Mr. Dikel points out a fundamental shift in pain management practice that I noticed several years ago, starting with my experience at Stanford in 2011.
Sometime in the past 10 years or so, psychiatry or psychiatrists were pushed aside as pain management passed over to a new group with a different mentality altogether. “Addiction medicine.”
And when the addiction medicine people took over from psychiatrists, they in some cases sent a letter out to patients that immediately proved that they had not a f — king clue about how to deal with pain patients.
The letters took a very authoritarian tone and notified “in no uncertain terms” that EVERYONE’S medication would be reviewed to see if they weren’t being dosed excessively, etc., etc., etc.
IF they understood pain patients’ mentality, even a little, or perhaps I should say if they gave a rat’s ass about how patients thought or felt, they would understand that the abovementioned statements would throw the patients into a terrible state of stress and anxiety, especially those who had to go through periods when it was not possible to get appropriate medication and treatment.
It was hellacious.
Maybe what went wrong is NOT something to do with the patients, maybe its something to do with the system — the new mentality, the new regime. Has anybody out there heard anybody asking that question?
at the way these people are approaching pain management may have an unintended but terrible result:
That pain patients who are cut off too soon because that is when the “evidence based” policies say they should be ready to quit, or who try to augment their sub-threshold pain management medication with something else, like maybe marijuana – which shows up in the drug-test cup and causes them to be cut off by their doctor and pain management clinic, those patients may be in tremendous pain without any way of controlling it.
And if you can’t control it[pain], believe me, it WILL control you.
Of course there are our keyboard commando friends who will pipe in and preach about how THEY’VE been in pain before and they just ignored it.
Or took two Tylenol and it did the trick. Or any other ridiculously ignorant, moronic statement of the same ilk.
I would suggest that they would only be proving that they have absolutely no idea in hell what they are talking about, and that whatever little pain they’ve dealt with is not even the same WORD as what somebody who genuinely needs something as strong as opioid medication to be able to function lives with every day of their lives.
Mr. Dikel then offers an alternate explanation for the sad demise of a famous pain patient. I, too, don’t believe Prince was addicted to opioids, but rather that he needed this medication to continue making his art, his music, and his fantastic performances.
In today’s atmosphere of prohibition and intense scrutiny, he may not have been able to procure his medications from a doctor…
The last thing has to do with Prince, who was found dead in his home outside Minneapolis early one morning from an overdose of Fentanyl.
anyone who was in Minnesota in the 1980s when Prince was first coming to be known, or anyone else who was a fan, knew that Prince was always proud of the fact that he did NOT smoke, drink, or use drugs. And that didn’t change.
Wow. Where do I start.
What did happen to Prince? Let me suggest a different scenario. This much is true: Prince was all of about 5’3″ tall, and always wore platform shoes — HIGH platform shoes. Including when he was on stage during his act — running, dancing, jumping, standing on his feet for hours. By the time he was 50 years old, even before, he was in tremendous pain from all those years of punishment to his hips, his knees, his ankles, his back.
The following is hypothetical. He may have been under the treatment of a pain management doctor, given his very legitimate basis for seeking pain management. It is possible that, even though Prince was in a great deal of pain, after Michael Jackson, Prince’s doctor wanted to make sure he doesn’t give him too much medication and risk an overdose and end his career, like Michael’s doctor.
maybe he decided to set a maximum limit on dosage, telling Prince, as the pain management people are wont to do these days, “We’ll see you in a month. If you still feel its not enough by then, maybe we’ll consider raising your dose.”
So Prince is under-dosed. Maybe this dose mostly takes the edge off, but the pain is always there — it never goes away. And when the pain spikes, it can knock you back like being kicked by a horse.
And for those who have not dealt with this kind of pain, it’s damn hard to function when the pain never, ever, stops.
This is the crazy-making part of having chronic pain: it does not and will not ever end. The pain is not something that will ever “heal” so the need for pain medication never stops.
There’s no “recovery” from pain like there is from addiction.
Needing opioids for pain relief means our lives will not improve when they are taken away, unlike those who need opioids to get high, who benefit from ending their use.
So maybe Prince tells his bodyguard or head of security, “Get a hold of someone who knows where to get this stuff and tell them to find me something for this pain — on the street if necessary. Just. Do. It. NOW.”
So maybe this someone goes out and finds a dealer with some stuff that he says will take care of any pain ” its some kick-your-ass stuff! Like 10… no 100 times stronger than morphine!”
doesn’t pass any of it on to Prince about how strong it is, certainly not that its 100 times more powerful than morphine.
So maybe he takes the same amount as he would morphine. And it kills him.
So that’s my alternative hypothesis to the pain management physician who claimed Prince was an addict with no proof, evidence, or any solid basis for that statement
If that were the case, then Prince died of an underdose.
This essay is worth reading in its entirety: The Opioid Underdose Epidemic
Author: Thomas Dikel
I am a Developmental Psychopathologist (child development, clinical and forensic psychology, and neuropsychology), focus on child abuse, adult trauma, and PTSD.
Prince is another casualty in the pointless and cruel “war on drugs”.
He had a medical problem called “chronic pain” that is not treated as a medical problem, but as an addiction problem. Any use of opioid pain relievers is immediately labeled a “Substance Use Disorder” and effective pain relief is withheld.
Of course he couldn’t go to a doctor and get effective treatment for his pain.
Instead of allowing him to take a medication that’s effective for his medical condition, he would be coerced into unscientific, unproven, and mostly ineffective “alternative” treatments and drug regimens.