Woman’s online journal of disorder paves way for new medical courses

http://www.kpaddock.org/

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“Opioid painkillers cause chronic pain” stories leave physician reader in agony

www.healthnewsreview.org/2016/06/opioid-painkillers-cause-chronic-pain-stories-leave-physician-reader-in-agony/

When writing in 1953 of the structure of deoxyribonucleic acid (DNA), Watson and Crick concluded: “It has not escaped our notice that the specific pairing that we have postulated immediately suggests a possible copying mechanism for the genetic material.”

Words like “postulated,” “suggests,” and “possible” seem quaint in 2016.  Instead, we have researchers and their accomplices in the news media who trumpet “game-changing” “breakthroughs” on daily basis – often with the flimsiest of scientific support.

The latest example: opioids causing pain

Consider the headlines generated this week by a study which documented a phenomenon known as opioid-induced hyperalgesia. This is the idea that opioid medication, instead of calming pain, might actually make pain worse.

Denver Post: CU Boulder study: Narcotic painkillers cause chronic pain

FOX News: Opioids may prolong chronic pain, study suggests

Washington Post: Opioid paradox: Could morphine use hurt as much as it helps by prolonging chronic pain?

Forbes: Prescription painkillers may worsen and lengthen chronic pain

Much has been made of opioid-induced hyperalgesia. Whether it is clinically important for patients with chronic pain on standard opioid medication is unclear. Even the most recent reviews of this phenomenon are unable to determine its prevalence (see here and here), and studies have generally been experimental in nature or with unusual administration of opioids (for example, the drugs have been administered intrathecally; that is, via direct injection close to the spinal cord).

A closer look at the study

As it so happens, the new Proceedings of the National Academy of Sciences study being reported on also involved intrathecal administration of medication.

Not only that, but the study also involved rats who had sutures tied around their sciatic nerves.

The sciatic nerve was tied and the animals were left in pain for 10 days. Then, the researchers administered morphine directly to spinal cords of these rodents for 5 days.

Their conclusion? “That morphine increased the vigor and speed of hindpaw withdrawal to the von Frey filaments in SD rats was supported by increased startle (converted to force; N) to a 0.2-mA shock.”

In other words, the rats that received the morphine showed increased sensitivity to a plastic “hair” and an electric shock.

Use of rat models to help elucidate human disease is nothing new. But use of rats to claim that the study’s “implications for people taking opioids like morphine, oxycodone and methadone are great, since we show the short-term decision to take such opioids can have devastating consequences of making pain worse and longer lasting” is nothing short of ridiculous and harmful.

A PR news release drives the narrative

That sensational quote, originating in the University of Colorado Boulder news release, was subsequently picked up by the Denver Post and a variety of other outlets that covered the story. While most of this coverage did acknowledge (in the body text of the story) that the study involved rodents, few stories pushed back against the researchers’ attempts to draw a straight line from this animal study to humans. Readers drew the same straight line: Of the over 300 reader comments on the Denver Post article alone, almost all are about humans, not rats.

Science magazine was one of those rare outlets that provided the perspective of an independent expert, who offered the following indispensable context:

The finding certainly shouldn’t be the basis for withholding opioids from people in pain, says Catherine Cahill, a neuroscientist at the University of California, Irvine. These drugs also work to block the emotional component of pain in the brain, she notes—a form of relief this study doesn’t account for. And opioids might not prolong pain in humans the way they did in these rats, she says, because the dosing of morphine and its quick cessation likely caused repeated withdrawal that can increase stress and inflammation. Humans usually don’t experience the same withdrawal because they take sustained-release formulations and taper off opioids gradually.

What’s more, none of the coverage that I saw tried to put this 5-day rat study into any appropriate historical perspective. Opium-derived products have been used to relieve pain since ancient times. Opium was one of the only medications not consigned to the bottom of the sea by Oliver Wendell Holmes in 1860. Morphine has been on the World Health Organization’s list of essential medicines since its inception. Yet opioids are not available to 5 billion people with consequent unmitigated pain and suffering. The American Geriatrics Society has determined opioids to be a potentially “indispensable” treatment for selected patients. British geriatric guidelines are similar. While advocating their judicious use, Canadian guidelines note that “opioids can be an effective treatment for chronic non-cancer pain (CNCP) and should be considered.”

Consider the CDC context

This rat study and the related coverage aren’t taking place in a vacuum. They’re taking place amid the CDC’s recent recommendations for the use of opioids in chronic pain — guidelines that excluded a Cochrane review showing effectiveness. The CDC took the acknowledged limited study in this area and interpreted it as evidence only of harm. Can harms happen with chronic opioid use? Yes. Can benefits also happen? Yes. By not acknowledging this dual truth, the CDC recommendations – and especially the rhetoric that has surrounded them (e.g. “prescription opioids are just as addictive as heroin”) – risk creating more heat than light.

This is in contrast to the National Institutes of Health 2014 report “Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain.” The report found that:

Patients, providers, and advocates all agree that there is a subset of patients for whom opioids are an effective treatment method for their chronic pain, and that limiting or denying access to opioids for these patients can be harmful.

… Biased media reports on opioids also affect patients. Stories that focus on opioid misuse and fatalities related to opioid overdose may increase anxiety and fear among some stable, treated patients that their medications could be tapered or discontinued to “prevent addiction.”

The CDC guidelines also excluded acute pain. I’m not sure how 10 days of sudden unrelieved pain is considered by a rat, but it sounds acute to me.

Here we see in miniature the flaws of basic science and public health policy alike in their promulgation of questionable “evidence.”  A rat study headlined “Narcotic painkillers cause chronic pain” – that  doesn’t mention the rat subjects – is the latest example of the pendulum being pulled back so far it is straining credulity as well as contributing to people’s suffering.

The next time a patient of mine becomes a rat, has its sciatic nerve constricted with sutures, and asks for 5 days of morphine near its spinal cord 10 days later, maybe I’ll take another look at this study. In the meantime, I’ll tell my patients to ignore the unbalanced news coverage that the research spawned. I’ll also follow universal precautions in prescribing opioids, listen carefully to my patients and their context, work to find the best approach for mitigating their pain, limit side effects and untoward outcomes, respond effectively should they occur, and practice with a compassion not shown to these rats.

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As seen posted on another closed Face Book page for chronic painers

“Both my adoptive parents worked for the federal government their entire working lives. My dad, who was a supervisory accountant with General Services Administration, is now retired, but my mom still works for GSA. Anyway, she pays bills for a lot of government agencies and she was talking to her contact at the DEA about a bill and he asked how I was doing.

Of course, the subject of pain meds came up and he told her something that will probably not shock you, but will make you angry. The DEA has an internal goal of removing opioids from the hands of patients by not allowing doctors to prescribe them. They would like to see the goal accomplished by 2020. If they get their way, it will be illegal for doctors to prescribe opioids *in the US* *for any reason”

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Marijuana News Roundup: 7 Marijuana-related Bills Introduced in US Congress

http://finance.yahoo.com/news/marijuana-news-roundup-7-marijuana-131342170.html

A total of seven bills that would support the marijuana industry were introduced in Congress last Thursday, three in the Senate and four in the House. The Senate bills were all sponsored by Senator Ron Wyden (D-OR), including one co-sponsored by Senators Rand Paul (R-KY) and Michael Bennet (D-CO). The House bills were introduced by Earl Blumenauer (D-OR), Carlos Curbelo (R-FL), and Jared Polis (D-CO). The new bills seek similar, but not identical, changes to U.S. laws related to the cannabis industry.

Both houses of Congress will consider legislation that would allow industry businesses in states where marijuana is legal to deduct costs of doing business from their taxes. If passed and signed by the President, legal marijuana businesses would be treated like any other U.S. business for the purposes of tax filing.

The House and Senate are also considering reforming banking laws that would guarantee cannabis industry participants access to banks, provide for bankruptcy protection, and prohibit civil forfeiture against legal businesses, among many other. One bill was introduced in the Senate and two in the House related to these changes.

Finally, both houses will consider removing marijuana from the list if federally controlled substances and establish an excise tax on cannabis not to exceed 25% of the sale price.

DEA Asks Colorado AG’s Office for Info on Marijuana Crimes, “for the new administration”
Amid speculation about how the Trump administration will confront marijuana legalization in states such as Colorado, a Drug Enforcement Administration supervisor has sent an e-mail to a prosecutor in the state attorney general’s office seeking information, “for the new administration.”

The e-mail was sent early last month by a supervisor on the financial investigations team in the DEA’s Denver field office to Michael Melito, a senior assistant attorney general. The e-mail asks for Melito to provide case numbers for several prosecutions relating to marijuana, including one that involved multiple people charged with growing pot illegally in Colorado and then shipping it out of state.

The e-mail was first reported by the International Business Times, which obtained it through an open records request.

“Some of our intel people are trying to track down info regarding some of DEA’s better marijuana investigations for the new administration,” the e-mail states. “Hopefully it will lead to some positive changes.

Argentina Legalizes Medical Cannabis, Creates Research Program with Free Access
Argentina’s Senate has given final legislative approval to a bill legalizing the use of cannabis oil and other marijuana derivatives for medicinal purposes, and setting up a regulatory framework for the state to prescribe and distribute them to patients.

The legislation approved by senators Wednesday also creates a medical marijuana research program at the Health Ministry, which must “guarantee free access” to cannabis oil and other derivatives to patients who join the program. The legislation was passed by the Chamber of Deputies earlier.

“In history, the big things always come in small steps,” said Valeria Salech, president of a private pro-medical marijuana group called Mama Cultiva Argentina, which has argued that cannabis can radically change the quality of life for children suffering everything from HIV to epilepsy.

Her group is already lobbying to push the legislation further, to permit the families of patients to grow their own marijuana.

Under the new legislation, government agencies will be authorized to grow marijuana for research purposes and to produce cannabis oil and derivatives for patients. The state can import cannabis derivatives until they can be produced locally.

Read more at The Cannabist.

Gov. John Kasich Says Medical Marijuana Plays No Role in Fighting Ohio’s Opioid Crisis
Gov. John Kasich said Thursday he doesn’t think Ohio’s new medical marijuana program will help mitigate the state’s opioid crisis, though recent studies indicate otherwise.

Kasich was asked at a news conference announcing new opioid prescription limits what role medical marijuana might play in addressing the growing number of opiate overdose deaths in Ohio. Kasich said telling kids not to do drugs but that marijuana is OK sends a mixed message.

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The ‘Gateway Drug’ Is Alcohol, Not Marijuana

countercurrentnews.com/2016/12/gateway-drug-alcohol-not-marijuana/

Researchers at the University of Florida have found that the theory of a “gateway drug” is not associated with marijuana – results from the Guttman scale indicated that alcohol represented the gateway drug, leading to the use of tobacco, marijuana, and other illicit substances. Furthermore, students who used alcohol “exhibited a significantly greater likelihood of using both licit and illicit drugs”.

In an interview with Raw Story, co-author Adam E. Barry said that his studies were intended to correct some of the propaganda that has infected American culture since the “Reefer Madness” era.

“Some of these earlier iterations needed to be fleshed out, that’s why we wanted to study this. The latest form of the gateway theory is that it begins with [cannabis] and moves on finally to what laypeople often call ‘harder drugs’. As you can see from the findings of our study, it confirmed this gateway hypothesis, but it follows progression from licit substances, specifically alcohol, and moves on to illicit substances,” Barry said. These findings walk hand-in-hand with a 2012 study from Yale that found that alcohol and cigarettes were much more likely than marijuana to precede opiate abuse.

Researchers used a nationally representative sample of high school seniors, evaluating data collected through the University of Michigan’s Monitoring the Future survey, which tracks drug use trends among youth in the US. Barry’s study focused on data collected from 14,577 high school seniors from 120 public and private schools in the United States.

By comparing substance abuse rates between drinkers and non-drinkers, the researchers found that seniors in high school who had consumed alcohol at least once in their lives “were 13 times more likely to use cigarettes, 16 times more likely to use marijuana and other narcotics, and 13 times more likely to use cocaine”.

In the sample of students, alcohol also represented the most commonly used substance, with 72.2 percent of students reporting alcohol consumption at some point in their lifetime. Comparatively, 45 percent of students reported using tobacco, and 43.3 percent cited marijuana use.

“The findings from this investigation support that alcohol should receive primary attention in school-based substance abuse prevention programming, as the use of other substances could be impacted by delaying or preventing alcohol use. Therefore, it seems prudent for school and public health officials to focus prevention efforts, policies, and monies, on addressing adolescent alcohol use,” the study concluded.

Scientists had earlier discovered that cannabis, a therapeutic healing herb, may actually reduce brain damage caused by alcohol. A 2013 study from the University of Kentucky and the University of Maryland concluded that a chemical in marijuana called cannabidiol could be used to treat alcohol-induced neuro-degeneration.

Results of a very recent study has led to the conclusion that ‘illegal’ marijuana is far and away the safest ‘legal’ drug. Based on the findings, the researchers agreed that weed is 114 times less deadly than alcohol.

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Merck’s Former Doctor Predicts Gardasil to Become the Greatest Medical Scandal of All Time

www.realfarmacy.com/gardasil-scandal/

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine” – (source) Marica Angell. She is a physician and author, along with being the first woman to serve as editor-in-chief of The New England Journal of Medicine – regarded as one of the most prestigious peer-reviewed medical journals in the world.

Since the Food and Drug Administration (FDA) approved Merck & Co.’s Gardasil vaccine in 2006, it has been surrounded by tremendous amounts of information, controversy and misinformation. This controversy has garnered much attention as people become more aware of the importance of paying attention to what goes into their bodies. It’s imperative that one examines a large body of evidence before believing what is seen on TV or stated on a radio advertisement, and people are slowly starting to wake up to this fact.

“It is a vaccine that’s been highly marketed, the benefits are over-hyped, and the dangers are underestimated.” –  (Taken from the ONE MORE GIRL DOCUMENTARY) – Dr. Chris Shaw, Professor at the University of British Columbia, in the department of Neuroscience, Ophthalmology, and Visual Sciences.

Gardasil, also known as the Human papilloma virus (HPV) vaccine, is given as a series of three shots over 6 months to protect against HPV infection and its associated health problems. Two vaccines (Cervarix and Gardasil) are said to protect against cervical cancers in women. Gardasil is also said to protect against genital warts and cancers of the anus, vagina and vulva. Both vaccines are available for females, while only Gardasil is available for males.

The Centers For Disease Control (CDC) claims that the HPV vaccine offers the best protection to girls and boys who receive all three vaccine doses and have time to develop an immune response before being sexually active.  This is why it is recommended for children who have reached the age of 11 or 12.

There is a long list of educated people speaking out about this vaccine. This time around, it’s Dr. Bernard Dalbergue, a former pharmaceutical industry physician with Gardasil manufacturer Merck who has started to raise his voice against the HPV vaccine, along with the pharmaceutical industry as a whole. He joins a long list of experts from within the industry who have slammed the rampant manipulation and control of clinical research done by the pharmaceutical industry.

This quote is taken from an interview that happened in April of 2014, from an issue of the French magazine Principes de Santé (Health Principles):

“The full extent of the Gardasil scandal needs to be assessed: everyone knew when this vaccine was released on the American market that it would prove to be worthless.  Diane Harper, a major opinion leader in the United States, was one of the first to blow the whistle, pointing out the fraud and scam of it all.I predict that Gardasil will become the greatest medical scandal of all time because at some point in time, the evidence will add up to prove that this vaccine, technical and scientific feat that it may be, has absolutely no effect on cervical cancer and that all the very many adverse effects which destroy lives and even kill, serve no other purpose than to generate profit for the manufacturers. Gardasil is useless and costs a fortune!  In addition, decision-makers at all levels are aware of it! Cases of Guillain-Barré syndrome, paralysis of the lower limbs, vaccine-induced MS and vaccine-induced encephalitis can be found, whatever the vaccine.” (source) – Dr. Bernard Dalbergue

Dr. Dalbergue has also recently released a book titled “Omerta dans les labos pharmaceutiques: Confessions d’un medicine,” which goes into more detail about corruption in the medical/pharmaceutical industry. He also recently made an appearance on a popular radio show in France, you can watch here. Althought it’s in French, it’s nice to put a face to the name so that you can see he is real.

Scandal, misinformation, and data manipulation have become part and parcel of clinical research and pharmaceutical drug development. It is important that we realize this as fact and not hearsay; apart from whistle-blowers, there are numerous documents that illustrate this reality. One of the best examples (out of many) comes from Lucija Tomljenovic, PhD, from the Neural Dynamics Research Group in the Department of Ophthalmology and Visual Sciences at the University of British Columbia. In 2011 she obtained documents which reveal that vaccine manufacturers, pharmaceutical companies, and health authorities have known about the multiple dangers associated with vaccines but have chosen to withhold them from the public. The documents were obtained from the UK Department of Health (DH) and the Joint Committee on Vaccination and Immunization (JCVI), who advise the Secretaries of State for Health in the UK about diseases preventable through immunizations. You can read those documents here.

Here’s what she had to say about Gardasil:

Another doctor making noise regarding the HPV vaccine is Dr. Diane Harper. Dr. Harper helped design and carry out the Phase II and Phase III safety and effectiveness studies to get Gardasil approved, and authored many of the published papers about it. She has been a paid speaker and consultant to Merck. It’s very unusual for a researcher to publicly criticize a medicine or vaccine she helped get approved, it is a credit to her character for doing so. It also says a lot that she agreed to participate in the ONE MORE GIRL documentary, which implies (I believe) there is a chance she resonates with the other information that’s stated in the documentary that she has not said publicly.

ONE MORE GIRL is an answer to Merck & Co’s One Less Girl marketing campaign for the HPV vaccine Gardasil. The parents who encouraged their daughters to get the HPV vaccine did so on the advice of their doctors, their government, and their belief in pharmaceutical industry. They were not “anti-vaccine,” they played by the rules, and now they are paying the price. It’s a documentary that has several experts from the industry, various doctors, and university researchers speaking out about the vaccine.

“They created a huge amount of fear in mothers, and appealed to mothers’ sense of duty to get them to get their daughters vaccinated” – Dr Diane Harper (source)

The above quote was taken from the film, and here is an excerpt of her raising some important things to consider regarding the vaccine.

Some Research

If we are talking about recent research regarding the HPV vaccine, a new review was just published  in the journal Autoimmunity Reviews titled, “On the relationship between human papilloma virus vaccine and autoimmune disease.” 

The authors of this study came to the same conclusion as Dr. Harper, a doctor that was directly involved with the clinical trials for the approval of the vaccine (mentioned earlier in the article). They concluded that:

“The decision to vaccinate with HPV vaccine is a personal decision, not one that must be made for public health. HPV is not a lethal disease in 95% of the infections; and the other 5% are detectable and treatable in the precancerous stage.” (If you are interested you can access the paper here)

They also listed several conditions in which HPV vaccination is most likely the culprit, having been linked to a variety of autoimmune diseases which include: Multiple sclerosis, Guillain-Barre syndrome, primary ovarian failure, and more.

The 2008 FDA Closing Statement on Gardasil reports that 73.3% of the ‘healthy’ girls who participated in the clinical trials developed ‘New Medical Conditions. The list below highlights some of the ‘New Medical Conditions’ reported in the 2008 FDA Closing Statement on Gardasil. (source)

• Blood & Lymphatic System Disorders 2.9% = 1 in 34
• Gastrointestinal Disorders 13.4% = 1 in 7
• General & Administration Site Conditions 3.8% = 1 in 33
• Immune System Disorders 2.4% =1 in 50
• Infections & Infestations 52.9% = 1 in 2
• Injury, Poisoning, & Procedural Complications 8.0% =1 in 12
• Investigations 11.8% =1 in 9
• Musculoskeletal & Connective Tissue Disorders 6.8% =1 in 14
• Nervous System Disorders 9.4% = 1 in 10
• Pregnancy, Puerperium & Perinatal Conditions 2.0% = 1 in 50
• Psychiatric Disorders 4.4% =1 in 22
• Renal Disorders 2.7% =1 in 37
• Reproductive & Brest Disorders 24.8 % = 1 in 14
• Respiratory, Thoracic & Mediastinal Disorders 5.5% = 1 in 18
• Skin & Subcutaneous Tissue Disorders 7.4% = 1 in 13
• Surgical Procedures = Appendectomy 10.2% = 1 in 10

A year ago the vaccine was taken off the recommended vaccine schedule in Japan due to its adverse effects. What’s even more concerning is the fact that today’s vaccine has twice the amount of aluminum in it.

Related CE Article:

This is what can happen to children who receive aluminum containing vaccines.

Another groundbreaking article titled “Quantifying the possible cross-reactivity  risk of an HPV16 vaccine, published in the Journal of Experimental Therapeutics and Oncology concluded that:

“The number of viral matches and their locations make the occurrence of side autoimmune cross-reactions in the human host following HPV16-based vaccination almost unavoidable.” (source)

The list is literally endless, and for the sake of not turning this article into an essay, I’ll stop here. Hopefully I’ve provided you with enough information to further your research if interested. If you want to look at more scientific data, you can check out:

Giant Database of Studies Regarding The Gardasil Vaccine.

I am going to end this article with another important video:

Sources:
Collective Evolution

All other sources are linked throughout the article.
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964337/

http://www.greenmedinfo.com/anti-therapeutic-action/vaccination-hpv-gardisil

http://www.sciencedirect.com/science/article/pii/S1568997214000664

http://onemoregirlmovie.com/

http://www.cbsnews.com/news/gardasil-researcher-speaks-out/

 http://nsnbc.me/wp-content/uploads/2013/05/BSEM-2011.pdf

Giant Database of Studies Regarding The Gardasil Vaccine.

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Why Untreated Chronic Pain is a Medical Emergency

https://edsinfo.wordpress.com/2015/04/15/why-untreated-chronic-pain-is-a-medical-emergency/

Alex DeLuca, M.D., FASAM, MPH;Written testimony submitted to the Senate Subcommittee on Crime and Drugs regarding the “Gen Rx: Abuse of Prescription and OTC Drugs” hearing; 2008–03–08.

Untreated Chronic Pain is Acute Pain

The physiological changes associated with acute pain, and their intimate neurological relationship with brain centers controlling emotion, and the evolutionary purpose of these normal bodily responses, are classically understood as the “Fight or Flight” reaction,

When these adaptive physiologic responses outlive their usefulness the fight or flight response becomes pathological, leading to chronic cardiovascular stress, hyperglycemia which both predisposes to and worsens diabetes, splanchnic vasoconstriction leading to impaired digestive function and potentially to catastrophic consequences such as mesenteric insufficiency. 

Unrelieved pain can be accurately thought of as the “universal complicator” which worsens all co-existing medical or psychiatric problems through the stress mechanisms reviewed above, and by inducing cognitive and behavioral changes in the sufferer that can interfere with obtaining needed medical care

Dr. Daniel Carr, director of the New England Medical Center, put it this way:

Chronic pain is like water damage to a house – if it goes on long enough, the house collapses,” [sighs Dr. Carr] “By the time most patients make their way to a pain clinic, it’s very late. What the majority of doctors see in a chronic-pain patient is an overwhelming, off-putting ruin: a ruined body and a ruined life.”

Dr. Carr is exactly right, and the relentless presence of pain has more than immediate effects. The duration of pain, especially when never interrupted by truly pain-free times, creates a cumulative impact on our lives.

Consequences of Untreated and Inadequately-treated Pain

we must also consider often profound decrements in family and occupational functioning, and iatrogenic morbidity consequent to the very common mis-identification of pain patient as drug seeker.

The overall deleterious effect of chronic pain on an individual’s existence and outlook is so overwhelming that it cannot be overstated. The risk of death by suicide is more than doubled in chronic pain patients, relative to national rates.

What happens to patients denied needed pharmacological pain relief is well documented. For example, morbidity and mortality resulting from the high incidence of moderate to severe postoperative pain continues to be a major problem despite an array of available advanced analgesic technology

Patients who received less than 10 mg of parenteral morphine sulfate equivalents per day were more likely to develop delirium than patients who received more analgesia (RR 5.4, 95% CI 2.4–12.3)… Avoiding opioids or using very low doses of opioids increased the risk of delirium. Cognitively intact patients with undertreated pain were nine times more likely to develop delirium than patients whose pain was adequately treated. Undertreated pain and inadequate analgesia appear to be risk factors for delirium in frail older adults. [7]

Pain Sufferers are Medically Discriminated Against

Chronic pain patients are routinely treated as a special class of patient, often with severely restricted liberties – prevented from consulting multiple physicians and using multiple pharmacies as they might please, for example, and in many cases have little say in what treatment modalities or which medications will be used. These are basic liberties unquestioned in a free society for every other class of sufferer

chronic pain patients are often seen by medical professionals primarily as prescription or medication problems, rather than as whole individuals who very often present an array of complex comorbid medical, psychological, and social problems

Instead these complex general medical patients are ‘cared for’ as if their primary and only medical problem was taking prescribed analgesic medication.

This attitude explains why most so-called Pain Treatment Centers have reshaped themselves into Addiction Treatment Centers.  Even with a documented cause for pain, the primary goal of these programs, whether stated or not, is to coerce patients to stop taking their pain medications.

This may work for a small number of pain patients who may not really need opioids in the first place, but is a “cruel and unusual” punishment for those of us with serious, documented, pain-causing illnesses.

The published success rate of these programs has nothing to do with pain – it is measured by how many people leave the program taking no pain medication, but there is no data about the aftermath, how many manage to stay off their medication long-term.

their obvious primary medical need is for medical stabilization, not knee-jerk detoxification

Chronic Pain is a Legitimate Medical Disease

Chronic pain is probably the most disabling, and most preventable, sequelae to untreated, and inadequately treated, severe pain.

Following a painful trauma or disease, chronicity of pain may develop in the absence of effective relief. A continuous flow of pain signals into the pain mediating pathways of the dorsal horn of the spinal cord alters those pathways through physiological processes known as central sensitization, and neuroplasticity. The end result is the disease of chronic pain in which a damaged nervous system becomes the pain source generator separated from whatever the initial pain source was.

Aggressive treatment of severe pain, capable of protecting these critical spinal pain tracts, is the standard care recommended in order to achieve satisfactory relief and prevention of intractable chronic pain

Medications represent the mainstay therapeutic approach to patients with acute or chronic pain syndromes… aimed at controlling the mechanisms of nociception, [the] complex biochemical activity [occurring] along and within the pain pathways of the peripheral and central nervous system (CNS)… Aggressive treatment of severe pain is recommended in order to achieve satisfactory relief and prevention of intractable chronic pain.

we are seeing ominous scientific evidence in modern imaging studies of a maladaptive and abnormal persistence of brain activity associated with loss of brain mass in the chronic pain population

Atrophy is most advanced in the areas of the brain that process pain and emotions. In a 2006 news article, a researcher into the pathophysiological effects of chronic pain on brain anatomy and cognitive/emotional functioning, explained:

This constant firing of neurons in these regions of the brain could cause permanent damage, Chialvo said. “We know when neurons fire too much they may change their connections with other neurons or even die because they can’t sustain high activity for so long,” he explained

It is well known that chronic pain can result in anxiety, depression and reduced quality of life

Recent evidence indicates that chronic pain is associated with a specific cognitive deficit, which may impact everyday behavior especially in risky, emotionally laden, situations.

The areas involved include the prefrontal cortex and the thalamus, the part of the brain especially involved with cognition and emotions

The magnitude of this decrease is equivalent to the gray matter volume lost in 10–20 years of normal aging. The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain

clinicians have used opioid preparations to good analgesic effect since recorded history.

No newer medications will ever be as thoroughly proven safe as opioids, which have been used and studied for generations.  We know exactly what side effects there are, and they are fewer than most new drugs, with less than a 5% chance of becoming addicted if taken for pain.

In fields of medicine involving controlled substances, especially addiction medicine and pain medicine, the doctor-patient relationship has become grossly distorted.

doctors-in-good-standing who, faced with a patient in pain and therefore at risk of triggering an investigation, modify their treatment in an attempt to avoid regulatory attention

Examples include a blanket refusal to prescribe controlled substances even when clearly indicated, or selecting less effective and more toxic non-controlled medications when a trial of opioid analgesics would be in the best interests of a particular patient. At the very least, some degree of suspicion and mistrust will surely arise in any medical relationship involving controlled substances.

the quality of care most physicians provide is fairly close to the medical standard of care which is what the textbooks say one should do, and which is generally in line with core medical ethical obligations

For example, modern pain management textbooks universally recommend ‘titration to effect’ (simplistically: gradually increasing the opioid dose until the pain is relieved or until untreatable side effects prevent further dosage increase) as the procedure by which one properly treats chronic pain with opioid medications. Yet the overwhelmingly physicians in America do not practice titration to effect, or anything even vaguely resembling it, for fear of becoming ‘high dose prescriber’ targets of federal or state law enforcement.

It is a foundation of medicine back to ancient times that a primary obligation of a physician is to relieve suffering. A physician also has a fiduciary duty to act in the best interests of the individual patient at all times, and that the interests of the patient are to be held above all others, including those of family or the state.[23] These ethical obligations incumbent on all individual physicians extend to state licensing and regulatory boards which are composed of physicians monitoring and regulating themselves. [24]

A number of barriers to effective pain relief have been identified and include:

1. The failure of clinicians to identify pain relief as a priority in patient care;
2. Fear of regulatory scrutiny of prescribing practices for opioid analgesics;
3. The persistence of irrational beliefs and unsubstantiated fears about addiction, tolerance, dependence, and adverse side effects of opioid analgesics.

A rift has developed between the usual custom and practice standard of care (the medical community norm – what most reputable physicians do) and the reasonable physician standard of care (what the textbooks say to do – the medical standard of care), and this raises very serious and difficult dilemma for both individual physicians and medical board

Research into pathophysiology and natural history of chronic pain have dramatically altered our understanding of what chronic pain is, what causes it, and the changes in spinal cord and brain structure and function that mediate the disease process of chronic pain, which is generally progressive and neurodegenerative

This understanding explains many clinical observations in chronic pain patients, such as phantom limb syndrome, that the pain spreads to new areas of the body not involved in the initiating injury, and that it generally worsens if not aggressively treated. The progressive, neurodegenerational nature of chronic pain was recently shown in several imaging studies showing significant losses of neocortical grey matter in the prefrontal lobes and thalamus

Regarding the standard of care for pain management:

1) Delaying aggressive opioid therapy in favor of trying everything else first is not rational based on a modern, scientific understanding of the pathophysiology of chronic pain, and is therefore not the standard of care. Delaying opioid therapy could result in the disease of chronic pain.

2) Opioid titration to analgesic effect represents near ideal treatment for persistent pain, providing both quick relief of acute suffering and possible prevention of neurological damage known to underlie chronic pain.

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Corralling opioid supply won’t end the demand

http://www.ack.net/opinion/20170331/corralling-opioid-supply-wont-end-demand

Purdue Pharma pushed OxyContin with great success and profitability, as described in your March 26 editorial, “A prescription for responsibility.” In 2012 two CVS pharmacies in Sanford, Florida, ordered 3 million doses of oxycodone, fueling the supply of pills that made their way up I-95 to be sold locally.

Were the drug’s manufacturers aware that the average pharmacy ordered 69,000 doses of the drug per year? The Drug Enforcement Administration shut down the distribution warehouse, a move that was swiftly overturned by a federal judge.

Our struggle with opiates ends only when illegitimate demand for the drugs ceases. Corralling the supply is laudable but spawns unintended consequences, such as people now maiming their pets as a way to secure opiate drugs from veterinarians.

Eliminating demand requires robust treatment and recovery programs but will ultimately succeed or fail based on the effectiveness of education, prevention and early detection of children at risk.

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This letter was inserted in correspondence from our Part D provider.
If you read the first line on Federal civil rights laws and discrimination per age or disability in particular. If healthcare providers refuse to treat a pt because of “disability”… could they be charged/fined for violating Federal law ?

If your insurance company refuses to pay for the medication that your doctor has determined is medically necessary for you… is that discrimination of your “disability” ?

Could this be a area of potential class action against large entities that have established policy/procedures/protocol that limits/denies certain therapies for a particular group of pts.

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