Lady Gaga’s Fibromyalgia Puts Illness in the Spotlight

Lady Gaga’s Fibromyalgia Puts Illness in the Spotlight

https://www.vwscircle.com/index.php/2019/09/06/lady-gagas-fibromyalgia-puts-illness-in-the-spotlight/

THURSDAY, Sept. 21, 2017 (HealthDay News) — Last year, superstar Lady Gaga took to social media to announce that she has long struggled with fibromyalgia.

The news has put the painful and poorly understood illness center stage.

The singer postponed the European leg of her 2017 “Joanne” concert tour due to what she described as fibromyalgia-related “trauma and chronic pain.”

Gaga hasn’t offered up details of her condition, although it came just before a new TV documentary about the singer premiered on Netflix — reportedly highlighting some of her health concerns.

But one thing is already clear: the disease does, at times, pull the rug out from under the performer’s best-laid plans.

“The pain and disability seen in fibromyalgia is typically worse than almost any other chronic pain condition,” explained Dr. Daniel Clauw. He is a professor of anesthesiology, medicine/rheumatology and psychiatry at the University of Michigan.

“[The pain] doesn’t just affect one area of the body you can avoid moving, and often is accompanied by severe fatigue, sleep, memory and other issues,” Clauw noted.

Dr. Marco Loggia added that “it can be extremely debilitating.” Loggia is associate director of the Center for Integrative Pain NeuroImaging at Massachusetts General Hospital in Charlestown, Mass.

“Most of the patients we encounter in our research studies are significantly impacted by the disorder,” Loggia noted, “which sometimes prevents them from having normal work and social lives.”

Fibromyalgia was first recognized by the American Medical Association as a distinct disease back in 1987, and is “a relatively common chronic pain disorder,” Loggia said.

How common? The National Fibromyalgia & Chronic Pain Association (NFMCPA) indicates that the illness affects up to 4 percent of the world’s population, and anywhere from 5 million to 10 million Americans. It is much more common among women, who account for 80 percent of patients. Although it can affect children, it is most often diagnosed during middle age.

According to Loggia, the disorder is characterized “by persistent, widespread pain, fatigue, un-refreshing sleep, memory loss, poor concentration and other symptoms.”

The NFMCPA adds that it can also give rise to sensitivity to light and sound, as well as to a degree of psychological distress in the form of anxiety and depression.

But what exactly is it, and how does it develop?

The picture is murky, with the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases flatly acknowledging that “the causes of fibromyalgia are unknown.”

But experts suggest that the disorder is likely driven by several factors, including exposure to a traumatic event (like a car crash) and/or exposure to repetitive injuries. Central nervous system disturbances may also play a role, as might a genetic predisposition to feel pain in reaction to stimuli that most people perceive as benign.

Struggling to find more in-depth answers, Loggia noted that American and German researchers have recently identified a subset of fibromyalgia patients who appear to have abnormalities in some of their peripheral small nerve fibers.

His own research suggests that some degree of brain inflammation may be at play, given that brain inflammation is common among chronic back pain sufferers and most fibromyalgia patients suffer from chronic back pain.

Unfortunately, Clauw cautioned that the failure to identify a clear cause for fibromyalgia has given rise to the myth “that it is not real.” That, he said, is decidedly not the case.

Loggia agreed.

“Traditionally, patients with fibromyalgia have been met with a great deal of skepticism, stigma and even condescension, including by many physicians that are supposed to take care of them,” Loggia said. “Even today, their pain is often dismissed as ‘all in their head,’ not real,” he added.

“However, many studies — and particularly those using brain imaging techniques such as functional magnetic resonance imaging — have now provided substantial support to the notion that the excessive sensitivity to pain that these patients demonstrate is genuine. I think that it is time to stop dismissing these patients,” Loggia said.

What these patients need now are “better drug and non-drug treatments,” Clauw said.

“We’ve only begun to take this condition seriously from a research standpoint for about 20 to 30 years,” he noted, adding that there are no “really effective” drugs for fibromyalgia.

Loggia said that means a lot of the focus has been placed on pain management, with patients turning to interventions such as painkillers (opioids) as well as yoga and cognitive behavioral therapy. “But these interventions are rarely ‘completely curative,’” he added.

As for Lady Gaga, she likely faces a better prognosis than most.

“That this was diagnosed when she was younger is good, because many people go years or decades undiagnosed,” Clauw said. “But she also almost certainly got better recognition and treatment for her condition given who she is. Others in similar medical — but different social — situations would struggle to even find a doctor to see them and take them seriously.”

Note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate.

SOURCES: Daniel Clauw, M.D., professor, anesthesiology, medicine (rheumatology), and psychiatry, University of Michigan, Ann Arbor; Marco Loggia, Ph.D., assistant professor, radiology, Harvard Medical School, Boston, and associate director, Center for Integrative Pain NeuroImaging, A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Mass.

Resource: https://www.myfibroteam.com/resources/lady-gagas-fibromyalgia-puts-illness-in-the-spotlight?utm_source=facebook&utm_medium=organicsocial&utm_content=MyFibroTeam&utm_campaign=HealthDayFIBROladygaga

 

Pain Specialists Pile on CDC Opioid Guidelines

Pain Specialists Pile on CDC Opioid Guidelines

Chronic pain patients were left out to dry

https://www.medpagetoday.com/meetingcoverage/painweek/81995

LAS VEGAS — The 2016 CDC guidelines on opioid prescribing have had lasting consequences for patients with chronic pain, an expert said here.

In the 3 years since the guidelines were published, at least 33 states have enacted legislation that limits opioid prescribing, and although half of these states specify that the new limits are intended for patients with acute pain, many physicians have stopped prescribing opioids to chronic pain patients as well, according to Gary Jay, MD, of the University of North Carolina in Chapel Hill.

“[The guidelines] added to the burden of chronic pain patients who use — not abuse — medications,” Jay told a standing-room-only crowd here at PAINWeek. “Because without their medications, they’re unable to function.”

In April, the authors of the guidelines stated that the recommendations were not intended to force hard limits of opioid doses, abruptly taper or stop opioid use, or be applied to patients outside the guidelines’ scope, such as patients undergoing active cancer treatment or, in some cases, patients with chronic pain.

“The guideline is not intended to deny any patients who suffer with chronic pain from opioid therapy as an option for pain management,” wrote Deborah Dowell, MD, MPH, of the CDC, in Atlanta, in the form of a letter. “Rather, the guideline is intended to ensure that clinicians and patients consider all safe and effective treatment options for patients.”

Around the same time, the FDA also advised against rapidly tapering or ceasing opioid use based on the known harms of doing so.

But these announcements came as “too little too late,” Jay said.

In effect, the guidelines have left many high-impact chronic pain patients, who commonly have difficulty accomplishing work and self-care activities, “essentially function-less,” Jay said.

Thomas Kline, MD, PhD, a known advocate for chronic pain patients, has compiled a list of 40 patients who have died by suicide associated with forced tapering of opioids.

Jay said anecdotally that he has had patients who have done so.

Meanwhile, the discontinuation of prescription opioids may lead other chronic pain patients to turn to the street to obtain heroin or other illicit drugs to control their pain, Jay said.

“When nonfunctional patients as well as recreational drug users couldn’t access oxycodone, they found something else: heroin,” Jay said.

While overdose deaths from any opioid have increased dramatically since 2009, the number of prescription medication overdose deaths has remained low, Jay said, suggesting that other drugs, like synthetic fentanyl and heroin, are driving the epidemic.

The number of opioids being prescribed is also decreasing, despite the increase in opioid-related overdoses, he added.

“We have been told the ‘opioid crisis’ was secondary to the ‘prescription opioid crisis’ and an ‘addiction crisis,’ but these statements have never been backed up with evidence,” he said. “It is clear that the overdose deaths were the result of polypharmacy and illicit fentanyl or other illicit or illegally obtained drugs.”

All but one of the guidelines received category “A” recommendations, but are supported by the two lower categories of evidence, which rely on observational studies, randomized trials with severe limitations, or clinical observation.

According to the guidelines, they were designed to “reduce the risks associated with long-term opioid therapy, including opioid use disorder,” by reducing prescription opioids.

But while the National Institute on Drug Abuse reports that 8-12% of patients on long-term opioid therapy develop an opioid use disorder, the evidence supporting this association is mixed, Jay said. Other reports show rates of opioid abuse following long-term opioid therapy to be as low as 0.6%.

Addiction, a complex condition with a genetic basis, also differs from tolerance and physical dependence, Jay noted. In patients with genomic changes, opioid addictions can form immediately after their first exposure; just one pain pill will induce the addiction, he said.

However, in 2013, the American Psychiatric Association updated the Diagnostic and Statistical Manual of Mental Disorders, consolidating substance abuse and substance dependence into “substance use disorder.” Patients with high-impact chronic pain, therefore, may fall under this definition, since they are dependent on their medication to function, Jay said.

But despite the backlash the guidelines have received from professional organizations and patients, little has been done to change them, Jay concluded.

“Months after the FDA and CDC statements, pain physicians and pain patients are still not sure if anything changed,” he said. “While they stated the guidelines were used inappropriately, nobody has made them appropriate.”

When the right to die becomes the duty to die

Disabled 41-Year-Old Man is Euthanized After Funding for Home Health Care Runs Out

https://www.lifenews.com/2019/08/21/disabled-41-year-old-man-is-euthanized-after-funding-for-home-health-care-runs-out/

Canadian Sean Tagert, aged 41, was killed by assisted suicide after health officials decided to cut the funding for his in-home care hours.

Mr Tagert suffered from Motor Neurone Disease (MND) which is known in Canada as Amyotrophic Lateral Sclerosis (ALS). His illness reduced his ability to move his body, eat or speak, however his mental awareness remained unaffected. Doctors recommended 24-hour in-home care to support Mr Tagert.

However, Vancouver Coastal Health, initially only offered Mr Tagert 15.5 hours of care a day, which was then raised to 20 hours a day, meaning that Mr Tagert was forced to pay $263.50 a day for the remaining care that he needed to survive.

 Welcome to the great Canadian healthcare system

According to Grandin Media, on social media, Mr Tagert wrote a status which explained that two Vancouver Coastal Health officials visited his home and confirmed that they were cutting funding for his already inadequate care hours.

After receiving this news Mr Tagert wrote a number of devastating social media status’s which read: “So last Friday I officially submitted my medically assisted death paperwork, with lawyers and doctors, everything is in proper order. It’s been a month since I submitted my appeal to the Vancouver Coastal Health patient care quality department. They didn’t even respond….Welcome to the great Canadian healthcare system.”

Mr Tagert was killed by assisted suicide on August 6th.

Canada is home to some of the world’s most sinister euthanasia and assisted suicide laws, as even those without a terminal illness or those suffering from a mental illness are eligible to be killed by a medically assisted death.

Since Canada legalised euthanasia in 2016, there have been at least 6,749 cases of medically assisted deaths, with over 803 dead in the first 6 months of legalisation. 2018 saw Canada’s euthanasia figures soar with over 3000 Canadians killed by their doctor.

When the right to die becomes the duty to die

A ComRes poll found that nearly half of the British population is concerned that if the option of ending one’s life was made legal, some people would feel pressurised into killing themselves.

It is becoming increasingly evident that suicide laws could lead to vulnerable people seeing suicide as a treatment option, so as not to be a burden to others.

In a recent debate in the House Commons, MP Lynn McInnes expressed her concern at the very realistic possibility of the vulnerable being pressurised to die. Ms McInnes said: “My concern is that in the current climate, at a time of over-stretched NHS budgets and massively under-funded social care, if assisted dying was legalised, it would begin to be seen as an alternative to treatment and to care. There is a very real risk of a subtle yet dangerous culture change, in which vulnerable, terminally ill patients, come to see assisted dying as a treatment option, and indeed the best way to stop themselves becoming a burden to their families, to the NHS and to wider society.”

MP Jim Shannon also stated during the debate, that “the ‘right to die’ for the eloquent and well off would become a duty to die for the poor and vulnerable.”

We have a duty to protect the vulnerable

Director of SPUC’s Patients First Network, Antonia Tully said: “If assisted dying is legalised in Britain it could lead to a reduction in the quality of healthcare and risks promoting death as an alternative to medical treatment. We have a duty to protect the vulnerable, who deserve good healthcare and respect.”

Ms Tully continued: “Mr Tagert’s story should serve as a glaring warning to our MPs that assisted dying can make vulnerable people even more vulnerable. Assisted suicide is an inhumane response to suffering. It is a dangerous route to go down.”

LifeNews Note: Courtesy of SPUC. The Society for the Protection of Unborn Children is a leading pro-life organization in the United Kingdom.

 

 

Kevin Hart In ‘OK’ Mood and Intense Pain ..he’s still on heavy pain medication

Prevent Prescription Opioid Overdose – based on PARTIAL TRUTHS

Prevent Prescription Opioid Overdose

https://www.cdc.gov/rxawareness/prevent/

Saving lives from opioid overdose through the Rx Awareness campaign relies on the efforts of state and local agencies and organizations across the country. By sharing the campaign materials in your communities, you can broaden the reach of the message that, “It only takes a little to lose a lot.”

Get the Facts

Prescription opioids (like hydrocodone, oxycodone, and morphine) can be prescribed by doctors to treat moderate to severe pain, but have serious risks and side effects.

From 1999 to 2017, more than 200,000 people died from overdoses related to prescription opioids, with more than 17,000 prescription opioid overdose deaths occurring in 2017.

The most common drugs involved in prescription opioid overdose deaths include:

  • Oxycodone (such as OxyContin®)
  • Hydrocodone (such as Vicodin®)
  • Methadone

Overdose is not the only risk related to prescription opioids. Misuse, abuse, and opioid use disorder (addiction) are also potential dangers.

Anyone who takes prescription opioids can become addicted to them.

There are TWO KINDS OF FACTS:

Those that support your agenda …. Those that work AGAINST your agenda…

Take the figure of 200,000 people dying in the 19 yr period of 1999 – 2017 … that comes out to 29 deaths PER DAY…  a LOT LESS than the normal claim of over 100 OD drug deaths per day… that is typically quoted to describe the OPIATE CRISIS.

So what caused the other 100/day deaths…they are seeming to ignore in this press release… COULD IT BE ILLEGAL DRUGS , especially one or more of the 1400 illegal fentanyl analogs ?

Even the deaths of 17,000 in 2017… again that is 46 deaths/day …far less than the usual quote of drug OD deaths per day.

Of course in that same 19 yr time frame… alcohol would have contributed to some 1.5 + million and Tobacco/Nicotine would cause 9+ million deaths.  Those two “DRUGS” are only contributing to 1500 deaths/day….  BUT… we don’t have any discussion of a crisis involving those two legal drugs.

YES… anyone taking a legal opiate can become addicted to them… but… addiction is a mental health issue…. so prescribing a opiate to a person who is already diagnosed/treated for certain mental health issues and/or the pt has undiagnosed/untreated mental health issues… they can possibly become addicted… or the NEW TERM – opioid use disorder.

Hampering the Treatment of Chronic Pain

https://www.c-span.org/video/?188771-1/hampering-treatment-chronic-pain

The Cato Institute held a half-day conference entitled “Drug Cops and Doctors: Is the Drug Enforcement Administration Hampering the Treatment of Chronic Pain?” Members of the forum discussed the Drug Enforcement Administration’s efforts to eradicate prescription painkiller diversion and the subsequent effects on doctors, patients, and the treatment of pain.

In the first segment, members of the panel discussed pain, diversion, and public policy. The panelists also responded to questions from members of the audience.

As Wyoming tries to control supply of opioids, patient, prescriber complications emerge

As Wyoming tries to control supply of opioids, patient, prescriber complications emerge

https://www.cowboystatedaily.com/2019/09/05/as-wyoming-tries-to-control-supply-of-opioids-patient-prescriber-complications-emerge/

Through decades of numerous, unpredictable illnesses, pain has become a constant for Cody resident Dawn Scott.

But with the opioid epidemic raging in Wyoming and throughout the U.S., obtaining painkillers has become as unpredictable as epithelioid hemangioendothelioma, the rare cancer she fought in the late 1990s. 

The guarantee of a doctor prescribing opioids can be as uncertain as her thoracic outlet syndrome, the illness that resulted in 21 surgeries between 2014 and 2016, which left her with most of her collarbone removed and muscles that had been attached to the clavicle reattached to other parts of her body. 

“Once I tell them the amount of opioids I’m going to need to get relief — which is significant after 21 years of surgeries — I’m almost instantly labeled a seeker,” she said. “Unless it’s an ER doctor who knows me and knows my history. Newer doctors or loaner doctors don’t offer any form of pain control.”

As state leaders try to control the flow of opioids in Wyoming, complications have emerged. Chronic pain patients have had trouble getting the medicine they need to be comfortable and live productive lives. Physicians and other prescribers – already under watch by private insurers and government health care programs – have new laws to consider in their practice. 

But state leaders, concerned about addiction and its effects on families and communities in Wyoming, felt it necessary to change the law and make it harder to dispense and obtain opioids.

Last month, the Cowboy State Daily reported more than 100 million painkillers were shipped to Wyoming pharmacies between 2006 and 2012. The state, local governments and Indian tribes have sued drug makers and distributors, saying they aggressively marketed the medicines and downplayed their addictive tendencies. 

In February, the Wyoming Legislature passed Senate File 46 and Senate File 47 – its own response to the opioid epidemic. 

S.F. 46 prohibits prescribing and dispensing more than a 7-day supply of opioids in a 7-day period to an acute pain patient, with the Wyoming State Board of Pharmacy to establish “reasonable exceptions” for chronic pain, cancer treatment, palliative care and other clinical exceptions.  The pharmacy board is working on rules

The 7-day law is similar to restrictions in about 15 other states

S.F. 47 requires licensed health care professionals to take continuing education courses in the responsible prescribing of controlled substances, which includes opioids. 

The law also requires prescribers to upload controlled substance prescriptions electronically to the Wyoming Online Prescription Database by Jan. 1, 2021, so that doctors, pharmacists and other professionals can review what drugs a patient is on — and prevent abuse or adverse side effects.

The federal government has touted state-level prescription drug monitoring programs as a way to spot and close down “pill mills,” and reduce addiction and overdose deaths. Wyoming physicians — who feel they don’t have a problem with over-prescribing, save for a few extreme examples – say the new state laws are heaping on more regulations on top of various insurance and government health care programs, said Sheila Bush, the Wyoming Medical Society’s executive director.

For instance, Medicare encourages physicians to check the prescription drug monitoring program when writing opioid scripts. One private insurer may prohibit opioids for patients under a certain age, another may limit patients to three days of opioids. There are federal laws, and now state laws, she said. 

“Separate from all of this, you still have good clinical knowledge – the ability for a physician to look at a patient and know the history and say, ‘This is the best care for you today,’” Bush said.  “They’re inundated. There’s no consistency.”

The Medical Society was supportive of the Wyoming legislation because it knew the public had asked for changes in the law. The organization felt that having a seat at the table and providing doctors’ expertise could make the measures better, she said. 

But Wyoming patients with serious medical issues may suffer as a result of these policies. 

Scott, the Cody chronic pain patient, had a miscarriage in a 2016. She asked the physician for painkillers for her cramping. She received just one pill – two milligrams of the opioid Dilaudid. 

“My normal dosage to give me maximum relief is between 12-16 milligrams of Dilaudid,” she said, describing the following days as agonizing. 

Scott has since found a pain specialist in Billings, Montana, who has reduced her trips to the emergency room when migraines, cluster headaches and other pain flares up. 

Scott, who as an attorney has represented people with chronic pain, believes opioids aren’t addictive for everyone. Some patients use them responsibly to relieve pain, she said. Scott said she’s gone through periods in which she didn’t have to take any painkillers. 

“It’s sad, and I’ve watched addiction first-hand, not with opioids – but my dad died of alcoholism,” she said. “I understand the power of addiction. I understand there needs to be control. But there also needs to be a case-by-case basis, not just a blanket decision that, ‘I’m not going to ever offer over 2 milligrams of Dilaudid.’ They feel like their discretion is being scrutinized because of regulations. Some doctors want to help people and they’re limited.”

 

AARP in 2017 collected $627 million from UnitedHealth.. in royalties for using AARP’s name and access to AARP’s member mailing lists

JIM WATERS: Will the Real AARP Please Stand Up?

https://www.surfky.com/index.php/179-news/kentucky/143349-jim-waters-will-the-real-aarp-please-stand-up

KENTUCKY (9/5/19) — “To tell the Truth,” a popular TV game show from the annals of history, featured a panel of celebrity judges who would try to correctly identify contestants with unusual jobs or life experiences.

The twist was that while one of the contestants was sworn to tell the truth, two other impostors were also on the show and it was their job to fool the panelists by pretending to be the real contestant.

At the end of each show, panelists would vote on who they thought was the truth-teller.

Then the host would say to the three contestants: “Will the real circus performer please stand up?”

The three contestants would bob up and down; one would act like he was going to stand and then quickly slide back into his seat and then they would all do that until finally, the real circus performer stood up and was revealed.

It’s what needs to happen with AARP which promotes itself as a simple advocacy group looking out for the interests of older Americans yet harms seniors by supporting policies like Obamacare – which resulted in making one in three Kentuckians dependent on Medicaid – or opposing changes such as a recent proposal to lower out-of-pocket prescription-drug costs.

What gives?

Why would AARP oppose a rule requiring rebates paid by pharmaceutical companies to insurers through middlemen known as pharmacy benefits managers be shared with patients in a way that reduces their out-of-pocket costs for prescription drugs?

How could they oppose such a basic idea if they’re really just a simple advocacy group whose sole mission is to advocate for seniors’ best interests?

Follow the money and find an answer.

What very few Kentucky seniors know is that AARP receives most of its revenue from UnitedHealth rather than membership dues.

AARP in 2017 collected $627 million from UnitedHealth, the nation’s largest health insurer which pays the seniors’ group royalties for the right to market its insurance plans using AARP’s name and logo, compared to $301 million in membership dues.

Chris Jacobs, founder and CEO of Juniper Research Group, reviewed AARP’s financial statements and reported the group made more than $4.5 billion in income since 2015 just from selling health insurance plans and generating investment income from UnitedHealth plan premiums.

Which explains why AARP paid folks to run around at this year’s Fancy Farm political barbecue as part of its #StopRxGreed propaganda campaign, which blames only drug companies for those higher out-of-pocket prescription costs which affect seniors on fixed incomes the most.

There’s certainly enough blame to go around when it comes to higher healthcare costs in general and prescription medicines in particular.

This columnist recently expressed disapproval of some of the practices of pharmaceutical companies – particularly when it comes to brand-name drug manufacturers attempting to keep cheaper generics off the market.

Still, it’s dishonest for AARP to claim advocacy for seniors yet oppose policies that would lower up-front prescription costs, all because it would cut into insurers’ profits, which UnitedHealth – AARP’s deep pocket – and its middlemen oppose.

In a recent op-ed, AARP Kentucky state president Charlotte Whitaker admonishes: “No Kentuckian should be forced to choose between putting food on the table or buying a lifesaving medication.”

I couldn’t agree more.

Unfortunately, Whittaker can’t go all the way with her argument; she can only blame one party – “Big Pharma,” as she puts it – and will, understandably, not bite the hand that feeds her group by even mentioning insurers or their middlemen as significant contributors to higher out-of-pocket prescription costs.

Currently, I’m being inundated with mail from AARP wanting me to join their organization.

For me, the bobbing and weaving has ended; the real AARP has stood up and my response: No thanks.

Jim Waters is president and CEO of the Bluegrass Institute for Public Policy Solutions, Kentucky’s free-market think tank. Read previous columns at www.bipps.org. He can be reached at jwaters@freedomkentucky.com and @bipps on Twitter.

SurfKY News

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changing the definition of pain … means that it is no longer exists or treatable ?

Who is really behind a proposed new definition of pain?

https://www.statnews.com/2019/09/05/pain-new-definition-proposed/

A new definition of pain is out for comment from the International Association for the Study of Pain, an influential global alliance of researchers.

When I heard about it, my hair stood on end. Some people think a new definition could lead to new therapies. But as a 23-year veteran of serious pain from a progressive disorder, I dread losing the old therapy: opioids.

Prescription opioids have lost favor since the national opioid crisis, when a growing number of people fell victim to an increasingly unrelated supply of these drugs. Prescribed drugs, illicit drugs — the distinction between the two, and their respective contributions to overdoses, hasn’t been widely grasped. And so there’s much ado about opioid replacements such as ineffective drugs, “mindfulness,” chiropractic, cognitive behavior therapy, “coping and acceptance,” acupuncture, virtual reality, and more. The problem is that none of these has been proven or even properly tested. New drugs likely to work on severe pain aren’t anywhere near the pipeline. And most of us already know what we’d pick for a broken bone or a kidney stone.

As someone who lives with a lot of pain, I care deeply about pain treatment. In the last two years, I’ve lost care twice, without warning, because of the thoughtless, often self-interested policy that’s fueling the fad to get everyone off pills. My longtime primary care doctor, threatened by her regulator, suddenly stopped prescribing opioids. Next, the government abruptly closed my pain specialist’s practice.

As a writer, I care as deeply about words. Here’s the old definition of pain that the International Association for the Study of Pain (IASP) laid out in 1994: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

It ain’t broke. Why fix it?

Here’s the proposed new definition: An aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury.

Look what the cat dragged in. Something only resembling damage might cause pain. Despite disclaimers in the notes attached to the new definition, here’s the slippery slope: Pain might result from a verifiable injury, or it might not. It might be an illusion, an inconvenient mental trick. If it’s all in your head, pain obviously won’t need a Percocet.

And there’s more — or in this case, less. Treatment, which was declared a must in the notes accompanying the old definition, goes unmentioned in the notes accompanying the new one.

The IASP is accepting comments on the new definition until midnight on Sept. 11.

One thing I notice about the opioid crisis is this: the more talk, the less pain care. Will a new definition help, or will it harm?

How did we get here? The IASP always seemed to be a good guy in the conversation about pain relief — by whatever methods it takes. Since 2010, the organization has been associated with what was long considered one of the world’s best pain clinics, at McGill University in Montréal. The clinic’s former director is past president of IASP. He’s written thoughtfully about untreated pain, even mourning Spain’s Philip II, a 16th-century Catholic who died in needless agony from cancer while refusing all help but God’s.

Back in 2010, IASP issued its “Declaration of Montréal,” after the city in which it was crafted during the group’s 13th world congress. It’s strong stuff. “Recognizing,” it says, “the intrinsic dignity of all persons and that withholding of pain treatment is profoundly wrong, leading to unnecessary suffering which is harmful; we declare that the following human rights must be recognized throughout the world:

  • The right of all people to have access to pain management without discrimination
  • The right of people in pain to acknowledgment of their pain and to be informed about how it can be assessed and managed
  • The right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained health care professionals.”

Who could argue with that?

Almost everyone, it turns out: governments, prescribers, insurers, news media, the public. It’s wonderful that professionals who really know pain once declared these rights for people like me — for all of us, actually, since at some point we’ll all have pain. But who’s listening now? The deprescribing whirlwind has battered many like me beyond repair. However carefully chosen the words of the declaration, they’re not binding in the least.

Dr. Yoram Shir, the current director of the McGill clinic, has said that pain patients on opioids “hate” the drugs. Prescription pills feed overdoses. Doctors should be dissuaded from prescribing them and patients from taking them.

IASP has changed, too, and some of the changes unnerve me. For instance, Christine Chambers, a psychologist, is championing a new IASP initiative called the North American Pain School. Health Canada ponied up $1.6 million for her work to “bridge the gap between current treatments and evidence-based solutions.” At the annual conference of Canada’s pain specialists last year, Chambers brought in her colleague Dr. Jane Ballantyne, the enduring president of the opioid-averse lobbying group Physicians for Responsible Opioid Prescribing, as the conference keynote speaker — and then declined to comment to the media on her choice.

PROP’s executive director, Dr. Andrew Kolodny, has called medical opioids “heroin pills.” Ballantyne famously recommends “coping and acceptance” over drugs for intractable pain, and has been a paid consultant to states suing drug manufacturers, whom they blame for overdoses.

Ballantyne also helped craft IASP’s 2018 Position Statement on Opioids. It advises caution “when prescribing opioids for chronic pain, focusing instead on strategies that integrate behavioral and physical treatments,” because, we’re told, opioids are good only for acute pain, cancer pain, and end-of-life care. When used “indiscriminately” (meaning for chronic pain, according to the statement), we’re also told that the use of opioids has led to “high rates of prescription opioid abuse, unacceptable death rates, and enormous societal burdens.”

Recent research, and much of IASP’s own work, says otherwise. Take, for example, the largest study to date, of 2.2 million North Carolinians, which pegs the risk of dying due to medical use of opioids at just 0.022%.

What, exactly, is pain? It’s not something I need spelled out. But as the IASP rejiggered its answer to that question, did these colleagues weigh in? Another PROP director, Dr. Mark Sullivan, sits on the definition task force, where opinion lists the ship by favoring “nonnarcotic methods” and “risk containment for opioid misuse, abuse and addiction associated with medical prescribing.”

The IASP and its task force comprise many points of view. But even if the rewrite were less trendy, I’d question the need for it.

In our new no-opioids culture, pronouncements like the IASP’s lead to more resources going to “innovations” and “emerging research” that disparage and displace proven therapies, leaving nothing for people living with pain.

What matters is what’s done, not what’s said. George Orwell wasn’t the first to observe that what’s said can be designed to obscure what’s done. Funding attaches to words. Will more parsing mean more mindfulness and acupuncture for victims of head-on car crashes? And more advantage for opioid detractors, whose opinions spell opportunity in the form of research grants, publishing records, jobs, media prominence, speaking engagements, paid testimony and other consulting for law firms, as well as promoting alternative analgesics and addiction drugs for pharmaceutical companies?

Let’s look at who is behind new declarations and definitions, and who isn’t — understanding the players helps us understand the argument. Let’s watch the data, not the news, and check facts and sources. The IASP’s rewrite is on the way to kicking medical opioids to the curb. Maybe we will do that someday, and maybe that will be fine.

But until then, I’ll stick with opioids … if I can.

Death Certificate Project Accuses 64 Calif. Doctors

Death Certificate Project Accuses 64 Calif. Doctors

https://www.medpagetoday.com/painmanagement/opioids/81954

The so-called Death Certificate Project initiated by the Medical Board of California that began in 2015 has now resulted in formal accusals of wrongdoing filed against 64 physicians related to their drug prescribing, primarily involving opioids, newly updated records show.

Five of the 64 have surrendered their licenses; six others were put on probation, and eight received public reprimands.

These are out of a total of 469 physicians investigated for excessive prescribing because of patients’ overdose deaths in 2012 or 2013.

Two of the 64 accusations were withdrawn, according to statistics released by the board last week.

The remaining 43 physicans of the 64 accused still await final decisions; half of these have been hanging more than 7 months and five for nearly a year.

Beyond the 64 doctors against whom an accusation had been filed, another 11 of the 469 are still under investigation. It remains to be seen whether a round orange gavel signifying a disciplinary action will mark any of their profile pages.

The agency’s investigators continue to prowl the state Department of Justice’s prescription drug database to identify doctors who prescribed opioids to a patient who, according to a death certificate, fatally overdosed in 2012 or 2013, even as long as three years after that doctor wrote that script, and not necessarily from the same drug the doctor prescribed.

Separate investigations were conducted of 72 nurse practitioners, physician assistants, and osteopathic physicians — who are governed by different state boards — but the results of those were not immediately available.

In the next leg of the investigation, the medical board, which licenses some 140,000 physicians, will scrutinize practices of doctors whose patients fatally overdosed in 2016 and 2017, when presumably far more conservative opioid prescribing had replaced more liberal practices and as the extent of addiction potential and lethality of these drugs was better understood.

‘Witch-hunt’

The project is intended to stop overdoses and save lives. But it has been harshly lambasted by some doctors as a “witch hunt.” It also has disrupted practices by many physicians who — prior to 2014 — were abiding by the now outdated mantra that patients’ pain complaints should be aggressively treated with whatever it takes.

Many representatives of organized physician groups said the project is now hurting patients in pain trying to get relief. Pain specialists’ waiting lists have backed up and increasing numbers of primary care providers refuse to prescribe opioids in fear that years later, a patient death — even by suicide — may put their licenses under public scrutiny as well.

But Kimberly Kirchmeyer, the medical board’s executive director, defended the project. In an e-mailed statement, she said it “is helping the board meet its mission of consumer protection in a proactive way.” She added that her agency “will continue to find ways to improve this process.”

In remarks to the board during its January meeting, Kirchmeyer gave more detail. She said expert reviewers looked for high-dose opioid prescribing patterns that included morphine equivalencies greater than 90 mg, opioids in combination with sedating drugs like benzodiazepines, Soma, sleeping pills, and other unsafe combinations of medications. Additionally, the reviewers zeroed in on doctors who prescribed dangerous drugs frequently, “and other red flags.”

A welcome change?

Perhaps not surprisingly, consumer advocates have applauded the Death Certificate Project for calling out doctors with reckless prescribing habits.

Carmen Balber, executive director of Consumer Watchdog, spoke from “the injured patient’s perspective,” saying, “Doctors in this state are accustomed to weak or non-existent regulatory oversight. For patient safety, it’s about time that the medical board started acting to proactively investigate the opioid crisis.”

In many accusations she’s read, dangerous prescribing practices are obvious. “Patients are not getting medical exams. Doctors are not confirming the injuries the patients came forward with. Doctors are prescribing wildly excessive doses of medications. Even to a lay person it seems blatantly obvious that action should have been taken,” Balber said.

Patient safety activist Eric Andrist of Los Angeles, who started the newer Patient Safety League which posts stories about medical harm and patient experiences, travels around the state to every medical board meeting to complain that the agency is too soft, allowing hundreds of dangerous doctors to get off with no more than a slap on the wrist. He said he’s pleasantly surprised the board tackled the opioid issue in the first place.

“They’ve always said that they don’t and won’t look for cases themselves … and only act on complaints brought to them,” he said. Without this initiative, these doctors would never have been punished or called out. He also praised the yield of 19 accusations resulting in disciplinary action to date — even with 43 more to go — because by his count the agency’s average is much lower.

Five licenses surrendered

Among the most egregious cases, those that prompted five physicians to surrender their licenses, departure from the standard of care was especially well documented.

In the longest accusation, a 63-page petition to revoke the license of Frank D. Gilman, MD, of San Diego, the board listed hundreds of prescriptions written for four patients. He prescribed 370 prescriptions for one of them, and of those more than 200 were for oxycodone. Two of his patients died from overdoses. Gilman was accused of gross negligence, repeated negligent acts, incompetence, repeated acts of clearly excessive prescribing, and failure to maintain adequate and accurate medical records.

John Winthrop Pierce, MD, of San Francisco, surrendered his license after one of his patients died of an overdose of hydrocodone. The board’s 28-page accusation said that he had prescribed a long-acting combination of fentanyl and morphine for another patient who had exhibited suicide ideation, and overall prescribing behavior that constituted gross negligence and repeated negligent acts.

Robert M. Littman, MD, of San Diego, also surrendered his license after the board’s accusation said that his treatment of a patient, who was found dead at her home from “carisoprodol, lorazepam, oxycodone, zolpidem and trazodone toxicity” with traces of amphetamines and clonazepam, constituted “gross negligence.” The patient had received prescriptions from multiple doctors, and “doctor shopped,” but Littman had failed to conduct toxicology screenings and had not checked the prescription database to see what other prescriptions she had been getting.

Philipp Leo Bannwart, MD, of Zermatt, Switzerland, surrendered his license after the board found fault with his treatment of a patient in Concord, near San Francisco. She died of “acute methadone intoxication.” The board accusation says that Bannwart wrote combination prescriptions for her, including methadone, Percocet, Norco, and promethazine-codeine syrup, constituting what the board called “gross negligence, repeated negligent acts/incompetence/improper prescribing without an appropriate prior examination and medical indication.”

Daniel George Clark, MD, of Auburn, surrendered his license after the agency found that a patient died after Clark increased dosages of fentanyl, which it labeled “gross negligence.”

Probation and public reprimand

Six accused physicians were placed on probation for periods of 3-7 years: Ashmead Ali, MD, of California City; Jay Milton Beams, MD, of Susanville; Harold Budhram, MD, of Shasta Lake; William Lee Matzner, MD, of Simi Valley; Michelle Anne Orengo-McFarlane, MD, of Martinez; and Ilona Sylvester, MD, of Thousand Oaks.

Another eight physicians were formally reprimanded and ordered to take courses on prescribing practices and, in most cases, medical record-keeping: Alyn Gary Anderson, MD, of Huntington Beach; Michael S. Basch, MD, of Temecula; Jose Rosendo Cesena, MD, of El Cajon; Vorakiat Charuvastra, MD, of Los Angeles; Moshe Miller Lewis, MD, of San Francisco; Diana Maria Prince, MD, of Rohnert Park; Charles Yang, MD, of Huntington Beach; and Tahir Yaqub, MD, of Atwater.

Still-pending accusations against the remaining 43 physicians can be read here.

The California Medical Association did not respond to a request for comment about the current status of the Death Certificate Project. But in an interview late last year, David Aizuss, MD, CMA president and an ophthalmologist from Encino, criticized the board for going after doctors because of how they prescribed controlled substances before 2014. “I don’t think it’s appropriate to apply our current clinical guidelines to what was going on six or seven years ago,” he said then.

Asked why the investigations take so long, medical board spokesman Carlos Villatoro replied that for the latest fiscal year ending June 30, 2018, it took an average of 322 days after an accusation was filed for the case to conclude without compromising due process. He added that the process involves the Attorney General’s office and the office of administrative hearings, both of which are outside the board’s control, he said.

Other MedPage Today stories about the California Medical Board’s Death Certificate Project:

‘Death Certificate Project’ Terrifies California Doctors

Provider Groups Hit Back at California’s Death Certificate Project

Calif.’s ‘Death Certificate Project’ Nabs 11 More Physicians

Foundation Wants Revamp in Calif.’s Death Certificate Project

Methodology Fixes Coming for Calif. Death Certificate Project