Needless Barriers…

Needless Barriers…

By David Nagel, MD.

Editor’s Note: Dr. Nagel is a pain management specialists in New Hampshire who is a frequent (and highly valued) contributor to the National Pain Report.

“Kemmerich groans.  He is feverish.  We get hold of an orderly outside and ask him to give Kemmerick a dose of morphia.

He refuses.  “If we were to give morphia to everyone, we would have to have tubs full…”

Erich Maria Remarque

From All Quiet on the Western Front

I never sought to be a pain management specialist.  I wanted to be a physiatrist.  I wanted to work with people with disabilities, to find a way to help them adapt to their challenges.   

Little did I know those I cared for would help me more than I ever helped them.  They guided me in directions I never imagined.  Caring for them allowed me to learn about myself sometimes for the better, sometimes for the worse.

Their suffering taught me about their pain; physical, emotional, spiritual.  Engaging with them distracted me from my desires and I felt an incredible responsibility to help them in a meaningful way.  

And so I became a pain management specialist.  I am still not totally sure what that means.  While I knew that I could not eliminate pain, I felt an unreasonable need to do so, not to help the patient, but rather to ease myself of the very real suffering I felt at my inability to eliminate their pain.   

As Schweitzer said, “Pain is a more terrible lord of mankind than even death itself.”  I have come to understand that is true both for the sufferer and those in their presence.

Still, I sought to find a way to make changes at the personal and societal level, and I tried to bring together those in a position to help.  With great effort, we succeeded, and we learned from each other.

At the peak of our success, I learned a new lesson:   the allure of power and money often dictate our paths.  Yet, those powers drive the Eisenhower equivalent of the medical-industrial complex whose self-interest often harm more than they help.  

And so those in need suffer while those in power grow wealthy.

How do they live with themselves?  I wonder.

How do I live with myself?  I wonder…

It has now been fifteen years since my group decided to close my pain practice.  A variety of reasons were given, most were merely a façade for shifts to a revenue centered business model.   

I have never been comfortable with the choices that were made.  I wrote the book Needless Suffering; How Society Fails Those with Chronic Pain as a way of both healing my wounds and those of society.  It was my hope that nobody would be forced to make the decisions I had to make in accepting a new practice, one contrary to my beliefs.

I am increasingly seeing that search as futile.  Like Remarques’s character Kemmerich, I see patients in pain every day who are denied access to care, whether it be morphia or otherwise.  I am a witness to their needless suffering, and I feel called to help.

As a result, I sought and continue to seek ways to re-invent myself, to re-create the fuzzy Shangri-la I had once built with others.

They are all gone now, but I reasoned that I could once again recreate this play with a new cast of characters.  

Realizing I could not create such change in my current practice, instead as a very real Rudolph, I would have to travel on alone to help find a home for those we view as misfits.

Our current world is often unfriendly to those who seek to make change alone.  So I sought the comfort of others; my own Yukon and Hermie.  Even in this world, there are rules, ones that often don’t make sense, but define what we do.  To better understand those rules, I sought legal counsel as a starting point.  

At great expense I met with two attorneys from two different states.  After listening to my rather passionate presentation of what I hoped to do, both responded in the same way:

While we understand your need to do this, to care for those in need, it is our obligation to inform you of our legal opinion that the risk is too great and you should not do this.

To which I answered,

Then who is to care for those in pain?

When one understands that this legal opinion is being given to every medical practice in the United States, it is not hard to see how difficult it becomes for those in pain.  For a brief point in time, someone did care.  Now they are gone.  And so those in pain suffer alone.  People are dying.  That is real.    

Is that not important?

So, what do we do to change these trends?  How do we create a voice that cannot be ignored?  That must be the starting point.  Only once that is accomplished, can we care for those in need.

Gandhi said, “The truth may turn out in terms of the current moods and trends of a blind society to be supremely unprofitable.”  

In order to make a difference, to help those in need, we must find a way to get beyond our greed and our fear.

David M. Nagel, M.D. is a specialist in Physical Medicine and Rehabilitation and Pain Management, and author of Needless Suffering: How Society Fails Those with Chronic Pain.  

(Editor’s Comment. Buy the book. This guy gets it.)

Follow on Twitter:

@NatPain Report


Authored by: David Nagel, MD

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Dr Nagel, thank you for being one of the compassionate ones.

I pray they never raid your office as that seems to be the final and only way to “control” those few of you left who dare to help.

God Bless.

Alan Edwards

Dr. Nagel does get it. Pain management was more effective and much less expensive in the past than now. He should understand patients deal with even more than pain. We are abused by pharmacists, abused by PCPs, abused by greedy specialists, etc. If the current trend is not stopped, premature death among pain patients will rise and already is. I personally cannot move, cannot shop, cannot walk upright and cannot think clearly since my treatment drastically changed to satisfy CDC voluntary guidelines. I am under partial care of my parents and live alone. Ineffective treatments since 1990 exhausted my savings and for whatever reason I am not eligible for government help even with cerebral palsy and severe spinal damage . However, the government turned my productive life into a housebound existence of constant pain. I, and many others, are headed towards and already experiencing suffering that is unnecessary but satisfies the pronouncements of pompous psychiatrists who influenced the government under Obama. I saw this coming having been ejected from medical establishments since the controlled substances act went into effect in 1971. The constitution and bill of rights are being ignored as is the Holy Bible. Two years ago I was happily dating and working on cars for free. Can’t the entire corrupt establishment see the medical disaster that is occuring?

I wish the doctor all the best.

Terri Lewis

Please complete this survey so we can aggregate the volume of your voices, and represent your stories. And when you do so, identify the NEEDLESS BARRIERS TO CARE you are experiencing…


Your truly one of the more compassionate Doctors out there, and I’ve been under the care of one the same. He has tried to make me more comfortable during my force off of oxycontin last year. I’m horrified that he will close his doors one day but he is an advocate for a pain free life with low opiate use, and I’m on board with a spinalcord stimulator implanted and MMJ licence in the making. Another fear of mine is the thought to just give up, exit all this pain. I haven’t felt that way in many years, I’ve had excellent results with oxycontin since my cord injury 15 years ago. My family doctor had me doing fine, blood pressure and all, I had very low monthly expenses all these years too. Everything has changed in every way. I’m afraid to voice my opinions except here on National pain report but if a lawyer gets in touch with me they’ll get an ear full. Thanks for sharing your story


Hi Gang,
As a life long Oregon Resident, I can truly say the entire State Legislature and The Oregon Health Authority have lost their minds. I recently spoke with the the Ombudsperson over the telephone concerning this Sadistically insane issue, and I asked them point blank how much their new guidelines will ‘save lives’ as they watch the suffering take their own, just to escape the torture they endure on a daily basis I have written repeatedly, my state senators from both party affiliations again and again and again, yet the only answers they can give me are the same false statistics, yet NONE of them will address the issue of the suffering and all the other negative effects that accompany a society emmersed in un-treated pain. . I suffer greatly, and I say to hell with them all! Even if or when this goes National in all 52 states, I will just have to hunker down near ‘The Border and head for Mexico…PERMANENTLY. I can tell you this…that these non-comps are throwing gas on the fire that Channels illegal drugs into the U.S.-which, is the real problem, and they are too Cowardly to confront them - Attacking the compliant, law -abiding innocent and suffering by kicking them when they are down is the new Oregon Paradigm.


Thank You
My saying is Cure US or Treat US too many have issues that we are faced with for the rest of our lives .I know many who are worse off than me yet 3 specialists in different fields have all said .There is nothing they can do for me but manage my pain for the rest of my life.I will only continue to get worse a surgeon made me a test subject with a level 3 neck surgery I did not consent ,my hardware in my neck is 2 sides of a lightning bolt shape type fusion.I have constant neck pain and arm pain from steroid injection in neck that hit a nerve that went into left arm.
Someone really needs to start a Go Fund Me for the fight we need money and someone who will be heard to fight for us PERIOD.It has been proven time and again that the people with pain that take these medicines are not cared about nor heard .Did patients going to FDA meeting help ? Did sending my story to FDA help ?

Kathleen Kaiser

Until this email I did not know anything about you. But I love what I’ve read in this email and I have purchased your book immediately after learning about it. I look forward to reading it.


Although this is worded beautifully, it is just words. I’m sorry but I just found out my pharmacy will no longer be taking any more scripts for pain medications. This will now cause me to have absolutely no quality of life anymore. More than words this is more actions against people in pain. Beautiful words are not helping me and my CPP friends. Actions would help me and all my CPP friends.


Here i go again !!! Ive had Chronic neck,head, shoulder and lower back pain for over 20 yrs. Today my Pain Meds were cut again by 30mg. This is [edit] I want to see our lawmakers suffer Chronic Pain and see how quick and how much Pain-Meds they get Prescribed. Guarantee as much as they want !!!! More [edit]


Thank you, Dr. Nagle, for a very powerful and moving article.I’ve been worried for many years about myself and my pain issues. With this latest move by Oregon my heart is frozen in fear for the poor and the sick,whose pain stories are much worse than mine. What is going on with our country?? The people I’ve told about this can’t believe it.
And I recently read an article in the paper stating its believed that anti-depressants will be targeted as the next “crisis”. People who are helped by these meds will start getting denied access. I’m sure that includes many CPP dealing with the stress of unrelenting pain.


Dr. Nagel, I can truly say this. There are not many Dr’s. left in the medical field like you, one who REALLY cares. Thank you so much! I have had sooooo many Dr’s since 1992, I used to have a few who really cared about my well being. It is down to one Dr. now. That would be my gastroenterologist. How sad! Thank you for supporting us! Thank you for being YOU!


Thank you doctor the Paul for showing someone in the treatment of pain not only understands the problem but has such empathy for it. Thank you! In my case I have a deteriorating CMT 2 condition of 18 years. the pain is bad enough but the emotional result of pure torture is even worse. As someone slowly removes all of your medication there can be only one result. And that is death by ones own hand. What our government is doing is worse then the Nazi death camps !

A. MacKenzie

I do not gain much from this article by Dr. Nagel. This sentence bothers me: “Yet, those powers drive the Eisenhower equivalent of the medical-industrial complex whose self-interest often harm more than they help.” What does that even mean? The term “medical-industrial complex” sounds to me like a term used by the Left in this country to take a jab at pharmaceutical companies. I believe it is an effort to harm the pharmaceutical companies, a frequently cited enemy of the Left, that is driving the opioid crisis itself, without concern for the many innocent people whose lives are severely affected by continuing to push the fallacy of the “opioid crisis”. Also I take issue at his reference to “morphia”, but no other opioid medications are mentioned. Morphine is the drug of choice for those practicing palliative sedation as a means around laws against assisted suicide. I will have to take a look at his book to see what is really underlying his concerns. I am beginning to question the motives of the National Pain Report.

A nice article. I hope Dr. Nagel can circulate it in places where other doctors will see it. In my opinion, if this nightmare we are living through is going to be stopped or redirected, the doctors must unite and advocate for themselves, especially as a group, and their patients. Currently, they (many doctors) have turned against the patients. I’ve seen it with my own eyes. We, the patients, cannot affect change by ourselves, I don’t believe. We don’t have enough power. If doctors were to organize and say NO to these government and insurance and pharmacy overreaches, it would have a huge impact. So far, doctors, except for a few, have been unwilling to do this. It has been shocking for me to witness the change in doctors’ behavior and attitudes…cold and uncaring, when the chips are down. But they are an essential class of humans and have a lot of clout, if they could organize into a negotiating block, instead of just turning a blind eye and running away.


Thank you for the truth. It may not be what I want to hear but at least I know what I’m dealing with. You have confirmed my worst fears of not being treated for the pain. It hasn’t happened yet to me, but I can see how I’m being set up for it to happen. And soon. My PCP has already given me the dumbest of reasons for decreased dosages, a change to Suboxone, the whole darned spiel.
Is there anyone or a group that is bringing everyone together to make noise in places where we can be heard? I have never protested anything in my life, but I my life depends on pain treatment and I would gladly do whatever it takes to fight this. I know I am not alone!


Its not so much us with pain that need to read this book I assume, isn’t it more for the President on down?

Kelly-Anne Bryan, RN

Thank you, Dr. Nagel, for your compassion and frank observations. As a long time hospital nurse and chronic pain patient, I share your frustrations. In the lines of Gandhi’s observation, what is ultimately profitable for a society is sadly not profitable in the immediate sense for select interests. Personal ambition and greed are the overriding drivers. It is a dark side of human history. As a society we should show love and compassion to one another, But we don’t.
So if we must work within such failings, how can we make the greater good profitable? What incentives might change how we care for others? Our care system needs to reward both patients and providers for positive outcomes. Payment needs to be wellness driven, rather than illness driven.

We are blessed to have a caring Doctor like you Dr. Nagal. I am in pain daily and when I think why this is, I am so hurt that we are thought of as less than human and our system does not care. Our gov. wants to use us as examples of being addicts. Because those who die of overdosing they handle that situation by taking away from the rest of us who need our pain lesson. we will die if this isn’t changed. either from the pain itself or from suicide because we cant stand the pain. Im sorry for thinking this. I cant help but think back on those who Hitler sent into what they thought were showers I believe, when it was the gas chamber. only this way, we are being killed off slowly in very bad pain. Im sorry, but just study about it. who let the gov. be in control of our medical instead of the doctors. My opinion, street drugs was why those were overdosing. why are the officials making more effort going after those instead of making an example out of the weak and innocent. we need a march into Washing D.C. and not move until they immediately change medicine for pain is reversed and then left alone. I wont ever vote again until that person first things leaves the medical field alone and let doctors give us what they see fits. I thank you Dr. Nagal. I know you care. Im sorry if I sound like I am just babbling. I know what I mean, I just have a hard time putting into words. God bless all of you in pain and believe god will take charge and make the changes. This is whats wrong when god was taken out of our state, governments. Evilness slipped in..This is so true. Thank You..


I think the response of the attorneys should serve as a wake-up call that something is broken and needs fixed. When a doctor cannot practice medicine, then something has to give.

Honestly, I do not understand this: Where are the medical professional associations in the midst of this? Are they unorganized, are they intentionally silent? Are there even discussions about what’s happening TO PATIENTS or is everyone truly just out to save their own skins?

What can we do?

I don’t want to lose my life.

If I don’t fight now, then it will be too late. How do we fight? Who can advocate for us that has power and a voice? How do we reach them?

I accepted I’ll live with pain. The medicines won’t make the pain go away. I cannot bring myself to accept that I may have to live with this pain without medication.

I’m sorry to ask these questions, but I have to.

I don’t want to see doctors advised not to help people like me. I know some people already have no doctors who are willing to treat them.

My sleep doctor rescheduled my appointment. When I opened the letter, I thought it was my pain doctor’s office and the first thing I read was that they cancelled my appointment.

It’s a shame that a simple letter puts me on high alert like that. I’m so afraid to even TALK with my doctor. I’m following her instructions very carefully… So, what about the patient who mistakenly does something wrong, or who is afraid to even ask a question!?!?

William Dorn

Remember what the bible says about a rich man and heaven. Help those in chronic pain before its to late.

Maureen M.

Dr. Nagel, oh how wonderful it is to hear from you again! It is disappointing to read about the woes that you are enduring with treating patients and the outcome of seeing the attorneys.
I know that you are a huge fighter for us, and that you understand our pain and plight so well, and I’ve always appreciated it.
Please please do not let the defeat cause you to go away too. People need you.
I read your book when it first came out and loved it! I love the caring and compassionate doctor that you are. Please keep searching for the best ways to beat this horrid system that we are up against. Keep strong and faithful. We must win this fight!


What a beautiful article! DR Nagel you are compassionate, passionate and humble in thought. I wish you had hundreds of Doctors like you to visit Mr.TRUMP. I feel if Chronic Pain Patients and Doctors start filing lawsuits in the thousands, we might be heard. God Bless you. Thank you for fighting for us, beside us and leading the way


Truly and educated, noble and passionate physician. But as with my physician those in positions of authority are at this point apparently warning him not to practice his type of medicine. The licensing agencies, the malpractice insurance agencies seem to be telling him they will not support him. And this is the problem. Physicians who are ready to push some boundaries and are being told they will be a focus of scrutiny and will lose in the long run. Again,I truly feel those of us in chronic pain will need to die in high numbers before anyone will focus on the problem and forGot sakes, who really cares if senior citizens get opiates to have a better quality of life? Thank you Doctor but I feel we are on the losing part of this effort.


This has me in tears. Thank you for your passion to help those suffering. Pain is ignored, pushed aside in our society. I have two children with complex health issues. They both have chronic pain also. Often doctors push this aside like an after thought even though it is much in forefront. There needs to be better options to manage pain, more research, more education. The trauma inflicted by unmanaged pain, undertreated pain is horrid as well as the response by many uneducated medial providers ‘just breathe’ the pain away. I believe in a comprehensive approach. The issue of pain deserves more funding, research and better treatment and care that does not break the soul.

Jessica Reible

Dr. Nagal, Thank you! You are an example of what all chronic pain patients deserve & need. I appreciate you & hope you can help all of us in chronic pain!

One thing I have learned through this entire process is to be an advocate for myself. I no longer believe everything my Dr. says to me. He has given me false facts many, many times (to silence my questions). My research has confirmed what I knew where untrue facts & I have brought the facts to him to discuss. My due diligence has labeled me as a “problem patient” & I am ignored by my Dr., nurses and clinic. A majority of Doctors have abandoned their oaths and let us down. I’m so glad to see there are still people like you that exist & take their oath seriously!


Oh my. How beautiful Dr. Nagel and yet chilling at the same time. I did not choose this path of pain, it chose me

Kerry Hart

Beautiful. And horrifying. Thank you, Dr. Nagel.