Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations – PPM Editorial – Authors of this commentary are: Richard A Lawhern, PhD and Stephen E Nadeau, MD – Feb 2019
Here is a great example of an excellent commentary on the Draft Report from the HHS. We can all use this as a template for how to organize our own comments.
The following review comments were submitted in response to the draft report, Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations, published by the HHS Pain Management Best Practices Inter-Agency Task Force.
To Be Praised
I urge everyone to start with the positive to make our later criticism more palatable. We have to remember the person reading our comments and try to be what they would regard as “reasonable”. Otherwise, I fear our commentary will be left unread and disregarded. Continue reading
Opioid Crisis: No Easy Fix to Its Social and Economic Determinants – Feb 2018
The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector.
I don’t see how this wrong idea can be called “accepted wisdom” when it is much more akin to “accepted nonsense” and “urban legend”.
Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness. Continue reading
When Chronic Pain Takes Away Your Life – By Peter Abaci, MD – Dec 2018
I find it unusual for a doctor to think about this, let alone write about it.
Pain changes us.
The minute we start to hurt, we make adaptions to how we move, what we do, and where we go.
This makes me think Dr. Abacci really does understand what it’s like to live with chronic pain. Continue reading
Structural Iatrogenesis — A 43-Year-Old Man with “Opioid Misuse” – Scott Stonington, M.D., Ph.D., and Diana Coffa, M.D. – February 21, 2019
Here’s a quick summary of a terrifying story:
“When he gets tangled in new restrictive policies on opioid prescribing, a factory worker with severe rheumatoid arthritis, whose pain must be managed for him to perform his job, ends up buying oxycodone from a friend.”
(I’ve quoted almost all the text of this case study because the NEJM is now behind a paywall with only 3 free articles a month, suddenly restricting our access to what our doctors are reading and upon which they base our treatments – just another screw being tightened on patients.) Continue reading
Opiophobia: The Irrational Fear of Opioids – by Dr. Jeffrey Grolig – National Pain Report – Feb 2019
The irrational fear of opioids, opiophobia, has plagued our country before. Prior to 2000, especially in the 1980s and 1990s, opiophobia ruled the medical community.
The fear was that opioids used for more than a short time would cause overdose, death and addiction. The War on Drugs from the Nixon era caused non-opiophobic doctors to be targeted, arrested and disciplined.
But then Dr. Russell Portenoy conducted research showing that chronic pain patients actually did well on these opioids, achieving an excellent quality of life with vanishingly few developing problems. Continue reading
Complications of Uncontrolled, Persistent Pain – By Forest Tennant, MD, DrPH – Jan 2018
To the unfortunate patient who is afflicted and the practitioner who treats it, incurable, persistent pain is truly its own disease regardless of its underlying cause.
Persistent pain, which is also often characterized as chronic or intractable, has all the ramifications of a disease in that it may have pre-clinical and overt phases.
I like that he calls it “persistent pain” instead of “chronic pain”, a term which has become synonymous in the public’s eye as a whining, complaining, catastrophizing, gonna-be addict. Continue reading
Calif. Medical Assn. President Shares Medical Horror Story – by Cheryl Clark, Contributing Writer, MedPage Today – Jan 2019
The new president of the California Medical Association was expecting to spend New Year’s at a wedding in Las Vegas.
Instead, David Aizuss, MD, posted on Facebook about his “eye opening” first-hand view of “American medicine at its worst.”
While I’m sorry for what he endured, I can’t help but be pleased that such a high-ranking doctor suffered exactly the same brutal treatment pain patients struggle with: the routine refusal to relieve pain (if not outright disbelief and accusations of drug-seeking). Continue reading
Fox Part 3 | Health experts offer solutions for unintended consequences of opioid crackdown – By Elizabeth Llorente | Fox News – December 12
Treating America’s Pain: Unintended Victims of the Opioid Crackdown, Part 3 – The Solutions
Solutions are obvious (rewrite CDC Opioid Guideline), but there’s just no political will to reverse course.
It looks like this Titanic will have to sink before anyone dares make corrections. Pain patients (like passengers on the Titanic) will just be sacrificed before we eventually see progress. Continue reading
Opioid Nation by Marcia Angell – December 6, 2018 Issue
This is a review of three books written about the so-called “opioid epidemic”.
The term opioid is now used to include opiates, which are derivatives of the opium poppy, and opioids, which originally referred only to synthesized drugs that act in the same way as opiates do.
Opium, the sap from the poppy, has been used throughout the world for thousands of years to treat pain and shortness of breath, suppress cough and diarrhea, and, maybe most often, simply for its tranquilizing effect. Continue reading
Pain management, prescription opioid mortality, and the CDC: is the devil in the data? by Michael E Schatman & Stephen J Ziegler – Journal of Pain Research – Oct 2017
Though a year old, this article explains the flaws in the CDC opioid prescribing guideline.
Transparency, freedom from bias, and accountability are, in principle, hallmarks of taxpayer-funded institutions. Unfortunately, it seems that at least one institution, the Centers for Disease Control and Prevention (CDC), continues to struggle with all three.
What began with a prescribing guideline created in secrecy has now evolved to the use of statistical data and public statements that fail to capture not only the complexity of the problem but also the distinction between licit and illicit opioids and their relationship to the alarming increase in unintentional overdose. Continue reading