National Pain Strategy Released – Now the Work Begins

National Pain Strategy Released - Now the Work Begins

By Ed Coghlan

The long awaited National Pain Strategy has been released.

“This is our country’s first coordinated effort to develop a plan to address the care of those in pain. It is a seminal event because it calls for a complete transformation in pain prevention, care and education,” Sean Mackey M.D., who directs the Stanford University Pain Program, told the National Pain Report.

The NPS was developed by a diverse team of experts from around the nation and leaders believes it is a roadmap toward achieving a system of care in which all people receive appropriate, high quality and evidence-based care for pain.

“It’s a really good thing that represents a huge effort,” said Cindy Steinberg, National Director of Policy and Advocacy for the US Pain Foundation, which is the largest pain advocacy group in the U.S.

Both Dr. Mackey and Ms. Steinberg were on the team that drafted the NPS and shared their thoughts with the National Pain Report.

In 2011, in recognition of the public health problem of pain in America, the Institute of Medicine called for a coordinated, national effort of public and private organizations to transform how the nation understands and approaches pain management and prevention.

The Strategy, which was released on Friday, calls for:

  • Developing methods and metrics to monitor and improve the prevention and management of pain.
  • Supporting the development of a system of patient-centered integrated pain management practices based on a biopsychosocial model of care that enables providers and patients to access the full spectrum of pain treatment options.
  • Taking steps to reduce barriers to pain care and improve the quality of pain care for vulnerable, stigmatized and underserved populations.
  • Increasing public awareness of pain, increasing patient knowledge of treatment options and risks, and helping to develop a better informed health care workforce with regard to pain management.

For the more than 100 million Americans suffering from chronic pain, the NPS represents a game plan that won’t result in overnight results, but is aimed to elevate the issue of chronic pain. What concerns Dr. Mackey and others who worked hard to develop the strategy is how it will be implemented.

“Achieving the goals outlined in the NPS will require leadership from HHS,” Dr. Mackey said. “We ask HHS to lead in tasking the relevant stakeholders with implementation of the strategic goals, establishing accountability for progress, and identification and allocation of resources to advance the Strategy. While we look to HHS for leadership, we all need to stand ready to partner and help in any way we can.”

The US Pain Foundation’s Steinberg couldn’t agree more.

“We simply have to come up with better treatments, improved access, and expanding education for both providers and patients,” she said. “Our work is cut out for us, but the implementation of this strategy is critical for the chronic pain sufferer.”

The often fractious pain community needs to come together over this plan.

“The pain community should channel its energy to implementing this,” said Steinberg. ”When you look at what AIDS advocates did to educate all us about the disease resulted in more research and more public understanding. We need to do the same for pain.”

While the earlier drafts of the NPS did not spend a lot of time talking about opioids, the final version addresses the use of opioids, understandable given the attention that federal agencies have been giving the use of opioids. It probably wasn’t coincidental that the CDC announced its voluntary guidelines earlier this week, in advance of the NPS release.

As the NIH press release said:

“Better pain care, achieved through implementation of the National Pain Strategy, is an essential element in the Secretary’s initiative to address the opioid epidemic. Access to care that appropriately assesses benefits and risks to people suffering from pain remains a priority that needs to be balanced with efforts to curb inappropriate opioid prescribing and use practices. The Strategy provides opportunities for reducing the need for and over-reliance on prescription opioid medications, including:

  • Improving provider education on pain management practices and team-based care in which multiple treatment options are offered – moving away from an opioid-centric treatment paradigm.
  • Improving patient self-management strategies, as well as patient access to quality, multidisciplinary care that does not depend solely on prescription medications, especially for vulnerable populations.
  • Encouraging the evaluation of risks and benefits of current pain treatment regimens.
  • Providing patients with educational tools to encourage safer use of prescription opioids.
  • Conducting research to identify how best to provide the appropriate pain treatments to individual patients based on their unique medical conditions and preferences.”

What happens now?

The US Pain Foundation’s Steinberg said it’s time to get active.

“Join a group, call your Congressman’s office and make noise,” she said.

The U.S. Pain Foundation has a program that is designed to identify advocates. If you’d like to become part of that, click here.

To read the NPS, click here.

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Authored by: Ed Coghlan

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John Gost

Mark my words, “you” the people at the so-called NPS and CDC are going to “kill people” with your arrogance and stupidity. Suicide rates? Just wait until you see suicide rates climb after you take away the only thing that gives so many any relief at “all.” The fact “is” that you have no idea what living in uncontrollable pain is really like. In your arrogance, you say, “Oh, yes, I’ve treated people in pain for so many years, blah, blah, blah, but until you have experienced it “yourself,” you simply “do…not…know.” When someone comes to a doctor, in utter hopelessness; when a grown man cries out loud in the lobby, that should tell you that there is more to this issue than meets the eye and yet you “fail to listen.” That’s what happened to me. I was at the counter at my general practitioner’s office waiting to pick up a note to excuse me from jury duty (which cost me a co-payment for the privilege.) I was at my wit’s end, and, although I fought to suppress the emotion, I simply started weeping uncontrollably. They didn’t want me scaring the other patients in the lobby, so they brought me into the back to see my doctor for a few minutes. He is a good man but he is also one of “you” and preaches about how he “will not” prescribe opiates on account of addiction and everything else, so I wound up leaving with nothing but higher doses of Tramadol and Neurontin that did “nothing” except make me sleep for days on end. Out of sheer desperation, and I could only do this because I had a PPO instead of an HMO that would have required a referral from this same doctor who was not about to give it to me on account of ignorance, arrogance, misinformation and his deep Catholic faith. It was about “survival,” however, and I sought out pain management doctors. The first gave me Celebrex, which helped a little but not nearly enough to get the pain under control. Oddly enough, it was my forward thinking psychologist who “finally” prescribed me Oxycontin with the warning that, “there is nowhere to go after this.” It frightened me but it also “saved-my-life!” For the first time since it had happened, I received relief from pain, and it was like God’s hand coming down from Heaven to aid me. The dose was way too low and was not really enough but it was “something.” A few days after Michael Jackson killed himself with Propothol, however, this doctor became frightened and released me with a list of local pain management doctors. Oddly enough, yet another idiot, some young, weeping female with a talent for manipulating men by feigning emotion and an addicts urge to “get high” was his undoing not long after that. The fool killed herself with the beloved drug and he lost his license to practice + faced legal action of various types. This also happened… Read more »


It would help to have anything. I come from a small, but close family who are all sweeties. But I’ve been left out. Everyone else is healthy. I will need help within the next year and it will have to come from the state. I don’t even use Medicaid, although I could. I will need them when the time comes,

Jean Price

K…I know what you are saying must be true, yet I can’t imagine the added pain of not being valued as a family member. I suppose this may be one piece of the puzzle of why our families are not vocal…yet again, it’s so difficult to understand since they too will lose more when we are in more pain and even less able to function. To anyone out there whose family members are unsupportive or worse, I adopt you all! Although I can’t feed everyone, or pay for college! I’m probably old enough to be mom to most of you anyway…and suppose I’m board certified since my kids mostly still want to be around me. I am starting to dialogue with my family and what I am hearing is “If they won’t listen to you, why would they listen to us?” And they also said they have no idea where to start. To me , this really just means they don’t have a clue about what’s going on, except to affirm my sadness over what’s happening. This is enough, some days. But I really think it would help to have so much more.


Jean, for many of us our families consider us to be negative influences for them, they don’t want our problems in their neat lives, and they don’t believe 1/4 of what we say. Some have really good support.

Jean Price

Reading some of these and other articles today, I was stuck by the difference in our voices on pain treatment being heard over and along with the voices of those who have lost loved ones to addiction and overdose. They are speaking on behalf of those they lost. Where are our families? Why aren’t they speaking out on our behalf, since they have lost part of us too, like we have lost parts of ourselves to pain. Why aren’t they irate about our restricted medications and abusive treatments that cause more suffering and pain? Why aren’t they addressing Congress and the CDC and NIH and all the other agencies to tell their stories AND our stories and get support for us? Do they feel as powerless as we do? Do they think this will get better? Do they understand enough to rally for us? Do they realize how hard it is for us? Do they realize how it has impacted their lives? I don’t know the answers to these questions…but I do think they warrant some attention. We need them and we need to tell them so! They stand a better chance of being heard than we do! After all, we are the problem!


This is advocacy ?
This is just more support for pain medication rhetoric, the government is trying to get the country to believe. I use pain medication as part of my treatment plan. Many days I wouldn’t be able to do chores, care fir my family or go out with my family without them. Chronic pain sufferers DO NOT get a high fom their medication, thus NO addiction. These studies are showing a realistic view of the world.

Richard Dobson, MD (Retired)

An Australian study has looked at suicidal ideation (thinking about suicide as an alternative to life as it is) as well as ideation-to-action (transition from simply thinking about suicide to making a real attempt at suicide). [] They looked at suicide and correlated it with a tool known as the Pain Self-Efficacy Questionnaire (PSEQ) in an ongoing study of 1544 people with chronic pain. ( The PSEQ is a series of 10 questions about how the person is able to function, e.g. can you work, can you achieve your life goals, can you enjoy life with family and friends, etc. Each question is rated 0 (completely unable) to 6 (no impairment at all). The overall score is the sum of the points on each question. Based on my experience of 20 years of dealing with chronic pain patients (average of 15 years of pain in each patient) and having seen most of them on a monthly or quarterly basis, it seems to me the crisis among pain patients is for those who would score in the range of 10 to 20 with out pain meds and increasing to 15 to 40 with pain meds. These are estimates based on my observations and are not based on any patient reports.

It does seem to me that the CDC “Guidelines” will impact most those at the lower end of the PSEQ. I fear that we will see many innocent pain patient forced to endure a decline in functional status of 10 to 20 points or more on the PSEQ. That is certainly consistent with the laments documented in the previous comments.

It should be noted that in the the study showed that a lower score on the PSEQ was associated with a significant risk of past 12 month increase in ideation-to-action.

Perhaps the CDC and the NPS would have served the chronic pain community better by more scientific approach to analysis of the problems. The lead is well documented by our friends “Down Under.” We should follow the lead.

Gabriele Lahr

These new guidelines have some good advise
However, it was the ease for addicts to obtain opioits so easily. Now the national information program to monitor the patients prescription activity shows Dr shopping and access of what they are getting
Are they aware of diagnosis of what medical ailment the patients endure. Well they should. In my case I not only have a severly torn cartilage in one hip and some tearing of the other, a unsuccessful back surgery which now has a torn f4 nerve root and fibromyalgia that has become so severe after a decade of battling it with minimal medication to the point that I barely can walk maybe 5 steps before I feel the burning and weakness so badly that I have to stop long enough to gather my strength to walk another fee steps. Lately I have collapsed at work and had seizure like attacks where all my limbs started jerking and flapping out of control. To have to go to a pain management clinic because my drs can only give me one fill of 5ml of codine is ridiculous. Now I hear that drs are proclaiming that opioits only work 3 to 6 weeks is a bunch of crap. People to need to find alternative ways if possible thru rehabilitation and meditation is a good way to ease pain but many ailments must be medicated. Your new policies are to extreme and unfair to real victims of pain do to their illnesses. Have some compassion and consideration for us victims.

Judith Notchick

As a Chronic Pain Patient, I take it that my voice does not need to be heard once again because perhaps I came way to close to the truth? I used no profanity, remained on issue. Why were my comments, negative but true…left out of the discussion? Obviously, The sick and injured need to close our mouths, lay our pens down and submit to recommendations which the suits have made “on our behalf” which do not benefit, but in fact bring forth even more dire consequences for us who are already suffering. How can you qualify yourselves as an advocacy group when you are not representing us in the manner in which we need so crucially? It is sad. You sound so close to the CDC so called recommendations that it makes me wonder just what your motives are for ever becoming involved in this matter are. Certainly it was never to truly help our life and death struggle and the right to be heard. Your quelling my comments pretty much confirms the frightening conclusions that I reached. So, the bottom line is those who trusted you to carry forth our cries for help are now even more pathetic as victims of the political machine. I am glad that I have not trusted anyone else to carry forth my voice, but instead have been busily advocating for myself and the true pristine voices of Montanans who have been abandoned and left only with choices like: suicide, purchasing street drugs or becoming thieves and stealing from pharmacies. Which is LUDICROUS! I know it is cold, but thanks for nothing.

Kenneth D. Mckenna

This is a wonderful effort and I thank you for your efforts. If you read some of the comments from CDC director, Dr. Tom Frieden, you may come to realize he is making an attempt to abolish chronic pain patients completely by denying needed
medications to them. I feel he believes after enough time passes, they will just go away in disgust. Watch and see. Re read his comments. He is of the opinion all diversion starts and stops with the overprescribing of opioids to people with chronic pain. I’m so sick of hearing, ” They are only guidelines “. Well I don’t know if it’s because the V.A. is a govt. office or exactly why, but they have been following as if they are laws. Veterans can’t afford to go outside the V.A. for treatment, and there are no doctors willing to help anyway. I choose not to go into a diatribe about my medical problems, except to say that I have complied with everything they threw at me for twelve years. I asked my doctor, ” Doesn’t that count for anything “? The answer was a flat ” I’m sorry, no ! If I was on opioids at a higher than recommended dose for twelve years, and now they’re panicked and tapering as fast as they can, also was prescribed Benzos for twelve years at the same time, yet now it’s unsafe, who do I see about their so called ” unsafe ” practices for 12 years. Now they don’t want to admitt according to the guidelines they did anything wrong. Then why the drastic change ? You can not have it both ways. Nothing you do will change their minds. It is an effort to do away with doctors providing pain management for chronic pain. I look to see pain management doctors close doors in the next 5 years. Think I’m panicking ? Watch and see. Think Dr. Tom Frieden would give your report a glance ? Try it and see. I see many posts from people complaining about the guidelines. In the next sentence the talk about their fentanyl patches, their Oxy’s , etc. While many of us out here are being taken completely off our meds. I give up. Who do I fight ? Dr. Tom Frieden ? Oh yeah, he gives a damn. I no longer have a dog in the fight, if you feel you do, best of luck. I know my options, and they are bleak.

Judith Notchick

This is reprehensible. A catastrophe, in fooling Chronic Pain Patients into thinking that this organization was somehow different from the CDC, DEA and the entire regime which so keenly filled the public with fudged statistics and pickets being lined from the very top to the very bottom of this issue. It is disparaging to us, that we are of no value at all. Ethnic Cleansing has been alive and well throughout history, but now Chronic Pain Patients are caught up in UNETHICAL CLEANSING! Please understand that we know what kind of money and politics that we are against. Insurance companies who want the money flow to stop; the only way is to stop the heart of the patients who the money is being spent on. The true statistics which will never ever be revealed would easily show the Genocide which is continuing to gather steam. Lots of folks believe that ISIS is our most dangerous enemy. Though they are indeed evil and a real threat to the future of The Free World; the real danger to us comes from people wearing suits who simply see us as an annoying distraction. If we had our priorities straight, we would have asked why on earth citizens should trust our government with our medical care!!! Plain stupidity. America has been dumbed down and trusts organizations like yours to do the right thing. I wonder about the body count occurring since the CDC and you have so coincidentally announced the surety of long, lingering, agonizing, undignified deaths for genuine Chronic Pain Patients. What’s that you ask, Is this the description of the latest Science Fiction book? The horror is that it is very very close to REALITY.

Ginny Ickle

I am very disappointed that this document appears to mostly parrot the DEA “party line” about opiates being appropriate only for those at death’s door.
I had expected better.

Jean Price

Denise…I have read a couple of comments from cancer patients who said they weren’t able to get their meds either. Regardless, I agree having cancer/terminal cancer and pain should not be held as a higher priority for treament with opioids than having say rheumatoid arthritis or pancreatitis or fibromyalgia and pain. It makes no sense to treat patients who are expected to die and to not treat patients who are expected to live!! Oddly, few cancers cause severe pain…it’s mostly the treatments and surgeries from the cancer that create the pain. The same is true for many of us, treatments or surgeries created our pain and it turned into a long term pain problem! I certainly don’t mean to discredit the suffering and pain of people with cancer. I had breast cancer fourteen years ago, myself. Yet telling people in pain that we can’t have a viable treatment for our same pain issues because we’re not struggling with cancer is absurd. It’s like sentencing us to a full life span without quality of life, without the ability to adequately function, and WITH daily pain…all because we were fortunate enough to not have cancer! These are the type of things that make me think our battle is hopeless UNLESS our advocacy groups form a coalition and band together for strength to find a nationally known champion for our cause and/or take legal action against those in power who are discriminating and causing duress due to unfair pain treatment guidelines, slander, misuse of statistics., and denial of a proven effective treatment. I don’t see this happening because of THEIR own egos and politics. I am beginning to think the agencies dictating our care are seriously are not interested in our input because we are just seen as the problem…the addicts wanting their meds! So all our individual efforts will create little interest and little, if any impact toward reversing this…and this is so very disheartening, to say the least. As Dave said, they didn’t take input in the process….they certainly won’t just start doing so….unless they are somehow forced to. And that will take a real battle, nationally and legally!

Denise Shaw

Thank you Dave for saying what I didn’t express very well. I am tired of fighting, it’s not just my several chronic pain diseases I fight but most Drs and specialists to notice and care that the current treatment plan isn’t working! I do want to function better and live my life to its fullest but I can’t walk half a block with my dogs without stopping to stretch or wipe tears away from the agony!!! Do they, NPS and the CDC, think we, the majority of pain patients, don’t want to feel or get better? I have fought to remain walking for ten years now, and at first the Drs thought my foot would need amputation!!
I have to pay hundreds and hundreds of dollars every time I get pee tested at pain management and I did nothing wrong! Why should I incur the cost for their ridiculous policy? I am treated like a criminal, they even shut the water off as you pee so you can’t water down your urine!!! I am angry, tired and frustrated with ALWAYS paying for another’s addiction!!! I am a patient, not an addict, and deserve the same respect and assistance with my medical needs and treatment(s) as does anyone fighting a terminal illness like cancer!!!! My disease has no cure nor hope of remission at this point, higher on the pain scale then cancer and a progressive neurological disease, yet I can not have pain medication above their specified limit? Why is cancer so special that they are the only disease that is an exception? It definitely makes the guidelines appear incredibly skewed by special interest groups that only care about their agenda and screw the other millions of sufferers!!!!


Ms. Cooper- my God- for once, we agree. Yours truly, tried to convince you in the past- that the pain specialists- who were behind the NPS- even before they created the 2009 ” A call to Revolutionize Pain Care In America- weren’t focused on the needs of people in pain-as people in pain define them. Pain specialists consider people in pain unqualified to have an opinion worthy of their consideration.
And how remarkably fast the pain specialists- and their front groups who for years promoted opioids- after some unknown reason(and probably political pressure from Congress or the Obama administration) they now are calling for great restrictions on opioids. They are obviously not trustworthy. And this includes your hero- Dr. Webster and his good friend Dr. Mackey that want people in pain to abandon their beliefs and practices and get with his program. So now you see pain care in America has little to do with the needs, beliefs, wishes etc. of people in pain- its all about what government and pain specialists needs and desires. They wish to dictate to people in pain what they can and cant have- regardless of what people in pain want. Now people in pain have been dealt a cruel blow- those experts and so called advocacy groups they trusted have been dishonest and unfair. Gee- I could have told you that before ” A Call to Revolutionize Pain Care in America” was created.
Now will see what the conquered nation known as people in pain will do to redress the sorry state of affairs in pain care today.


Chrystal augustyniak, when “they” talk about educating drs about chronic pain, to me that means not prescribing opiates for chronic pain period. If it meant prescribing opiates, the language would be different. Do you mean that you have been to over 50 pain management drs and only one of them was willing to prescribe opiates ? I’m sorry I wasn’t sure if you meant, pcp’s, rheums, pain management or a combination. Usually pain management drs will prescribe pain meds, although it may take going to a few to find one that will and you have to sign a pain contract, have random drug screens, etc. Sometimes the amount of pain meds a person is taking can make it difficult, if not impossible to find a dr.


Kristine (Krissy), as long as you are alright without opioids being used for chronic pain, I understand how you could be impressed with this.

They have no authority to make insurance companies cover alternative pain management. Gettting most insurance’s to cover a lot of things that dr and patients think are needed now is often like pulling teeth. No insurance company is going to spend money to cover these alternatives because they care about the patient. Especially when pain meds are/were way cheaper.

A lot of people are reading this thinking that they are going to help those that are poor and can’t afford pain management with opioids as well as non medication forms of pain management to be able to afford it. They also think that somehow the stigma of taking opioids is going to be addressed. It isn’t going to be addressed, unless you think that not being able to get opioids prescribe for chronic pain is addressing the situation. Look at what the report does not say, not what it says.

I believe everything has to start somewhere. When the NPS was first proposed, I submitted my comments regarding specific concerns, one being some of the stigmatizing language that the IOM report, Relieving Pain in America clearly stated was a problem. The fact that they mention the CDC guidelines for opioid prescribing is troublesome to me. The CDC blatantly ignored pleas from advocacy groups to include stakeholders,including patients. The guidelines are thought by many to be grossly biased against people living with chronic pain. As an RN and past educator, I find grossly ill-fitted to the chronic pain community. To impose such rhetoric on the 100+ million Americans living with chronic pain, many who benefit from opioids and use them as prescribed, is like tying a lead weight to our legs and dropping us in the ocean. People are killing themselves because they cannot get relief from severe unrelenting pain. When that becomes a person’s only option, our medical forces that be should be paying close attention. Not to undermine the needs of those who become addicted or purposefully abuse drugs, they need help too, but they are in the minority here.


I am so glad I don’t have to deal with all this any more. There are solutions out there, herbals that can handle a heavy pain load. Screw pain management, screw these new “strategies”. I’m in serious pain every day without help from my kratom. I don’t have to play the game anymore, at least until they make kratom illegal too. They may do that but I’m not going backwards and using oxycodone again. I will move to another state, another country if I have to. Tired of seeing people hurt so bad they don’t want to live. This is incredible.

I have fibromyalgia had it for 11 years and let me say this I have tried everything.. I MEAN EVERYTHING.. so my question is, will access to pain meds be more accessible for patients like me?? Because on the contrary to what is being said DOCTORS DO NOT PRESCRIBE PAIN MEDS LIKE MOST WANT TO BELIEVE, I’ve seen over 50 doctors and only one was willing to prescribe pain meds to me and actually WORK WITH ME, educating doctors I don’t believe will change their overall view of chronic pain and would be ultimately left up to them anyway to prescribe pain meds which I’m sorry is laughable because most could care less about my suffering, my pcp I have now is so rude and ignorant that the moment I even mention pain anywhere she cuts me off and tells me she only believes in TEST RESULTS NOT A TAKE ILLNESS.. I swear if I hear that I will be Taught to live with the pain I WILL SCREAM, how can anyone learn to deal with pain? Article seems to be heading in that direction unless my perception of it is wrong (which could be the case)… I am also very concerned that now it is being said fibromyalgia is progressive, that word alone scares me, I have known people that have passed away “from complications” and I have noticed in myself how bad it has gotten and not just pain either, more and more symptoms show up all the time so I’m petrified on where this is going.. Every single day when I wake that’s even if I sleep regardless I feel I piece of who I was is gone and that is frightening…

This will do little to nothing to help the epidemic, pain patients will suffer, while addicts will still get high. The majority of us pain patients have already been down the road of “Alternatives”. Opiates was our LAST RESORT. Opiates is what helps us to function on a daily basis. It’s like I said, it’s our LAST RESORT when nothing else works or stops working. I’ve been suffering with chronic pain for 40+ years due to Charcot Marie Tooth disease, being hit by a drunk driver, degenerative disc disease, and many related illnesses and health issues.
Don’t take away our ONLY pain relief, our only option to live a quality of life.


“The Strategy provides opportunities for reducing the need for and over-reliance on prescription opioid medications, including:
Improving provider education on pain management practices and team-based care in which multiple treatment options are offered - moving away from an opioid-centric treatment paradigm.
Improving patient self-management strategies, as well as patient access to quality, multidisciplinary care that does not depend solely on prescription medications, especially for vulnerable populations.”

If they are going to be moving away from the use of opioids, I would like to know how they are going to force All insurance, including Medicaid, to pay for non medication forms of pain management. I said when they announced they were doing this that it would not increase access to opioids for the management of chronic pain and it will not, it wil do the opposite. I would hate to be 10-20 or more years younger and know that I was going to have to adjust to not having pain meds to manage my chronic severe pain, One of the sad things is that there is nothing that these people can do to get insurance compaines to cover these alternate pain management options, but they can push it so that drs begin to go by it, even if insurance won’t pay for it.

This whole thing was and is nothing but giving the people that will push to implement these alternative pain management options something to do that they can get paid for. If I had expected something positive from this, I would be very disapppointed.


I was dismayed that in the “strategy” their was specific language that opioid use is appropriate for acute pain, during the process of dying, and others (sorry I can’t remember the exact words), but chronic pain was completely left out. This scares me to know that opioid are not considered in controlling pain. Did I misread something? It was in the bullet points at the beginning. I believe in multi-modal approach to pain that includes opioid medications, NOT excluding them.

Jean Price

Dr. Dobson…I too was disheartened when this strategy didn’t discuss the benefit of opioid therapy for those with chronic pain. And also dismayed because most of us have already tried many of the alternative therapies they allude to without success or lasting effects. Obviously the Pain Foundation was part of the process to draft this, yet I still feel our biggest problem at best was poorly worst it seems they have supported the goal to decrease opioid use, which we have already been so negatively impacted by. I may be wrong, but did they ask us for input? I didn’t see it if they did. Did they let us know this was happening so we could send them our biggest concerns with the current treatments? Again, I must have missed this, if they did. I guess I feel our input has once again been left out of the equation in many areas this strategy addressed. As for when this plan addresses the “stakeholders”, it seems they mean the insurance companies, health care providers, and government organizations! I’m confused as to why WE, the people with pain, aren’t considered the biggest stakeholders in this problem. It’s our life at stake, our wellbeing, our families, our functioning, our incomes, and our quality of life. Regarding this article’s statement for “the often fractious pain community” to come together…I totally agree! Yet I have been told by other groups that the Pain Foundation itself declined to be part of their ideas, and it seemed to me they were reasonable ideas to support. I believe our advocacy groups would do well to follow their own advice! From my experience and knowledge, they are not working or banding together or supporting each other with the goal of people in pain as their top priority. I guess they too all have egos and politics in the way! Yet, we are once again left floundering. Remarkably, most patients with pain are on the same page! Most of us agree on the problems and the variety of solutions. I agree we need more research, and yes we need access and help paying for other pain therapies, yes we need more quality patient care too….and we also need opioids as a verified effective treatment option at dosages that will actually help and not leave us still unable to do the activities of daily life. No one wants dosages so high it leaves them unfunctional…that would be defeating the purpose! But reducing the dosages to a minimal level is not taking into consideration the individual needs! Minimal for who?! Perhaps someone with mild pain, yet ineffective for those with moderately severe and severe pain. No one expects to be totally pain free…but we do expect treatment to significantly lessen pain and help us toward our goals! I have suggested a coalition numerous times and heard nothing back. I’ve also suggested establishing a buddy system for those who are at the edge and contemplating suicide, with the goal of providing support… Read more »


I’m 34, I’ve been having my pain managed for 22 years due to Chronic Myeloproliferative Disease and a host of related problems. Pain management as it’s now termed is the single largest hassle in my life thanks to addicts and ignorant headline grabbing bureaucratic blunders. My own father lost his DEA license when a patient committed suicide. The cost was too high to fight so he just surrendered. I fear these rules are open to interpretation. Pain patients will suffer while addicts will still get high


The “rough beast” aka the National Pain Strategy has been released. And the pain specialists and front groups that supported it failed to reflect independent and diverse thought and the the great biosocial diversity that akes up people in pain. From the get go the pain specialists sought to exclude full participation of the greatest stakeholders from having input into the NPS- people in pain. When asked, about such Ms Porter was dishonest in answering claiming that special interest groups are the same as individuals in pain- undoubtedly to her and the 80 who created the NPS- the concern of individuals doesnt matter- as long as some special interest groups are heard. So individuals in pain have been releagted to moral and ccivil vagabondage by the creators and supporters of the NPS-it doesnt get more undemocratic then that. Undoubtedly, the pain specialists and their front groups believed the public and people in pain arent qualified to have an opinion worth considering in developing the NPS-and so who can believe that if it is implemented it will enlarge the needs of people in pain. On the contrary- we can expect the same disrespectful indifferentism that people in pain have been subjected to for so long as this plan is implemented As Dr Biro wrote- as long as the conversation lasts people in pain are not alone- the NPS never had a conversation with the American public- so too many people in pain will remain “the lonely abandoned folk” that Patrick Wall wrote of over a decade ago. The creators suffered from two fallacies’ there is no alternative fallacy and finish the job fallacy.. They reflect not just the undemocratic of the 80 that created such-but a heroic oversimplification of what is needed to create the symbols of a new day for people in pain. They ignored my own comments- even though i made them in a timely fashion-and I can only believe they ignored the opinions of all Americans who disagreed with their certaintist and infallible beliefs-beliefs i would add that not only dont meet evidence pyramid guidlines nor Bradford Hill criteria.They claim their approach is evidence based- but it is only too clear their biopsychosocial model has been underresearched and unproven-despite being in existence for over 40 years. And this is more evidence of their bias i creating the plan. The NPS is little more then a cut and paste job from the model national pain strategies on the IASP website. And not a very good cut and paste job at that- for even the IASP leveled 6 serious criticisms against the NPS. They also didnt concern themselves with out of pocket expenses or difficluty finding the right providers Comments from the public-like my own were ignored and the American publics input was not welcome So the NPS reflects the undemocratice exceptionalism of so-called experts in “pain management” and who can deny it is the occupational strategy of a few pain specialists and their front groups writ large and riddled… Read more »


As I read the report about the “voluntary at this time” restrictions, there were a couple things that stood out to me.

It was stated that there wasn’t any research to show any benefits (or drawbacks) of opioid use over the 1 year level. Yet they claimed opioid use MUST be not worth the risk of harm over the benefits, based on research on ACUTE opioid use.

Seems like if research for chronic use of opioids could be done, or found for the over 1 year time period, it could be helpful.

Voluntary “at this time” is a very scary term, for one, I doubt many will wait to implement it.
Second, it implies that it won’t be voluntary, but will become mandatory imminently.
Third, it means we NEED to ACT NOW if we hope to make any relevant progress in this matter.

We need to reach out and educate like the Fibromyalgia campaign is and did. For many years many did not even think it was a real disease, and there STILL is no test for it. Now, not only do many drs and people understand it is a real disease, but their advocates and education for it is being spread like wildfire! This way, sufferers for the condition are more likely to get diagnosis and the help they need. Chronic pain sufferers, even though we have MANY reasons for WHY we may be suffering, could still learn a lot from how the Fibromyalgia campaign spread their message, and so the same.

We need a centralized message for chronic pain sufferers, and to spread it everywhere! Identify advocates, call, write, and talk to our senators and congressmen…OFTEN, educate drs, our loved ones, family and friends, make memes for FB and Pinterest, COVER EVERYWHERE with FACTS!

Tell them our personal stories, get permission from others to tell theirs, MAKE people see that opioids have benefits, CAN be used responsibly, and sometimes are the ONLY things that WORK for CHRONIC pain.

If we dont, we might not have opiods much longer, as the CDC decides that chronic pain does not “merit” any more consideration than acute pain, (as it is really doing now) & turns “voluntary at this time” into “mandatory”.

Kristine (Krissy)

I was impressed when I studied the document yesterday and took some notes. It calls for the importance of implementing policies that address many of the complaints pain patients have been struggling with. These objectives are supported by a list of specific people and organizations to be called upon for solving key points. They include federal agencies and collaborators — including advocates and patients!

It states: “Increased scientific knowledge regarding the pathophysiology of pain has led to the conclusion that chronic pain can be a disease in itself that requires adequate treatment and a research commitment.” (It points out that there needs to be better treatment for “high-impact” chronic pain — the term used for the kind of pain that should, in some cases, be solved with opioids).

Among the points discussed include, relieving the burden of stigmatization in the US by non-pain people and families, creating public health education for families and the general public (that we truly suffer and need care, medication, treatment modalities and support), and many more.

I found no mention of two things: Suicide and the DEA (except as a stakeholder in one or two areas).

This long document is worth the read!


Why so complicated??it is simple, DO BACKGROUND CHECKS on everyone ON OPIODS AND ban those that have any type of drug charges. That would get rid of probably a third at least of all these prescriptions and let those of us in real pain 24 7 get some kind of relief.

Denise Shaw

Its awesome on paper but as stated the interpretation once practioners implement these ideas and whether the health insurance industry also adapts these changes is another matter and barrier to pain patients!
I have battled for a non medicinal approach many times in my ten year battle with chronic pain and health insurance providers just don’t see why some need PT, or aqua therapy for example past the ten visits normally allowed. If I don’t demonstrate significant marked improvement they consider it maintaining my current abilities and refuse to cover it! I improve very slowly as I can’t push too much or I flare and go backwards. I also need that help maintaining in a warm water environment but because I can’t afford to install my own indoor heated pool or hot tub, I lose out! Heck I just invested almost $3,000 in a bed that was adjustable just so I could get more restorative sleep and help myself yet that’s an expense I really couldn’t afford financially, but medically speaking I couldn’t afford not to do it; heck I have severe neuropathy of the feet with deformities and arthritis yet I can’t get specialized shoes covered because I am not a ‘diabetic’!! I just don’t understand why pain patients can’t get assistance for these medically necessary items that help lower pain levels and increase quality of life resulting in fewer medications and less expensive treatments needed? Plus these things provide mobility help resulting in a healthier patient over all: physically, emotionally, spiritually and socially!!!!
So although this appears positive how is it going to change the hardened, restrictive view that health insurance companies have adapted about pain patients?

Richard Dobson, MD

On page 29 of the report, discussing “disparities” in pain care the report states: “The Problem: A significant problem facing vulnerable populations arises from conscious and unconscious biases and negative attitudes, beliefs, perceptions, and misconceptions about higher-risk population groups (e.g. sex, gender, age, disability, ethnic, or racial bias) or about pain itself.6,47,48,49”. My initial reaction is that the information in the National Pain Strategy itself suffers from the depths of the implicit bias surrounding pain patients.

Oh well….but at least it is a step, a very small step, in the right direction.

Richard Dobson, MD

It is good to see the “National Pain Strategy” in concrete form, although I am more than a bit disheartened by what it leaves out. I refer specifically to the injuries from falls that are a common problem for all of those with chronic pain. (See “Chronic Pain and Falls” for a brief review with references Falls happen frequently in people with chronic pain and yet there is only on mention of falls in the NPS report and that is in a footnote on page 26. Furthermore there is only one mention of SUICIDE and that is on page 14. It simply mentions that suicide is more common.

At the same time there are 85 references to opioids, and on first glance it seems that most of these are reiterating the same old diatribe that they are dangerous (they are) but I see little discussion on their benefit.

For the record, opioids as a class kill by one mechanism only: they temporarily suppress breathing. Methadone has the added problem that it can interfere with cardiac rhythm, and that is probably why methadone has such a big role in overdose deaths. For the majority of opioid overdose victims, death would be prevented simply by providing respiratory support… know the old stand by “Mouth to Mouth resuscitation” or in today’s world of devices using an “Ambu Bag” or mask to artificially breath. After all, Narcan and Nasally administered naloxone work because they reverse the respiratory suppression. All of these deaths are due to an ACUTE event and not due to chronic stable dose administration.