War over painkillers rips apart the medical community

A ‘civil war’ over painkillers rips apart the medical community — and leaves patients in fear –  January 17, 2017 – By Bob Tedeschi @bobtedeschi

For Thomas P. Yacoe, the word is “terrifying.

Leah Hemberry describes it as “constant fear.

For Michael Tausig Jr., the terror is “beyond description.”

All three are patients struggling with chronic pain, but what they are describing is not physical agony but a war inside the medical community that is threatening their access to painkillers — and, by extension, their work, their relationships, and their sanity.  

This is exactly how I’ve been feeling: trapped between endless pain and my government’s callous attitude and ineffective solutions. The drug war cannot solve the problem of human addiction.

Two years after the United States saw a record 27,000 deaths involving prescription opioid medications and heroin, doctors and regulators are sharply restricting access to drugs like Oxycontin and Vicodin.

But as the pendulum swings in the other direction, many patients who genuinely need drugs to manage their pain say they are being left behind,.

“There’s a civil war in the pain community,” said Dr. Daniel B. Carr, president of the American Academy of Pain Medicine. “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.

“There’s almost a McCarthyism on this, that’s silencing so many people who are simply scared,” said Dr. Sean Mackey, who oversees Stanford University’s pain management program.

It’s significant that these two particular doctors, who are at the vanguard of the movement to treat pain without opioids, are starting to realize they have created a monster of anti-opioid sentiment that’s devouring doctor and patients alike.

“The thing is, we all want black and white. We don’t do well with nuance. And this is an incredibly nuanced issue.”

This is becoming a huge problem in many aspects of modern American culture as complex issues arise. In this country, more and more politicians campaign on soundbites of simple solutions that are completely unrealistic.

See also Simplistic Moral Solutions to Complex Social Problems

Nuance does not matter to people like Tausig, 43, who has been unable to work or socialize since 2008, when the last of his five spinal reconstruction surgeries left him in constant pain.

He last got a taste of life without opioids a few years ago, when his pharmacy’s corporate parent imposed opioid-distribution limits, forcing him to find a new one.

Now, with regulators and health industry leaders continuing to bear down on opioids, and the arrival of a new president whose statements indicate that he might further restrict opioid distribution, Tausig’s worries have deepened.

The medical community’s battle over painkillers burst out into the open in late 2015, when the New England Journal of Medicine published a commentary in which two doctors argued that chronic pain patients should focus not on reducing the intensity of their pain, but on their emotional reactions to it.

This is typical of people without pain – they just cannot understand the burden of chronic pain.

The authors, Dr. Jane C. Ballantyne, the president of Physicians for Responsible Opioid Prescribing, and Dr. Mark D. Sullivan, argued patients should pursue “coping and acceptance strategies that primarily reduce the suffering associated with pain and only secondarily reduce pain intensity.”

The pair argued that patients who mainly focus on pain intensity tend to escalate their doses of opioids and worsen their quality of life.

But the comments also laid bare a fundamental problem in the debate over opioid treatments: Neither side has much evidence about the benefits or consequences of long-term use because almost no such studies exist.

Stanford’s Mackey said those risks are important to recognize. But, he said, nearly 15,000 people die a year from anti-inflammatory medications like ibuprofen.

“People aren’t talking about that,” he said.

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One thought on “War over painkillers rips apart the medical community

  1. Kathy C

    Too bad we are now in the Fact Free Era!
    The Medical Community is in the process of removing words like “Failed Back Surgery Syndrome.’ They are attempting to classify pain as a “Mental Health Issue.’ Big Pharma and the Low Income Clinics started this my State years ago, The more i read about this debacle, i realized that here are powerful Industry people working to obscure Medical Data, The Industries found it was “Inconvenient”. In college I had a Math Professor, he was brilliant, the response he taught me for any problem, was “Plug and Chug.” Essentially you put the variable into the Equation, then work it.
    This led me to the Pain Problem, I substituted Diabetes with Pain. Pain can be ignored because it is hard to quantify, but Diabetes now an Epidemic in the U.S. too has been under counted. One would think that such a serious cause of death and disability would have been tracked by Federal Agencies, Researchers or Health improvement organizations. They did some A
    Advertising, but nothing near the amount need for such and expensive and widespread problem. Diabetes and Back Injuries are 2 of the 3 most expensive conditions for the Healthcare System. They have been under-counting the deaths from Diabetes for years. There is some Talk, that the Sugar Lobby, actually got Physicians to recommend exercise over the reduction of sugar Intake.
    The more I dug the more I realized, that all of the numbers they use, as Markers in Healthcare, the Data they are allowed to collect, is skewed. Big Pharma and the Medical Industry have been Lobbying our Congress for decades, with pseudo Science. They decided that the collection of Data by Medicare, the largest Insurer in the U.S. was “Government Overreach.” This does not have to make sense. Most of the research they do is working backwards with the ICD-10 billing codes, which have also been limited to avoid Context, or the capture of “problems.” Even the Death Reporting requirements are vague, and non scientific. So the numbers they are gettign are not really usable. These powerful groups decided that collecting Data was a problem, it could lead to reduced payments for Physicians. Even the use of comparative quality research is extremely limited, by the Contorted reasoning of these Industry Groups, it is “Government Intrusion” or some such nonsense. So Next time you hear a “Study” or some other Announcement of anything, check the source.

    Article about he Missed Diabetes Deaths,
    https://www.sciencedaily.com/releases/2017/01/170125145848.htm
    An Article about “Comparative” Medicine, and attempts by CMS to get comparative Data. Notice the collection is extremely limited.
    https://www.sciencedaily.com/releases/2017/01/170125145839.htm
    These are the “Dark Money groups interfering with Data Collection, Most Important!
    http://www.motherjones.com/politics/2017/01/tom-price-health-secretary-fringe-medical-group

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