Pain Expert: ‘I Haven’t Prescribed an Opioid in a Decade’
Daniel Clauw, MD, states the case for avoiding opioids in chronic pain
http://www.medpagetoday.com/PainManagement/PainManagement/62730?
Daniel Clauw, MD, is professor of medicine, anesthesia, and psychiatry at the University of Michigan and director of the Chronic Pain and Fatigue Research Center. In this era of increasing opioid abuse and overdoses, and harsh criticism for physicians’ use of opioids in the setting of chronic pain, he shared his (not at all subtle) opinion in a “Doc to Doc” conversation with me.
Despite treating patients with a range of chronic pain issues, from fibromyalgia to interstitial cystitis to low back pain, Clauw says, “I haven’t prescribed an opioid for chronic pain in at least a decade.” With that phrase, he has thrown down the gauntlet to other docs who feel that opioids are an acceptable, if lamentable, option for chronic pain treatment. Indeed, Clauw feels that doctors jump too quickly to opioids when patients might be better managed with tricyclics, gabapentinoids, or even complementary and alternative therapies.
Are docs responsible for the opioid epidemic? Clauw states that we have certainly played a role. He calls out surgeons and dentists who prescribe 30 days (or more) of opioids routinely postoperatively. Surgeons “give these large prescriptions of opioids because they don’t want to be called back for pain … I get that that makes your job easier.”
Whether you find his viewpoint insightful or woefully unrealistic, his advice may very well stick with you. Watch the video to hear all of his observations.
F. Perry Wilson, MD, MSCE, is an assistant professor of medicine at the Yale School of Medicine. He earned his BA from Harvard University, graduating with honors with a degree in biochemistry. He then attended Columbia College of Physicians and Surgeons in New York City. From there he moved to Philadelphia to complete his internal medicine residency and nephrology fellowship at the Hospital of the University of Pennsylvania. During his post graduate years, he also obtained a Master of Science in Clinical Epidemiology from the University of Pennsylvania. He is an accomplished author of many scientific articles and holds several NIH grants. He is a MedPage Today reviewer, and in addition to his video analyses, he authors a blog, The Methods Man. You can follow @methodsmanmd on Twitter.
Filed under: General Problems
The problem is the that the CDC and DEA are not “govt” agencies. They are registered for profit corporations. The “guidelines” and ”regulations” are enforced as laws which is the real illegality because they are unelected bureaucrats.
When did unelected bureaucrats gain control over our lives. This is not representative govt, this is rule by edicts and dictates as in dictatorial govt. People think there needs to be some idiot in a military uniform or other silly costume to be fascist. Not true, the US is the most fascist country that has ever been assembled. Every entity w/in America is INCORPORATED. The police depts, courts, ATF, DEA, FDA, DHS,CIA, FBI, USDA, and every other of the 400+ “govt” agencies.
Until we recognize that corporations are not representative govt this will continue unabated.
They don’t need rewriting or more competent advisers, they need to be dismantled because they are ILLEGAL. The absurdity of these extra-legal organizations calling doctors, patients,pharmacists, or even addicts behaviors illegal is absurd.
This interview is of a woman who set out to stop mandatory vaccination in case of an epidemic/pandemic in her local school system. What she found should shock every American to their core.
https://youtu.be/23MJRRubfdg
Just how did one class of medications become suddenly “politically incorrect “???? Medications the UN has deemed “essential medicines”? Doctors who prescribe LEGAL medications and the patients who need them because nothing else has worked are demonized continuously especially in the last several years. Great spin machine using the CDC, and media lies, but lets land the blame of decent patient and doctor vilification’s, and condoned patient torture squarely where it belongs, we have suffered long enough under this now- past- regime. This has to stop now!
http://allianceforpatientaccess.org/the-obama-administrations-final-say-on-opioids/
I agree w/some of what u say,,,,,but would add,,,,we need to get back to the action of legally recognizing ,”informed Consent,” as adults,,,at any time we can so No,,,to any doctors,,,,,,Stop blaming them for a individual adults irresponsibility,,jmo,,maryw
THANK YOU!!!! So well-written and such a thoughtful and supportive response. These CDC guidelines need to be trashed before others are tortured.
I entered the following comment to the Medpage article. We’ll see if it survives moderation:
This so-called “pain expert” is a part of the problem, not the solutions. He has effectively discharged the majority of his patients to the care of more competent and compassionate doctors, by refusing them effective treatment. He may also be partly responsible for the deaths by suicide of some number of his patients who have been plunged into total disability and despair by his cavalier attitude. and refusal of care.
As a technically trained medical layman, I have supported chronic pain patients in online venues and social media for over 20 years. I wrote most of the Wikipedia entry on Atypical Trigeminal Neuralgia, and revised the NINDS Trigeminal Neuralgia Fact Sheet with oversight and validation by physicians. I daily interact with a membership of over 20,000 patients and family members in 25+ Facebook groups.
From this background, I must report that although a few patients report helpful outcomes with acupuncture and chiropractic, I haven’t seen ONE patient report of effective pain control using Rational Cognitive Therapy. Not ONE. By contrast I’ve seen a good many reports of patients being coerced into RCT as part of STEP (“Fail First”) therapy — and further damaged by delay of truly effective medical treatment. There is also medical evidence that surgical interventions are presently dangerous for many patients, with an unacceptably low success rate.
It can be argued that the present “epidemic” of opioid overdose deaths may have begun 15 years ago, partly from too liberal a standard on prescription of powerful pain relief medications. Ill trained doctors over-prescribed for acute pain, and ignored the manipulations of addicts who misrepresented their own condition. But these unconsidered policies no longer apply. Now the pendulum has swung entirely too far toward arbitrary restriction of both supply and treatment. The mess is compounded by malicious and arbitrary DEA prosecution of pain physicians who are trying to help their patients.
Opioids prescribed to valid pain patients whose conditions cannot be expected to resolve are NOT a causative factor in well over 3/4 of the “opioid-RELATED” deaths each year. There is ample evidence that reformulation of Oxycontin in abuse-resistant forms in 2009 has been directly responsible for a migration of drug abusers to street Heroin and illegally imported Fentanil, which continue to dominate death statistics along with Morphine and Methadone. It is highly plausible that some present deaths in patients who have a current opioid prescription are in fact a consequence of UNDER-treatment of their agony.
There are many tens of thousands of patients in the US who have been on stable doses of opioids for years without evidence of opioid abuse disorder or its compulsive drug-seeking behaviors. Thousands of them have been on doses exceeding 400 MMED (Milligram Morphine Equivalent Dose), due to genetic enzyme deficiencies which make them poor metabolizers of opioids, anti-seizure medication alternatives, or both. Arbitrary and scientifically fraudulent restrictions on these meds are driving these people into disability, denying them work and family relationship. Some have already committed suicide, and more will do so.
The only ethically sound responses to this medical debacle must include immediate withdrawal of the CDC prescription guidelines on opioids (March 2016) for a re-write by a working group led by pain management specialists and pain patients themselves — rather than by addiction treatment psychiatrists intent on diverting more patients into their own specialty.
A useful and well researched contrary view to that of the author is offered in the following article: “Neat, Plausible, and Generally Wrong: A Response to the CDC Recommendations for Chronic Opioid Use”
https://medium.com/@stmartin/neat-plausible-and-generally-wrong-a-response-to-the-cdc-recommendations-for-chronic-opioid-use-5c9d9d319f71#.s9af6z5x3
Doc, I completely agree w/ you! I am a patient advocate w/ a back round in psychology & addiction that has worked w/ patients for over 20yrs. & I am a chronic pain patient that started from a severe birth injury to both hips. So I can see these issues from all sides & can assure anyone that addiction in legit & compliant pain pts. is quite rare; while the benefits of opioids used long term by these patients are MANY!
Over the 46yrs. that I have been in pain, I have had docs do terrible things to me in effort to “fix” me & all they have done is made me much worse! I have been on opioids for 15+yrs. w/ breaks off of them to try new meds/treatments. Like epidurals that I was made to get even though my back really didn’t hurt much & my knees & hips were my major sources of pain. Now after having 8 epidurals, my back NEVER stops hurting & I now get migraines!
All the steroid shots in my joints have caused major tissue damage & led to 3 knee surgeries & have very little cart. left in them!
Tylenol caused me to lose about 80% of my liver function (which thankfully has now recovered about 70% over the last 5 yrs. after stopping w/ Tylenol!!)
However the worst thing was that less than 1 year on Celebrex left me w/ congestive heart failure & uncontrollable bp that has led to 6 mini strokes! My ave. bp runs at 155/110 & that is w/ me on 3 different bp meds.!!
All the opioids have done is to give me some relief from my 24/7 pain.
No one talks about all the risks & side effects of all these so called preferred & “safer” meds./treatments & down plays that opioids; when taken properly are among the safest & least damaging meds. known!
Why is the risk of addiction worse than heart & liver failure or massive & multiple strokes? Had I been given the HONEST TRUTH about ALL treatment options & allowed to choose what risks that I was willing to take w/ MY OWN body; I would have chosen the SMALL risk of addiction in a heartbeat!!
I’ve said the same things so often. I am 72, been on OxyContin since the early 90’s, same dose (3 times a day) and the lowest dose. When I feel like the meds are not working as well I take one away a day or to for awhile. That helps bring the pain down like it should. When I read that a person is in terrible pain and they take a pill when it gets really bad it drives me crazy. I know we are having a hard time getting medication so I understand that is the only thing they can do.
I have a very good Pain Clinic and I am on the same program since the 90’s. I also took a DNA test and mine came out that I’m not an addictive personality and have a high pain threshold. That made me feel better and the doctor felt sure of me too. We all know that DNA is not all it should be but I liked my outcome, Lol.
This is the way pain medication should be taken (Doctors tell me this) If you are suppose to take your pain med 3 times a day that is what should be done. After you have done that for a couple of days the medication evens out so you get a better result. If you take one pill when you are feeling extra awful then it won’t help much.
We need to get the word out to Trumps people even though we know they are super busy right now. Just keep sending the same letter over and over again. There should be hundreds of us doing that but no one feels well enough to tackle that job.
I am not addicted I’m dependent on the medication. I don’t trust the other medication they try to get us to take, they are very hard on your organs. Remember, I’m 72 and the OxyContin and breakthrough med I take in the middle of the night has not harmed my organs. God Bless all of us.
”I take one away ,a day or 2,that helps bring the pain down,”’????When I hear I take a pain medicine when the physical pain gets really bad,,it drives me crazy,”??
It is physically impossible for anyone to physically feel the physical pain of another,,literally,impossible,,,thus,,,what works for u,,may not work for everyone,,I can tell u,,your theory,,does NOT,NOR EVER HAS worked for me,,My pancreas acts up,,i am physical pain,i take my medicine,,my back inturn act up from a swollen pancreas,,,Or simply using my back like ever other person in the world,,,actual i can’t,,but i’ll try,,my muscles all along thee thoracic swell instantly,,it hurts,physically,i take my medicine,,as prescribed,,,thus,,again,,what works for 1,,should never be institutionalized as working for all,,,that’s partly how we got into this mess,jmo,maryw
I am shocked that he has any patients at all. He’s clearly torturing those in his care and living on another planet. Or, perhaps his patients aren’t in that much pain as the rest of us? If he were a CRPS sufferer for years on end without any relief, I guarantee he would be begging for opioids.
You are also right about what Obama did to the medical profession and pain patients! As I said we must write to anyone that Trump has chosen to head the Health Care. We need to tell our story without sounding like “poor me”. I include a link that explains what is happening. Steve Pharmacist has a lot of worthwhile articles.
After Trump is done their will be no affordable Health care for those who have pre-existing conditions so getting pain medications will be the least of of our problems as chronic pain patients. Trumps actions have shown that those who are not white healthly man then you are a second class citizen.
I will spare myself the video, as I am witnessing the results of Harvard professor Dr. Ronald Heifetz, and former president Barack Obama’s Healthcare Reform Act, AKA/ Wellness and Recovery Model. Promoting the CDC, [Center For Disease Control], to over-ride Medically Trained, and universally decided definitions- constituting pain, torture, and inhumane practices, I am overwhelmed that this hasn’t been brought into question.
CDC, DEA, and related organizations overseeing “Healthcare” must return to their previous level of purpose, [destructive insights included], as the damage and continuing genocide, have reached a point of no return.
jmo,,both agency should be charged for the federal charge of torture..Any government entity that has aided or abetting to this forced endurement of physical pain onto the medically ill should formally be charge w/torture,,,put their asss in jail for life,,as is the sentence if convicted,,,as they have done to 10,000’s humanbeings who have been forced off their MEDICINES, because of thee governments abuse of just power derived from the govern,,,
FOR every person that has been denied their medicine,that once worked for them,until Dr.Government GOT INVOLVED HAS SENTENCE THOSE CPP,,, a life sentence of torture ,in their own bodies,,,which they can only leave thru death,,,maryw
Thank you for your post. It makes me angry when I think of what Obama and his team has done to people in chronic pain. I am 72 years old and have been on the same medication (OxyContin) since the early 90’s. Same dose and always without exception have stuck to it. It is the lowest dose too. My pain doctor has asked me several times if I want it increased (dose) and I always say no even though my pain is usually about a 7. There was a post above that said outright I am addicted, really! She or he has been listening to Obama and his gang or they have a family member that is addicted and have been hurt by it. They don’t understand chronic pain and think they can call a person an addict like they did to me. I don’t know whether to feel sorry for them or get angry (which hurts too)
I needed to read your comment, Thanks again.
Here’s a simple question. Wouldn’t thousands upon thousands of chronic pain sufferers currently using a steady dosage of opioids without an increase over years of treating their pain. Patients who have also never shown any signs of abuse, addiction and have never failed a UA or a pill count. Wouldn’t this all be considered a running scientific study showing that opioids do and are helping these people???
Determining pain levels or the effects of opioids on lab animals in my opinion is the inconclusive research. Growing up on a farm and in my 51 years of life, I have never met a single animal that could verbally tell anyone how they felt before or after medical treatment. Sure, knowing an individual animal like a pet an owner can tell when they hurt or don’t feel well but that’s because the animal and owner are connected. Lab mice and rats just don’t have this connection with scientists.
Then, I would like to know what the difference in levels are between malignant pain, acute pain and chronic pain. Does any one of these types of pain feel any differently than the others? Does a level 8 malignant pain hurt worse than a level 8 chronic pain? This doctor sounds to me more like he’s guilty of pain cause discrimination just like the CDC is. Granted, if his techniques are working with his patients then that’s a good thing. But if his patients are still suffering with alternative therapies and he still refuses pain medications, there’s a problem.
You said exactly what I was thinking. I also am uneasy when the Dr works in psychiatry. There are a lot of Drs that have a very negative attitude about pain medication.
I am 72 yrs old and after trying all kinds of therapy and Medication my Dr. Put me on OxyContin and a breakthrough pain pills. I’ve been on the same low dose since the early 90’s. Like you I stuck to my program and still do. I’m in a lot of pain, the medication helps me. If I forget to take the pain medication boy do I know how bad the pain really is!
Pain patients are not addicted we are dependent, there is a huge difference. You explained this very well.
Now the DEA & CDC and other government offices have taken over Drs and how they practice and what they can do. If you are a pain patient absolutely no Dr will take pain patients. I got lucky and found a good pain Clinic, they are keeping me on the same dose and they think I’m doing fine.
We all need to get in touch with people that have been appointed by President Trump. I like Pharmacist Steve, he has great articles and he is a pain patient. Look him up
We must be proactive. Take care.
Read your comments from the perspective of PROP members, and you will begin to see the many ways in which they believe what you say unwittingly reveals your “addiction.” They truly believe that you are addicted and, of not, that you only continue to take OxyContin to stave off withdrawal pains. That, in fact, if you agreed to taper off opioids and start taking Elavil, or no drugs at all, that your pain would improve immensely. And that in retrospect, you would then recognize your “addiction,” and how profoundly your “addiction” had been hurting you and your family. Then you would thank Dr. Clauw for helping you so, so much. You might even then take up the banner, like Betts Tully, and join them in their temperance crusade. These people are not going to change their mind. I repeat, these people are NOT going to change their mind.
Robert,,,everyone has a rite to their OPINION,,AND THEORY,,,RITE?? however,,when that theory physically hurts another humanbeing willfully,,,and it is a government agency doing soo,,,its call TORTURE,,,, which is illegal,,,jmo,,I speak about truth and fact,,,It is factually,truthfully, literally IMPOSSIBLE,,for anyone to physically feel the physical pain of another,,,,that is truthfully a fact,,,I could NEVER EVER physically feel your physical pain from your medical illnes,,rite,,Sooo w/that truth in mind,,,,Since it is factually,truthfully impossible for anyone to literally physical feel the physical pain of another,,NO-ONE,,,NO-ONE HAS THE RITE TO FORCED PHYSICAL PAIN ONTO ANOTHER,,,For the flip side of their theory,,is they are now forcing physical pain onto another,,which is illegal and criminally a chargeable offense of torture,which carries a life sentence,,appropriately so…Furthermore in the big picture here,,,,would u forced physical pain onto another humanbeing???NO,, sooo why would these humanbeings be ok w/forcing physical pain onto a medically ill humanbeing,when it NOT OK????iT SHOWS their inability for compassion,empathy,logic,inability to recognize reality,,,all signs of a true psychopathic personality,,,Soo,,why are these humanbeings who are incapable of empathy or recognizing truth,reality,or consequence of their ,”theories,” in any position of power??I mean,,their inability to see the reality,that their action’s,their ,”theory,” has cause physical harm onto a humanbeing,forcible,is sooo disturbing, and unlawful I would think any government official would dismiss it in fear of formal charges of torture,,,
I mean thee people u speak of are essentially starting another Pennhurst,,where because u were crippled by a medical condition,u were called crazy,,because u screamed in unrelenting physical; pain w/out medicines to lessen that physical pain,,Does our government WANT another Pennhurst??Or is our main objective to learn from are mistakles in history and strive towards a humane ,civilized society??maryw
Read my comments! My question to you is have you ever been in chronic pain? How do you come to your point of view, did you have a family member or friend who was addictive? Read my comments! That is insulting to say the least!
There are millions of people who are chronic pain sufferers and latterly could not live with the pain with out the pain medication. The CDC & FDA EPA have lumped all of us in with addicts and are telling people like you how bad pain medication is. I don’t know what made you post this to me but I recommend you learn about us before doing it again. Help real addicts.
By the way, a year ago I was asked by my pain doctor to take a DNA test and I agreed. Mine came back that I don’t have an addictive problem and I have a high pain threshold.
Heres a thought 4 u Ms.Carol,,what if u tested positive for what ,”they label,” as this addictive gene,,,would that make your physical pain any less???No,,,correct,,,jmo,,that ,”addiction gene,” is bullshit,,,”they”’ labelled it a ,”addiction gene,” they being prop,aganda,klondike bar etc,,in reality,,it literally could be a marker for people in true physical pain,,,,it is,,,just a ;label u know,,,a theory,,,,not a scientific fact,,,,maryw