advocating for pain patients..there are few docs willing to do this. I have CRPS, Interstitial cystitis, and now in horrific pain with right trochanter bursitis. It is very hard to be hopeful. I attempted suicide this past winter after getting very drunk. I am not a drinker normally. But desparate people turn to desperate solutions if only for temporary relief. I am not suicidal at present and decided to not do any more drinking, but I am depressed and trying to hold on.

  41. Alyce Clarke at 7:47 am

    Thank you so much for your comments. I have lived with PHN ( from shingles which almost kiilled me) since 2003 with no relief, just take that pill when you wake up. Some days the pain is tolerable and some days it is totally out of control. I will die with this misery as there is no cure. I even quite talking about it to my family or doctors, talking doesn’t seem to make a difference. I just had knee surgery, going through rehab and my surgeon warned me that my pain meds will not be refilled. Some days I could use a little HELP.

  42. Beth Acker at 7:42 am

    I applaud the efforts made to try and get the social stigma reversed so that maybe, just maybe, we can get medical professionals and society in general to stop looking at every pain patient as a product from a pill mill. The pill mill situation puts a big light on those who abuse opioids but the net thrown by the Javert’s of our society cause even more pain to true pain sufferers by making life extremely difficult in the search for legitimate pain management, medications and therapies. Besides spinal cord damage with multiple fusions and spine maladies I also have arachnoiditis due to the multiple surgeries. This incurable condition is extremely painful but with proper opioid management I can have a life that otherwise would be unbearable and inhumane. I’m just tired of pharmacists and medical professionals that view and treat every opioid patient as a potential criminal. I’m just a human being that lives with tremendous pain that requires medication, if I had a choice I wouldn’t be on any medication ever but if I want any quality of life to spend enjoying my family then I must rely on opioids to make my pain at least tolerable. Thanks to anyone trying to help those like me who just want help living with pain but don’t want to be looked at like a drug addict by choice.

  43. Carla Cheshire at 7:11 am

    Dr. Nagel, thanks for writing this historical background of pain and opiates. Until now I didn’t understand why no one listens to us, the chronic pain patient. It is eye-opening to see that we’re rated lower than drug addicts as now they are seen as a profit-center where we are a drain on society. Just ask Bain Capital Management who is investing in drug rehab centers while people in pain are being cut from the only medications that help them lead some semblance of a normal life. Where are the law firms stepping up to help us? How can it be legal/ethical to force a portion of the populace into increased pain, withdrawal with no help and for some suicide after taking an oath to do no harm? Is this the outcome the CDC and the Federal government are hoping for?

  44. Gayle Nolen at 7:08 am

    Thank you for your compassionate and informative article about pain control. I fell and fractured L1T12 a bit over 10 yr ago. The pain was excruciating but at that time I was compassionately treated with an opioid. Losing most of the vision in my R. eye from a retinal detachment has made my balance worse and falls more frequent. My TENS unit and PT have not helped for long. I was able to move about and enjoy life somewhat while being treated for pain. That ended 3 yr. ago with stricter rulings and lack of pain meds. (Will I use a pain clinic? No. Lack of funds and a great lack of compassion prevent this.) When taken suddenly off my pain medicine, I had no withdrawal, no craving for drugs. But I would definitely like to have my life back. I do believe that pain meds would once again restore some comfort. I have hope that the ‘tide will turn’ but perhaps not in my lifetime.

  45. JR at 5:03 am

    Dr. Nagel,

    Your dissertation of the chronic pain community (myself included) is a “much needed” ally in what has become a travesty with respect to those who suffer from chronic pain on a daily basis.

    Moreover, it is my feeling (after countless visits to my chronic pain doctor) that the opioid overdoses — many which lead to death — is more important than those with chronic pain. My monthly visits consist of urine tests (all of which are negative for any trace of additional pain medication), injections (I’ve lost count of these procedures) which, more often than not, aren’t helpful at all and, lastly, dealing with a PA that has absolutely no compassion for my chronic pain and, instead, puts me through what often feels like an interrogation of where the pain is, the pain level, how often does it occur, etc. It is an unpleasant experience and one that I dread on a monthly basis.

    Another important aspect is once I’ve had an injection, my doctor wants to know how much relief the injection has given me. When I answer (honestly I might add), he gets angry and then begins to push my body back which, in turn, causes me to cringe with pain. The look on his face says it all and there any need for an explanation.

    My last visit — three weeks ago — included yet another injection with anesthesia . The pattern never changes — I go home and sleep for the rest of the day. The very next day I receive a call from his office with inquiries about how I’m feeling. “Has your pain gotten better? On a scale of 1 to 10, where’s your pain level now?”

    In my humble opinion, a day is not enough time to diagnose the effect of the injection. But something happened this time around. I received a call from a pharmacy that I’ve never used before. The woman wanted to confirm my mailing address, phone number & insurance. Puzzled doesn’t cover my feelings as I had no idea what this was all about. She asked me if my doctor had talked to me about this? I responded that if he did, I don’t remember — once the injection is completed, you’re taken to an area to “wake-up”.

    After going back & forth, she revealed that the doctor had prescribed two injections. I asked her, “what are these for?” She said, these are for an overdose — you inject yourself to override the opioids.

    First of all, I am not an abuser of my pain medication. It’s the only thing that allows me to work five days a week, eight & sometimes ten hours a day. So, my mindset was a bit numb once she explained what this was for.

    To say that I’m tired of the treatment, the accusatory stares @ the pharmacy, the judgments rendered by others when they find out I take pain medication on a daily basis would be a gross understatement.

    We, the chronic pain sufferers need all the help we can get. I applaud your efforts, your article and do hope that one day, we will be treated with the respect we deserve. We aren’t all opiod abusers — as you stated the ratio of chronic pain sufferers v the abusers is huge.

    Thank you, Dr. Nagel.

  46. Beth at 4:46 am

    WONDERFUL article!! I suffer from RA and fibromyalgia. It was freeing to read this and know this Doctor sees chronic pain through compassionate eyes. To be misunderstood is so hard to deal with and demeaning. I see light at the end of the tunnel! Thank you!!!

  47. Nancy Russo at 4:00 am

    Cruel and sadistic for doctors that know a person isn’t abusing Opiod to just drop them or stigmatize them when they know that 20 mg of an Opiod combined with other nerve meds works well.
    Not everyone responds the same way to this older class of nerve meds. People can and do take a small dose as needed responsibly.
    Half these doctors should be sanctioned for the comments (political) they make and the rude and cruel behavior. Why don’t they own the reason the pt is in Opiod to begin with is because one of their colleagues messed up a surgery crippling the patient. Never have I seen a group of hypocrisy like pain management. They blame the suffering patient because of Obamacare and FDA. Thanks! No wonder people are turning to herion.

  48. Jean Jankovich at 3:32 am

    Part of the “problem” rests with the medical professionals for not periodically not taking the time to reevaluate and then treat all complaints. I fell down a flight of concrete stairs back in 2011 and subsquently had a double cervical implant surgery. My lower back was also injured and I came out of my surgery with a slap tear to my left shoulder that hurts as bad as my lower back. I have neuropathy but never received the proper care on my shoulder or lower back.

    Too many pain doctors, insurance companies prefer to just send patients home with pills rather than offering alt treatments.

    I want to get off these drugs but can’t because I can’t get any professional to help me and am tired of fighting with Humana!

    The legislators need to understand the root cause of the so called epidemic and not be so quick to label the patient as an abuser rather than a victim.

  49. Dale Strohmaier at 3:20 am

    Thank you for a good understandable column here
    I take 15,2 milligram dialudid 450’in 30’days
    They do well in keeping my pain manageable which I score at a 4-8’or higher depending on the stress of an day’s activities
    I have fractured clavicle from a riding accident and what Doctors call, a classic case of fibromyalgia it’s a real big and does expressive damage to my joints.