Posted on 07/13/2019 5:27:23 AM PDT by GailA
Senator Joe Manchin (D-WV) and Mike Braun (R-IN) are still trying to address the fentanyl and heroin overdose crisis—soon to be joined by a methamphetamine and cocaine overdose crisis—by denying chronic pain patients access to pain relief. They have just introduced a bill they call The FDA Opioid Labeling Accuracy Act, which would “prohibit the Food and Drug Administration (FDA) from allowing opioids to be labeled for intended use of ‘around-the-clock, long-term opioid treatment’ until a study can be completed on the long-term use of opioids.”
Set aside the fact that most pain specialists agree that, in some cases, long-term opioid therapy is all that works for some chronic pain patients. The 2016 guidelines on opioid prescribing put forth by the Centers for Disease Control and Prevention have already been misinterpreted and misapplied by legislators and regulators, leading to forced and rapid tapering off of opioids in many chronic pain patients, causing many to resume lives immobilized by pain, and in many cases, seek relief in the black market or by suicide. It has gotten so bad that the CDC recently issued a “clarification” in April, reminding regulators that the guidelines were only meant to be suggestive, not prescriptive, and did not in any way mean to encourage the rapid tapering of patients on chronic opioids for pain management. Johns Hopkins bioethicist Travis Rieder, PhD delves deeply into this subject and relates his own experiences in his book, In Pain.
(Excerpt) Read more at cato.org ...
About 15 years ago the position of the FDA radically changed. Like I posted, they sent out speakers to CME events for years informing doctors of the “new guidlines for narcotic treatment of chronic pain”. They PROMOTED it. IMHO a mistake of massive proportion.
PM sent.
[[You will realize there are very few chronic pain conditions a Neurosurgeon with 40 years experience at Mass General didn’t encounter. ]]
I call BS- Respectfully-
[[Research investigating a popular form of surgery aimed at easing chronic shoulder pain doesn’t fix the problem, a careful, placebo-controlled study suggests.]]
[[Surgery is rarely used in chronic pain cases. If it is used, it’s generally the last resort. However, if you have serious neurological complications (such as bowel or bladder dysfunction), along with chronic pain, you may need immediate surgery.]]
https://www.spineuniverse.com/conditions/chronic-pain/surgery-chronic-pain
[[The biggest risk of sacroiliac joint fusion is the possibility that surgery won’t alleviate pain, and/or that fusion of the joint will be unsuccessful.]]
[[Despite careful diagnosis and a successful operation, some patients may still experience pain after their back surgery. This persistent pain or continuation of symptoms is known as failed back syndrome (sometimes called failed back surgery syndrome),
However, epidural fibrosis, the formation of scar tissue near the nerve root, can put pressure on the nerve roots and thereby cause pain.]]
Yup- just keep gettign surgeries- nothign to it-
http://www.back.com/back-pain/conditions/back-pain-after-surgery/index.htm
As well, there are many cases for which there are numerous pains for which surgery can not correct- fibromylagia being one of them ore common- who have intractable pain for which htere is no surgey-
Degenerative spinal disease post-surgery 32%
Degenerative spinal disease non-operable 22%
Fibromyalgia 15%
Migraine-vascular headache 8%
Neuropathies 6%
Congenital skeletal disease 5%
Headache-post trauma 3%
Reflex sympathetic dystrophy 3%
Osteoporosis 2%
Systemic lupus erythematosus 2%
Abdominal adhesions 1%
Interstitial cystitis 1%
[[Who Is the IP Patient?
The authors define IP as “pain that is excruciating, constant, incurable, and of such severity that it dominates virtually every conscious moment, produces mental and physical debilitation and may produce a desire to commit suicide for the sole purpose of stopping the pain.”]]
https://www.practicalpainmanagement.com/resources/intractable-pain
As you knowe0- there are many inoperable back pains- Many people can not get back operations for one or several reasons- both medically and financially- There have been too many surgeries, too much scar tissue- too much damage that has become irreparable- etc- There are things such as inoperable hernias that put people at too great a risk to have surgery- inoperable brain tumors- spinal tumors- on and on it goes- Your $400 book doesn’t address any of these situations- or conditions with multiple causes and locations of pain- surgery is not an options for these folks- so no- it’;s not true that he hasn’t ‘found many that he couldn’t operate on’ if He’s working at one of the largest hospitals in the world- If he made that claim, then he’s hiding the truth- and just because “there are very few chronic pain conditions a Neurosurgeon with 40 years experience at Mass General didn’t encounter.” doesn’t mean he operated on all of them and cured all or even most of these people of pain- it just means he’s encountered a great many people with various pain problems- IF He’s claiming he fixed most of them, then he’s leaving out the inoperable cases he didn’t take on-
I’m not spending all day on this- you and I disagree- greatly- many chronic pains can not be operated on- and many that can- do not result in complete cure, or sustained relief- and it’s not an option to just keep going back and getting risky, expensive surgeries for many- especially when there’s no promise of cure- Surgery is not something to be taken lightly- and not all conditions even qualify for surgery when there are other methods available- opioids included- because of the risks of surgery- and complication that can and often do arise-
[[[[Surgery is rarely used in chronic pain cases. If it is used, it’s generally the last resort. However, if you have serious neurological complications (such as bowel or bladder dysfunction), along with chronic pain, you may need immediate surgery.]]]]
And again, the reason it’s used as a last resort in many cases, is NOT because ‘doctors just don’t want to help the patient’ but because of the risks of surgery, and because surgery is not to be taken lightly- it’s a last resort- not a first resort- and that is the way it should be- You not only have the risk of the surgery itself, but hte risk of anesthesia- risk of infection- in hospital, risk of infections after you get home, complications etc- This is why surgery is last resort- almost 20,000 people are year in the US die from staff infections- more from other drug resistant infections-
Very good post. IP consumes you. It builds upon itself. It leads to physical and mental disease. It crushes the mind body and soul. There is no way out of it. The nanny state would rather you eat a bullet than a pain pill.
Thanks Bob!
I believe the biggest reason now for opioid death is how careless Mexican cartel chemists are in preparing their fentanyl cut heroin for the illicit market not oxycodone or hydrocodone prescribed etc
The government always goes after the lowest hanging fruit which in this case is the legitimate pain relief opiate user
Like me
I take 2-4 ten milligram oxycodone daily and have for a decade
And I get steroid shots and occasional prednisone pills as well
And I function fine and have never overtaken my pills except for a canine tooth abscess over the weekend once which was futile in any event
It’s my personal choice and I have the discipline not to take them excessively to reach that euphoria some covet
It’s like lubricant for me ..
I’ve had multiple open heart surgeries from a congenital malady and cervical issues
I’m glad to have them
Ditto when my mom died of cancer and my cousin with lupus
God created the poppy for this is my reckoning and I’m disgusted with busybodies who think they know better
The government and moralists just can’t help themselves
I’m sixty one and will take them till I die if I wish
Opioid crisis is about money now ....states and police agencies get grants to combat it so they pimp it
When I was a kid there was exponentially more recreational dope than now
Diet pills, barbiturates, and quaaludes just for starters and not near the uproar. Back then it was all about marihuana and psychedelics
Now that opiates are taboo we know what’s going to happen next.
More complications from unnecessary surgery. We’re also going to have more bleeding ulcers, kidney damage/failure, allergic reactions from NSAIDS.
And right now we’re already seein the suicides from forced opioid tapers, and increased deaths from street drugs.
In as you have indicated, lower back surgery has historically been the most common cause of iatrogenic chronic pain. Surgeons operating on chronic pain pains that were poor candidates because of medical and psych co-morbidities, long term pain, disc degeration without nerve compression, patients with diabetic neuropathy interpreted as sciatica (one of my favorites), 2nd 3rd and 4th re-operations with fusions beginning at L5-S1 and working up the spine.
The 2016 guidelines on opioid prescribing put forth by the Centers for Disease Control and Prevention have already been misinterpreted and misapplied by legislators and regulators...
2016, so, a part of the phase-in of Obamacare.
Think about this, we had one case (sure, n=1) I recall that really opened my eyes to what is possible. I honestly can’t remember what the diagnosis was or the guy’s daily dose of Morphine but it was substantial. He had a problem with chronic pain on one nerve root. We put a small catheter in that nerve root sleeve and hooked it up to a pump that infused 1 mg of Morphine a day. Right into the nerve root sleeve. It was 100% effective. The guy got off systemic opiates completely. Think about it. If you can do that with one nerve root why not several. The point I am trying to make is we aren’t even trying. We are buying into this “it’s opiates or nothing”. That is a false choice.
One of the most important things I learned as a resident was who NOT to operate on.
Opiates aren’t going away. Think of it as a temporary “witch burning”. There is nothing that can take their place. All I am saying is that people should have a choice. If they want to treat their chronic pain with narcotics they should be free to do so. Every patient I ever saw that was given a choice preferred effective, non-narcotic treatment. I do beleive that with enough imagination, understanding of anatomy, and with a number of tools in the tool box every patient could be offered an efffective, non-narcotic treatment for their chronic pain.
And for me they are GI issues. Tylenol is all I can do. I’m careful not to exceed the dosage.
My entire spine is Degenerative, Stenosis, bulges, spurs, herniation, stress fracture, annular tears, Profusions, and collapsed dics and calcified Lumbar, It is NOT operable, it will crumble due to the OP severity caused by the Nerve Blocs, Predisone, and Steroids, Predisone is the only 1 that actually works on Hives. Rest are Side effects, depending on if it is Celestone which is a 2 week horrid reaction, to Medrol based which is 4 days. NO pain relieve. Back doc got from C 3 down to S 1 and the tail bone. I furniture walk in the house. Use electric cart at the grocery store, other than going to the doctors and grocery store I’m house bound. And at 71 I have frequent FALLS. That is WHAT Your ATTITUDE condemns me to. I do all I can to maintain weight, and function, it’s taken me 2 yrs to partially rehab my hand from the Frozen thumb with a Mallet Index finger, so NO fine motor skills in my dominate R. Hand. Hate to think what you view of Autoimmune is?
AA is NOT treatable. It’s nerve damage. due to the spaghitti like adhesions that go up and down the spine and into the Gastro Tract. Good example of Socialized Medicine. Shannon Macleod can’t find a family doc who will even treat him, he is in stage 3, most don’t live beyond stage 2. I’d say he’s closer to stage 4.
I’ve gone through every PT, all the snake oil and not found one ounce of pain control.
“We specifically address that physicians should not discriminate against patients … who have complex or chronic health needs and we specifically say they should not refuse a patient by virtue of having a history of being prescribed opioids or other psychotropic prescriptions. “
You had better believe that this attitude is here in the US as well as in Canada. The problem especially with US is going to get worse for chronic pain because of two major factors: socialized medicine and the war against pain doctors.
Large hospital systems view CPPs as a money loser. They are time consuming for staff and they are typically on Medicare or Medicaid because of low income and/or disability. CPPs typically don’t do the money making procedure such as interventional pain, surgery etc. Medicaid pays about $25 and Medicare around $54 for a level 3 visit. Employed physicians don’t want the medical-legal risk to their licence, the complaints, and the time drag on their productivity. You make more money on heathy patients or the sick ones that need expensive procedures.
Right now, many of the pain clinics that prescribe opiate will not accept insurance especially Medicaid because of the low rates. With the no surprise biling rules legislation that could become law, these doctors will face a limiting charge and small practices will simply not be able to meet overheads. Moreover, the government is targeting small individual pain practices with an unprecedented intensity so there won’t be many if any left in a couple of years.
[[We are buying into this “it’s opiates or nothing”.]]
No we’re not- also we shouldn’t be pushing the “It’s surgery fixes everything therefore opioids are never needed for chronic pain” notion
It certainly sounds like you are suffering. It also sounds like you are seriously disabled. Are you getting the kind of assistance you really need? If you are falling you really do need some help.
Anyway...It wasn't a good time for me or my family. I did learn compassion though, and that is an important life lesson to learn.
I am grateful for the thousands of people ( literally ) who made my recovery possible: Chemists, engineers, surgeons, technicians, architects, contractors and support personnel, who made my recovery possible.
Amen!
I have Meniere’s the Inner Ear Perfusion was a Failure.
And NO I’m not receiving any medical care as the Neurosurgeons REFUSE to treat as does the Back Ortho. MY SPINE WILL CRUMPLE is what I’m Told.
You really need to update your knowledge on the meanings of PAIN.
IP or Intractable Pain is a Medical Disease and is a Subset of Chronic Pain.
Intractable pain, also known as Intractable Pain Disease or IP, is a severe, constant pain that is not curable by any known means and which causes a bed or house-bound state and early death if not adequately treated, usually with opioids and/or interventional procedures. What they mean by that is any snake oil they dream up. Take a Nature Walk, I can’t walk with out a motorized wheelchair, and Medicare/Tricare Life is NOT going to provide one.
Chronic pain is defined as pain that lasts at least 12 weeks. The pain may feel sharp or dull, causing a burning or aching sensation in the affected areas. It may be steady or intermittent, coming and going without any apparent reason. Chronic pain can occur in nearly any part of your body. The pain can feel different in the various affected areas.
Where as Acute pain is sudden and can be classified as Appendicitis, Labor, a knife cut that requires stitches.
Acute pain: Pain that comes on quickly, can be severe, but lasts a relatively shorter period of time. As opposed to chronic pain.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.