The Pain Wars

The Pain Wars

By Suzanne Stewart.

September is Pain Awareness Month - and people should be aware of what chronic pain patients go through.

To read the media, you’d think we are pill-popping complainers. We aren’t addicts, and it’s definitely not all in our head. We are real people living every day with high chronic pain illnesses. We do whatever is requested; whether it be to urinate in a cup, give blood or jump through any and all of the other hoops asked of us, we just do it. The National Survey on Drug Use and Health, has done studies that say “75% of all opioid misuse starts with people using medication that wasn’t prescribed for them” but obtained from a friend, family member or dealer”. ? As Maia Szalavitz wrote in the Scientific American, “Do you know that new addictions are uncommon among people who take opioids for pain in general All of this means that steps to limit prescribing opioids for chronic pain run a great risk of harming pain patients without doing much to stop addiction.”

We have seen our lives change in the last couple of years - and not for the better. There are things that are happening around us that we feel no control over. Our feelings are correct.

The people who use opioids are under attack and the lead attack dog is Dr. Andrew Kolodny. I read an article where he says that Tylenol essentially works to combat pain as well as prescription pain meds.

“And medications that can be just as effective as, or even more effective than opioids are Tylenol and Advil”. He says that these two OTC medications “work differently, so it’s safe to take them together.” He also states in this same article that “They really are safer than opioids, and we sometimes forget how helpful they can be”. In another article, “Kolodny states “many Americans are truly convinced that Opioids are helping them”. They can’t get out of bed without them”.

One would surmise, after reading several of these articles, that Kolodny thinks that we as pain patients should just accept the pain as if it is just a nuisance. If it were as easy as taking a Tylenol, (which on the bottle it actually states that it’s for “minor aches and pains”); there’d be no rising suicide rates within the pain community.

In 2015, the New England Journal of Medicine published a commentary in which two physicians, Dr. Jane Ballentyne and Dr. Mark D. Sullivan argued their position on chronic pain and acceptance. Our own National Pain Report published an article on November 29, 2015, “Accepting Pain More Important Than Reducing Pain Intensity Because Opioids Are Harmful, Docs Write in NEJM Commentary”. The first line of the article is “People suffering in chronic pain need to learn to accept it because achieving a balance between the benefits and potential harms of opioids has become a matter of national importance. Dr. Bellantyne, the president of PROP (Physicians for Responsible Opioid Prescribing), says that “patients should pursue coping and acceptance strategies that primarily reduce the suffering associated with pain and only secondarily reduce pain intensity. Dr.’s Bellantyne & Sullivan (Dr. Sullivan is the Executive Director of Collaborative Opioid Prescribing Education (COPE), stated that the patients who report the greatest intensity of chronic pain are often overwhelmed, are burdened by coexisting substance use or other mental health conditions. Instead of opioids, these doctors say that an interdisciplinary and multimodal treatment coupled with coping and acceptance strategies are critical. In addition, they conclude that a willingness to accept pain and engagement in life activities despite pain, may reduce suffering and disability without necessarily reducing pain intensity. The two Dr’s also said that “patients should not focus on reducing the intensity of their pain, but their emotional reactions to it” (NEJM 2015 Commentary). I’m thinking that maybe all of those who, in my opinion, feel that we just need to accept and cope better, need to take a “pain challenge”.

Maybe they should volunteer to be part of an experiment where they somehow feel the pain that many of us feel and they don’t know the time frame for how long they will feel that way? I’m not sure they would feel the same way afterwards, are you?

Kolodny and his minions appear to feel that pain patients and drug addicts are not two distinct groups. He says “the opioid crisis is about addiction, and the reason that overdose deaths are at historically high levels and the death rate for middle-aged white Americans is going up, is due in large part to the epidemic of opioid addiction with overdose deaths occurring most commonly in people with legitimate prescriptions.”

Dr. Kolodny this is wrong! The problem is actually illicit, NOT MEDICAL, drug use. A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care. A more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent. What this truly means to us is that all of these limits on opioid prescribing for chronic pain patients puts us, the pain patients, at great risk of harm. But guess what? It is not going to do much to stop addiction!

We, the chronic pain community not only have to live with physical agony but with this “Opioid Crisis”. The true crisis is that the chronic pain community is losing access to reduction of their pain. This is affecting the patients’ work, if they in fact are still able to work. It is also affecting our families, relationships and at its worst, our sanity! The American Academy of Pain Medicine says that there is a “civil war” going on in the pain community. Their president, Dr. Daniel B. Carr, says that “One group believes the primary goal of pain treatment is curtailing opioid prescribing. The other group looks at the disability, the human suffering, the expense of chronic pain”. We must continue to stand up and keep fighting for what we need. Andrew Kolodny says that “in the end, chronic pain patients need more and more opioid medications in order to curtail the pain”. But there are an abundance of pain patients who never increase their dosage of opioid medications throughout many years.

As pain patients, we simply must fight back. The people at PROP have grabbed the initiative and turned concerns about opioid addictions into an attack on millions of chronic pain patients.

It must be pointed that people who own drug treatment facilities are benefiting from Dr. Kolodny’s efforts at demonizing the pain patient.

In the meantime, state agencies, federal bureaucracies and others simply stay silent on what will happen to pain patients if opioids go away.

We can’t let that happen.

Suzanne has lived with a Systemic CRPS & several other chronic pain illnesses since a MVA in 2002. Prior to being disabled from chronic pain, she was an Interpreter for the Deaf at a hospital & worked with Deaf children. Since 2005, Suzanne’s been a patient Health advocate, support group leader & Mentor.  She continues doing these things today, but also does public speaking, awareness events and she’s a Writer/blogger & an Ambassador for the U.S. Pain Foundation. 

For entertainment she creates advocacy videos & uplifting ASL cover song videos on You tube and she writes in her own blog Tears Of Truth. You can follow her here: ).

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Authored by: Suzanne Stewart

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Barry Porch

We cronic pain suffers are being punished for what some stupid people have done I live in newjersey and all pain management doctors are cutting back our meds way to much I have been through 6 failed lower back operations damage nerve scar tissue on nerve 5 deterioration disc upper back 3 severe multiple bone spurs sticking me in my nerves and 2 bulging disc in my neck and another bulging disc in my lower back 2 cages at the L4-LA and one is coming out I need both kneese replace and now my DEPRESSION meds do not work very severe sleep disorder and the pain is now so bad I spend my days on couch or in bed I’m 55 years old and when I talk to my new pain doctor about what is going on because cutting my meds seems it goes in 1 ear and out the other I go see him in a few days let him know what my psychiatris said I had 1 breakdown and my life almost came to a end my emotions are all messed up and I’m having bad thoughts again if my pain doc does not raise my meds back up I will have to leave the state of new Jersey and try a pain management in Delaware but it’s just getting very hard to cope with this painful body. I hope soon there will be a change in the laws we cronic pain suffers must keep fighting for our rights.

Why is Dr. Kolodny the only doctor influencing the CDC, DEA, FDA with his extremely biased & non-scientific data. He & his group PROP gave the CDC untrue statistics & the CDC is not being scrutinized. Instead the media is promoting the dishonest & flawed 3rd party information as well - I can not even remember how many times I have read articles that claim that two thirds of all addicts & deaths are caused by prescriptions - which is a lie. Why is NO ONE in the media world or the medical industry, including doctors, nurses & pharmacists standing up for the people who pay their wages. For some reason addicts who lie, steal, alter & abuse drugs & lie about how they got started by jumping on the blame game wagon. Why are other doctors not coming out & confronting Kolodny & PROP for their conflicts of interest that started the ball rolling.

Danny Elliott

Cherylmarie, I don’t think I’ve ever read a better description of the type of daily/weekly battle with chronic, severe pain that I’ve been struggling with for 26+ years. In the first 4-5 years, I would bounce back fairly quickly, but the years of muscle atrophy from being in the torture chamber I call my pain room. As for Kolodny, I fight wishing bad things, but I don’t - I don’t want anyone to suffer like I do. Thanks for an excellent comment.


Yes I can do all that self distracting stuff like meditate, exercise, yoga, read pain articles and books, socialize, clean my house, cook etc. but not when my pain is SEVEN OVER TEN I’m toast. It’s lay in bed all day and TV can’t even distract me. Then when that crisis is over its a week to recover and trying to get caught up. Then the cycle starts again. Doctors don’t seem to get the concept that all that stuff is worthless (exercise, socalize) unless your pain is halfway under control.

Oh and the Kolodny statement was also something to the effect of pain patients say they can’t get out of bed without pain meds and that’s what heroin addicts say too about not having their heroin. So lumping us in together again. I wish I was a heroin addict instead of a chronic pain sufferer, at least I’d have a chance at a new start. And maybe some compassion
No cure for me…..

Anne Fuqua

Excellent job Suzanne! I’m glad you DIDN’T back down! Kolodny thought he’d won, but you didn’t back down. You reached out for help you hit back with facts and evidence. Way to go!


National Pain The Cato Institute calls for a calm and reasonable approach to opiates, and a “willingness to admit policy mistakes.” “Let’s Stop the Hysterical Rhetoric about the Opioid Crisis” By Jeffrey A. Singer In the article, the author states”If policy makers in the Trump administration want to effectively address the problem, there are other ways to do it. They should promote “harm reduction” programs, including pilot “heroin maintenance” programs, such as those that have worked successfully in Switzerland, the UK, Germany, the Netherlands, and Canada. They should also take note of recent evidence from Johns Hopkins University, the University of Michigan, and the RAND Corporation that have shown a dramatic decrease in opioid use and overdose rates in states that have legalized marijuana for medicinal use.” In addition, we should heed the recommendations of other physicians who are conducting studies. A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide AnGee Baldini, MD,corresponding author Michael Von Korff, ScD, and Elizabeth H. B. Lin, MD, MPHcorresponding “Despite increased use of opioids for long-term management of chronic pain, there remain large gaps in understanding of the basic physiology, efficacy, and side effects of opioid medications, particularly when used over long periods of time.54 Limitations of this literature review are inextricably linked to the weaknesses in the available evidence. There is a need for additional research on adverse effects of opioids across all systems and for studies that evaluate aggregate risks of chronic opioid therapy relative to observed benefits. Future research should take into account not just adverse effects related to chronic opioid therapy, but also differences in risk by differences in regimen (eg, by dose, sustained-release versus short-acting opioids) and by the methods of prescribing and monitoring. Research must also investigate the long-term efficacy of chronic opioid therapy, titrating opioid dosages appropriately, developing care plans for patients at varying levels of drug abuse, and adequacy of monitoring.49 A systems-based understanding and characterization of adverse effects may help improve patient care outcomes in managing chronic pain.” We should also heed the recommendations of these PM healthcare Practitioners who are calling for a more humane, sound and reasonable approach to patient care for the CPP. Justification of Morphine Equivalent Opioid Dosage Above 90 mg One team’s rationale for justifying prescribing higher dosages of opioids. By Forest Tennant, MD, DrPH, Martin J. Porcelli, DO, Lloyd Costello, MD and Scott Guess, PharmD, RPh “Federal and state guidelines for opioid prescribing caution and warn physicians about the risks of prescribing a daily opioid dosage over 90 MME. Third-party payors often try to use these guidelines as a rationale to restrict payment for opioid dosages. Although federal and state guidelines do not restrict dosages above 90 MME, they call for a justification before prescribing above this level. To our knowledge, no federal or state guideline has published specific criteria or requirements for prescribing doses above 90 MME. We have developed a structured evaluation protocol to justify a daily opioid dosage over 90… Read more »

Michelle Thum

Scott Michaels try Dr. Chessler in Escondido. If he’s still practicing. Good luck!

Let me add support for the Suzanne Stewart’s well researched and highly topical article. Andrew Kolodny and Jayne Ballentyne have actively pursued an anti-opioid agenda for several years. In my opinion, both have been responsible for advocating hysteria that is anything but responsible in their claims as leaders of “Physicians for Responsible Opioid Prescribing”. Their influence also appears to have been a factor in the many dangerous deficiencies, biases and violations of research standards incorporated into the March 2016 CDC opioid prescription guidelines. Let is be as candid and clear as we can about a complicated issue of public health. Published studies on chronic pain treatment and addiction risk are by not yet conclusive. In a 2010 Cochrane Review of published studies of thousands of patients who had never used opioids before their first prescription, fewer than one-half of one percent were diagnosed with drug abuse disorder a year later. Other studies suggest abuse risks as high as 10%, often with long lists of “confounds” and qualifications. Your conclusions may depend on the source you choose to believe. Funding for serious long term research in this area of public policy has been abysmally absent for the last 20 years. However, no less an authority than the US National Institute on Drug Abuse informs us that 90% of all addicts begin to abuse drugs or alcohol in their teens — long before the great majority of them are ever seen by a doctor for pain conditions severe enough to justify prescription of opioids for more than a few days. We all hear the stories of high school athletes who get hooked on pain pills after a couple of weeks exposure — but real cases of such “instant addiction” are exceedingly rare. Regardless of their personal tragedy, these patients are unrepresentative statistical outliers. The current “opioid crisis” is vastly mis-characterized by financially or professionally self-interested advocates who blame liberalized prescription policies and over-prescription by doctors in the 1990s for a present “epidemic” of overdose deaths. But in States like Massachusetts, where overdose-related deaths have been matched to prescription drug monitoring databases, it is found that fewer than 25% of overdose victims have a current prescription for opioid pain killers. More than half of overdose deaths are complicated by alcohol or anti-anxiety pills or both. So reality is not as simple as the drug war advocates would have us believe. As noted in other articles on National Pain Report, the current “opioid crisis” is one of drug diversion and of cartels marketing street drugs like heroin, imported fentanyl, morphine stolen from hospitals, and methadone diverted from community treatment programs. The “crisis” is NOT caused by careless doctors over-treating legitimate pain patients. Most likely it never was. Numbers of opioid prescriptions have dropped steadily for the last three years while deaths from heroin have continued to rise. It is now unambiguously clear that solutions for America’s addiction crisis will be more social than medical. Addiction is a disorder of adolescent immaturity, social isolation and… Read more »


Thank you for this informative article. As a chronic pain patient who suffered at the advice of a doctor years ago to take Advil or Motrin for chronic pain. I only developed an sensitivity to taking too many of those OTC’s because they didn’t work and I was desperate for relief!

I was ecstatic when Allene became OTC, but again, it offered little relief for my pain and I became allergic to it.

I finally met a doctor that would treat my pain in 2005 with opioids and that is when I became a productive citizen again. Fentanyl gave me my life back.

Last year, I was told by another doctor that my health issues were being caused by my long term opiate use. I went through hell tapering and getting off the Fentanyl patches. It’s been 10 months and I have been in much worse pain and living a less productive life

Nobody knows what chronic pain feels like unless they experience it. I only wish it was all in my head!

Does anybody know how our voices can be heard?

In case no one has noticed… attorneys are lining up in mass to sue anyone.. any entity that are in the legal medication distribution system… now also including insurance companies for paying for opiates. Recent report out of Dayton OH area - 99% of all OD had an illegal fentanyl or Heroin in their toxicology. Study earlier in the year from the Boston area indicated that only 8.3% of the people who OD’d had a prescription for the opiate that showed up in toxicology.. Does this suggest that some/many/all of those 8.3% may have been SUICIDES ?
IMO.. the whole foundation of the war on drugs is when our judicial system declared that opiate addiction was a CRIME and not a DISEASE… the chronic pain community pooling their dollars to create a ‘legal defense fund” to challenge the constitutionality of that decision… could cause the whole war on drugs infrastructure to collapse…
After all, our previous Surgeon General made a public statement that addiction is a mental health issue and not a moral failing.. this statement is a place to start

Mark Ibsen MD

Is it true that Dr Kolodny Himself was upset about an earlier draft of this article,
Demanded it be taken down under threat of lawsuit,
That within 12 hours
Many advocates for pain refugees provided the crossreferenced articles required to satisfy this bully?

I am grateful that NAtional pain report is willing to stand up
Make some changes
Publish this article against the threat of further bullying.
As if Dr Kolodny annotates his lies with cross referenced articles proving his points.
Certainly not when he calls all pain pills( except the suboxone he prompted) are heroin pills.

And makes outlandish claims about od deaths,
Claims that doctors like myself contribute to the epidemic of deaths.

At least three of my patients have died since losing access to their pain relief.

So sad.
Enough lies
Enough bullying
Enough scapegoating of
Pain refugees and the doctors who try to help them.


Summer Platz

If people read only one article about the opioid “crisis”, please let it be this one. It takes on every argument and battles it with logic, and valid expertise.

Thank you for taking this immense beast of a war, and cutting it down to the bare bones of facts, motivations (recreational use, money), who is really fanning the flames of panic, and most importantly, who suffers the most when outside agencies, instead of doctors, start making medical decisions about patient treatment and care.


Am so glad to have someone speaking up for the Chronic Pain Community. We are people in pain. We aren’t drug addicts looking to get high. Personally I just want to be able to go to work everyday and sleep at night. Medication helps me. It helps many and now they (whoever “THEY” are) want to take it away because they know whats best for us. Excuse me but this has worked for a long time and will if “THEY” will just stop attacking us. We are pain patients not animals.


People in pain need to have structural changes in all levels og government and a new bill of rights to protect them against the healthcare industry. In 2010 i created the american pain rights act and only 210 people signed on. So people in pain are not always their best advocates.
The great wrongs 8n pain care today have resulted from great selfishness and carelessness in govt. and healthcare and the failure of people in pain to demand representation and a bill of rights.
It will not be easy to reverse the sorry state of affairs in pain care but people in pain can learn from the civil rights movement workers rights movement environmental movement and animal rights movement.
I myself am actively pushing the federal government to cure pain and i am making progress. It has taken a lot of time and effort but if i can make progress so can the many people suffering pain.

Mark Ibsen MD

You are absolutely right.
Thank you for throwing down the gauntlet.

There seems to be two views in this:
The patients view
The view of those who benefit from taking away all opiates.

In addition to Kolodny and his ilk,
The ASIPP has been aggressive in creating an environment of fear about opiates.

Let’s have Congressional hearings
With participants under oath
Invite all stakeholders to be involved.

Kolodny May be right about some things( not that I have seen that)
I know Dr Tennant is right about the intractable pain patient.

I just don’t think regulators or
Legislators ought to be deciding.
My request is that the medical profession stand up for patients and stop selling out our integrity over fear of
Losing- jobs, license, 💰,
And return to the Hippocratic Oath of
Do No Harm.

Great article

Danny Elliott

Concerning the part of this story that relates to the percentage of people who get “addicted” to opioids, a recent Time magazine article was written about a study called the “National Survey on Drug Use and Health” in which “government researchers documented the effects of the opioid epidemic in the United States”. Interestingly, the title of the article is “Opioids: 60% of abusers don’t have a prescription” (a link to the article is at the end of this comment). 51,000 people participated, taking an hour long survey. Then, the researchers extrapolated that information to project the numbers for nationwide estimates. (I think that this is a bad way to suggest what the actual nationwide numbers are, just as I disagree with using this type of sampling method to project actual numbers when conducting the National Census. But that’s just my opinion.)

So, based on the survey, they say 92,000,000 Americans, or 40% of the population, “report using opioid medications”. That seems awfully high to me, especially considering that the study was conducted during the “War on Opioids” over the last few years.

However, there were some interesting findings, in addition to the 60% of opioid users who don’t have a prescription, that are supportive of what many of us have been saying all along. Of that 92 million, “nearly 5%” (or about 4.6 million) misuse medications, by either not having a prescription or taking more than is directed by the prescribing doctor. (Because I’ve become so skeptical of journalists, the “nearly 5%” makes me wonder how much over 4% the actual number is.) And of the 4.6 million who misuse the medicine, “nearly 2 million were addicted or had some type of addiction disorder.” When I did some more math, this study is actually saying that of the 92,000,000 who are using pain medications, 2,000,000 have addiction issues - that’s equals a 2.17% addiction rate!

But here’s the real kicker in this article (emphasis added by me): “People said the main reason they turned to opioids WAS TO RELIEVE PAIN, which the researchers say suggests that the DRUGS AREN’T EFFECTIVE IN ADDRESSING PAIN, or are too addictive to be useful as pain relievers.” What?! How in the world is that what the researchers got from people using opioids “to relieve pain”? It simply proves, once again, that statistics can be used to say whatever the researchers want them to say. Unbelievable…


It seems that….follow the buck, still, is in play. It always will be. You can give me a “lie detector” test as to the realized gain and benefit that opiid medication, has helped me to realize. I have remained a sovereign (as possible) patient for over 20 years. Responsible prescribing along with the benefit to me, personally FAR outweighs the unneccessary gambit of problems that go along with un managed pain.As I have realized with age, people are more alike, than different. People, patients with pain, treated by a physician, especially at a pain management facility wish only, to ease their pain and in most cases , be responsible for their everday life necessities. Many are able to realize that “life is not over”.
I was offered a “pain pump” but, in my state to many concessions had to be made with the pump. I also talked to some patients that alrady had a pump and just like all issues, about a group of the patients said it was “good” for them, others wished they had never did the procedure. I am of a mind that effective pain management with oral medications, injections, infusions, and all other methods of treatment singularly or in combination can achieve the best results but, that decision needs be left to the patient and the provider. In a management facility, the screenings are the norm. If the patient is prescribed medication and used as directed as the only effective treatment of pain management that suits the patients lifestyle, then why, crucify the millions for the perceived “good” of the few? Turn no one away whatever the issue, but, who is held accountable for the cost? Follow the Buck. I’m tired, older, and don’t wish (for over 20 years) to have screwed up and have the last effective treatment for pain management taken away from me through my own….actions. So I used medication “as prescribed” yet .GOV knows best.

Please PLEASE Know***THESE VIEWS IN THIS ARTICLE ARE MY OWN AND ONLY MY OWN AS A PRIVATE CITIZEN. THESE ARE NOT NECESSARILY THE VIEWS OF THE US PAIN FOUNDATION . I am an Ambassador which means that I do Awareness events etc but I am NOT appointed as one of their Advocates.

Michael G Langley, MD

I don’t know what it will take. But, we need to get the message out to the drug warriors of these two facts. 1) Pain patients are being harmed, increased suffering and suicides, due to abuse from our “doctors”. 2)The war on drugs has been a big failure. It has been a big money pit that has not decreased the drug addiction problem one iota! And, as you said, the people dying from drugs are, by far people, who want to use opiods recreationally. They get clandestinely produced drugs that include the newest demon drug, Fentanyl. It is hard to dose, for the amateur, especially if the potency is unknown, as it is with illegally manufactured drugs! It is going to take thinking out of the box, admitting the failure of Nixon’s war on the people who use drugs…hippies and blacks (talk about a racist and bigoted approach!) put all this together and it appears that doctors have lost their ability to have compassion, and think about what they are doing when they treat us. If they don’t treat us properly, they might as well put the gun to our heads! They certainly are not thinking of the suffering they can relieve And in the end, is that not more important than beating death? Fact is, none of us are going to avoid death. The voyage through life is the important thing. It should be a voyage with the east amount of stress to us that need some relief from the intractable pain, that won’t let many of us sleep. Even with all of the medication that I have for my pain, and a TENS unit, I still was only able to get four hours of sleep, last night, disturbed by constant reawakening due to uncontrolled neuropathy. But, my pain doctor and the neurologist both brag that they don’t have any peripheral neuropathy patients on “narcotics”. And, they thinks that is something to brag about!!….(;-( God deliver us from evil…(doctors?)

scott michaels

Does any know doctors in the temecula ca area 60 mile radius thatt prescribes high dose pain relievers for people with severe chronic pain

Larry fowler

It would seem there’s a sub set to your pain clinic pills are bad people. My clinic randomly reduces medication and does not info the patient they have done so. They also feel if meds are needed than a pain pump is the only answer, and they are happy to do the surgery. It would appear to me they are trying for the most monetary return with the least work for themselves. The pump is huge looking and a painfull procedure with the weaving of the tubes from front to back (spine) and the complications that can and do arrise are troublesome to the patient. My clinic tells us it’s the only way to control abuse…..are they ever in the dark with that line of thinking!!!