We have been hearing about the opioid epidemic for so many years we have lost track. It continues. The CDC recently reported a significant uptick in drug overdoses and deaths during the pandemic. No one doubts that opioid abuse has caused unbelievable suffering and death. But fear of addiction and the resulting opioid crackdown has also caused extraordinary suffering and death. Millions of people suffer severe chronic pain. Far too many of them consider suicide as the only option left to end their agony.
We Don’t Allow Animals to Suffer:
No reasonable human being would ever let an animal continue to suffer intense pain. If you have ever heard an animal in distress whimper or whine, you know what I mean. Why are some health professionals so callous to human suffering?
Through no fault of their own, many individuals are tortured by pain. In some cases, it is because of a military ambush. Far too many soldiers have been permanently injured by bombs or IEDs (improvised explosive devices).
Surgery gone bad can also lead to intense chronic pain. We have heard from many patients that a botched surgical procedure left them in agony for years. Accidents can also be traumatic to bones and tissue. Some bodies cannot be put back together after automobile wrecks.
Pain Management During the Opioid Crackdown:
There are lots of ways to treat moderate to severe pain. Doctors prescribe drugs such as NSAIDs (nonsteroidal anti-inflammatory drugs) or acetaminophen. They may work for mild pain, but are not very effective for really intense pain.
Medications like gabapentin (Neurontin) or tramadol (Ultram) work for some, but not everyone gets great relief from severe chronic pain. Physicians may also prescribe antidepressants because people who are really hurting are often depressed. But when severe pain continues, antidepressants cannot solve that problem.
Then there are things like acupuncture, physical therapy, meditation, autohypnosis, TENS (transcutaneous electrical nerve stimulation), spinal cord stimulation implants, etc. We believe that many people in chronic pain deserve total support from pain management clinics. Sometimes that involves prescriptions for opioids.
When the Opioid Crackdown Leaves People in Pain Suicidal:
When people are left with unrelenting pain, they sometimes consider suicide as the only way out of their misery.
This visitor to our website has reached the end of his rope:
“In June I will have suffered from severe chronic pain for 28 years. I will be dead before then. My doctor has cut me back from 180 mg of methadone and 75 mcg of fentanyl to 80 mg of methadone along with Robaxin. When I was first put on methadone and fentanyl after 13 years of pain, I was pain free for nearly 14 years.
“My doctor wants me off all opioids. I have three different types of severe pain.
“I also have dysphagia [trouble swallowing], which led to COPD. There is a possibility of improving the dysphagia, maybe even eliminating it altogether. Instead it looks like it might be my way out. I have already talked to my pulmonary doctor about discontinuing my nebulizer treatments so I could die without committing suicide. Since 2003 I’ve had 8 bouts of pneumonia. It wouldn’t be hard to get another one.
“He told me that he would make me as comfortable as possible if I chose to go into the hospital. I’m sick of hospitals, so I’d rather die at home.
“Believe me, I don’t want to die. I’m 61 years old. But I’m barely getting by now. I couldn’t function or tolerate the pain if my pain medicines were further reduced.
“I know that many people with pain like mine are using street drugs and alcohol to help them cope. I have no desire to do that.”
The Opioid Crackdown Has to Be Humanized:
For people who are suffering such intense pain, opioids can make life worth living. Lowering the dose because of some government edict is not personalized medicine. Prescribing a muscle relaxant such as methocarbamol (Robaxin) cannot ease severe chronic pain.
Alice shared her fear of “another opioid reduction”:
“I suffer with fibromyalgia, severe degenerative disk disease (DDD), and inflammatory osteoarthritis, along with multiple other co-morbidities. The DDD is so bad that my pain physicians have told me my entire spine is collapsing. My neck has been surgically fused at 4 levels and now has been further fused by arthritis.
“The entire clump of hardware/arthritis is now sliding down in front of the last cervical vertebrae causing nerve pain down both arms. Additionally, I had an injury to the dura of my spine that created a diverticula the size of a man’s fist that required a 7.5 hour neurosurgical procedure to correct and left me with cauda equina syndrome that affects my bladder.
“Before the surgery I could only sit for 6 minutes before I had fire-like nerve pain from my waist to the tips of my toes. I am a colon cancer survivor. I have been in severe pain since my mid 20’s and turn 64 tomorrow. I suffer with severe intractable pain that just keeps getting worse as more and more arthritis and bone spurs form in my joints, in my spine, everywhere that I have had surgery. I have had 27 operations.
“The opioids that I have been on for well over 30 years enabled me to work, function, remain upright, and remain a reasonably functioning woman who could help with household chores, walk my dog and play with my 2-year-old grandson. The doctors have reduced my opioid dose over the last year with still another reduction to come.
“I now spend 4 or 5 days a week in my recliner, unable to do basic household chores, unable to walk a 15-pound dog, unable even to answer my door at times, to sleep or to be a contributing adult. Showering is very hard, preparing a meal nearly impossible.
“I remain at a minimum of a 6 on the 1-10 pain scale and usually reach a 7 or 8 each and every day. The pain is stealing my life and my sanity from me, and the thought of another reduction of my opioids terrifies me. It makes me wonder if I can take it. Or will this be the proverbial straw that breaks me and causes me to end my life?
“People in my support group are afraid of what this unending pain will make them do. They talk of ending their lives, and though I am a Christian, I completely understand the absolute terror of more pain. Days are long, nights longer still and you cannot imagine the torture uncontrolled, unending pain causes. Please show compassion for the chronically ill. Show mercy; you have sentenced us to a life of torture.”
The Opioid Crackdown Is Out of Control:
Physicians have been told by medical societies to practice personalized medicine. That means treating each individual appropriately.
Guidelines that may be reasonable for tens of thousands of people may not work for a patient suffering from long-standing chronic pain. When federal bureaucrats, medical societies, guideline committees or pharmacy boards dictate how to treat pain, they should not be allowed to scare doctors away from prescribing appropriate pain relief for individual patients.
Has the Opioid Crackdown Affected Acute Pain Management?
It is easy to forget that acute pain can also be intolerable. Major surgery almost always results in significant pain. That’s true for back surgery as well as joint-replacement surgery.
Another reader suffered needlessly after a second knee replacement operation:
“I am in more pain than I can stand. I’ve hardly left my chair. The physical therapist says this is normal, but I don’t remember suffering like this after the first knee.
“The surgeon seemed more interested in keeping his opiate statistics low than in treating my pain. When he operated on my other knee a few years ago, he prescribed 10 mg of oxycodone for several weeks. It controlled the pain.
“When I asked about this, he said he no longer prescribes that. His practice must report to the government every month any opiates they prescribe. He said most of his patients do okay with just one week of 5 mg oxycodone. I’m not sure how well they are doing, or if they just don’t complain to him. But it isn’t enough for me.”
Balancing the Opioid Crackdown Against Patient Pain:
Pain is intensely personal and highly variable. The idea that a single regimen would work for every patient is not based on science.
Many people suffering from severe, intractable pain cannot get relief from non-narcotic medicines.
Doctors may prescribe muscle relaxants like methocarbamol (Robaxin), anticonvulsants such as gabapentin (Gralise, Neurontin) or pregabalin (Lyrica) or antidepressants including duloxetine (Cymbalta) or venlafaxine (Effexor). Nonsteroidal anti-inflammatory drugs such as celecoxib (Celebrex), ibuprofen (Motrin) or naproxen (Aleve) are used for mild to moderate pain with inflammation.
All of these medications have drawbacks as well as benefits. People in severe pain deserve personally tailored programs to help control it. In some cases, opiate medications are appropriate, despite government anti-addiction guidelines.
Listen to a Sensible Pain Specialist!
Dr. Sean Mackey says we need a revolution in thinking about pain. He knows what he is talking about. Sean Mackey, MD, PhD, is the Redlich Professor and Chief of the Division of Pain Medicine at Stanford University School of Medicine. He is Director of the Stanford Systems Neuroscience and Pain Lab and has additional appointments in the Departments of Anesthesiology, Perioperative, and Pain Medicine, Neurosciences and Neurology, by courtesy. He discusses the appropriate use of opioids for severe chronic pain.
You can listen to our interview with Dr. Mackey by clicking on the arrow in the green circle under his photograph. Or you can download the free mp3 file you will find at the bottom of the page. Here is a link to this show:
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