I hurt my back due to all the work I did as a first responder to the Anthrax Crisis in. 2001-2002 at work. I even got thanked by "W" for my Emergency Response efforts, I have the shinny certificate from Tommy Thompson thanking my outstanding efforts in the response to the 9/11 and Anthrax Crisis. Unfortuately, human bodies can only take so much of 24/7 call and eventually one wrong move and pop. Not all of us were at the twin towers or Pentagon to help respond. I have had three surgeries and numerous procedures. Not a day of less than 8/10 pain since 2002. Each resulting surgery has caused more damage to my body, nerves, scare tissue.
Workers Comp and all insurers want to treat conservatively. That is support Pharma. Federal workers Comp only pays for Physical therapy for 4 mo. After initial injury ( or after each surgery , but you can't start PT for 6 wks after fusion surgery. Time is counted).
This is what helps but I and others who can not work because of pain can not afford ( maybe if insurance paid I could recover) Massage Therapy. How about paying for heating my pool ( this would be less than the $1000 lido derm patchs with the heater, cover and gas/ electric) . Or pay $160-200/ mo for the health club with heated pool ( I could not join the senior pool in my county until 55 and the pool is only large enough for 12 people, class is by a lottery at limited times for 1/2 hr.) . Allow PT at least once a week for duration of injury
Workers Comp and all insurers want to treat conservatively. That is support Pharma. Federal workers Comp only pays for Physical therapy for 4 mo. After initial injury ( or after each surgery , but you can't start PT for 6 wks after fusion surgery. Time is counted).
This is what helps but I and others who can not work because of pain can not afford ( maybe if insurance paid I could recover) Massage Therapy. How about paying for heating my pool ( this would be less than the $1000 lido derm patchs with the heater, cover and gas/ electric) . Or pay $160-200/ mo for the health club with heated pool ( I could not join the senior pool in my county until 55 and the pool is only large enough for 12 people, class is by a lottery at limited times for 1/2 hr.) . Allow PT at least once a week for duration of injury
9
I really don't need to hear about someone who can get by on 120 Vicodin pills a year. Good for them.
What has become known is that with prescribed opioids being cut back the number of heroin deaths has spiked correspondingly to the decrease in prescribed opioid deaths. Does the FDA really expect patients to pretend that Advil works?
I'd really like to see the media write more about ordinary people who take opioids daily and run households, go to work, go to the gym because those medications work. Of course, witch hunts and sensationalism sell more papers.
What has become known is that with prescribed opioids being cut back the number of heroin deaths has spiked correspondingly to the decrease in prescribed opioid deaths. Does the FDA really expect patients to pretend that Advil works?
I'd really like to see the media write more about ordinary people who take opioids daily and run households, go to work, go to the gym because those medications work. Of course, witch hunts and sensationalism sell more papers.
38
I've lived with chronic daily pain and resulting limited mobility for over two years now. I do not take opioid pain meds. Period.
I do take occasional ibuprofen, 5 mg of muscle relaxants when the pain is unbearable. I've tried acupuncture, herbs, homeopathic remedies, pain management techniques and physical therapy to help cope. Exercise, stretching, a healthy diet, and physical therapy all help a lot.
I feel great empathy for all who suffer daily. But, for me, opioids are simply off limits. I refuse to take them. I've taken them for a few days, post-operatively, but refuse to become dependent on them.
I have two cousins who have become dependent on opioids. Destroyed both of them. One committed suicide accidentally. The other has absolutely no life. I choose life...even if it is a life with pain.
That said, It's not easy to deal with daily pain. It's exhausting. It wears you down, both physically and mentally.
I do take occasional ibuprofen, 5 mg of muscle relaxants when the pain is unbearable. I've tried acupuncture, herbs, homeopathic remedies, pain management techniques and physical therapy to help cope. Exercise, stretching, a healthy diet, and physical therapy all help a lot.
I feel great empathy for all who suffer daily. But, for me, opioids are simply off limits. I refuse to take them. I've taken them for a few days, post-operatively, but refuse to become dependent on them.
I have two cousins who have become dependent on opioids. Destroyed both of them. One committed suicide accidentally. The other has absolutely no life. I choose life...even if it is a life with pain.
That said, It's not easy to deal with daily pain. It's exhausting. It wears you down, both physically and mentally.
11
Let me get this straight: even though fibromyalgia "doesn't respond to opioids anyway" the doc continued the Percocet at a low dose. Why? To keep the patient from suffering? The patient is suffering on the dose of Percocet she was previously prescribed. If this lowered dose was to taper the patient gradually to achieve freedom from opioids, I wish the writer would have mentioned it. If the Percocet doesn't work in that condition, why not switch the patient to an actual placebo?
And is anyone helping the patient to undertake that recommended program of significant weight loss, regular aquatic therapy and stretching?
And is anyone helping the patient to undertake that recommended program of significant weight loss, regular aquatic therapy and stretching?
3
Totally absurd. The young people are at the heart of the epidemic and we take it out on those who legitimately need these meds to treat chronic pain. We needlessly add to their suffering and it does nothing to address the addiction epidemic.
It's all about appearance. I can deal with bureaucrats making up rules, but for doctors to go along like sheep I find contemptible
It's all about appearance. I can deal with bureaucrats making up rules, but for doctors to go along like sheep I find contemptible
24
The elderly are being blocked from living with dignity and dying with dignity by "authorities" and "experts"
People like Dr. McPherson are not at all worried about the suffering, they are just obsessed with regulating.
People like Dr. McPherson are not at all worried about the suffering, they are just obsessed with regulating.
21
"Acupuncture, chiropractic and hypnosis proved ineffective". That's because they're just woo-woo nonsense that somehow gained support thanks to confirmation bias and the placebo effect. My mom is in nearly constant pain for years now following a knee replacement. The painkillers are the only way she can cope. You have a choice...let those in pain have the relief without the moral judgement or accept that many more people will choose to end their own lives rather than suffer with, what for them, is unbearable, unrelenting pain.
21
The lady with "screaming pain from fibromyalgia" had one problem and one problem only (other than being fat and out of shape): she was addicted to Percocet. She was a junkie, and junkies are always in pain.
6
I hope someone will put together two facts:
1. Opioids are being more closely monitored. That's good, except that the people already in pain have to make a more painful monthly trip to get their medication.
2. Medicare has cut down on the amount of physical therapy available. If you've used up your PT allotment on a hip replacement therapy, and then you fall and break your shoulder, tough luck.
Less medication accompanied by less available alternative treatment makes makes so little sense that it seems purposefully cruel.
1. Opioids are being more closely monitored. That's good, except that the people already in pain have to make a more painful monthly trip to get their medication.
2. Medicare has cut down on the amount of physical therapy available. If you've used up your PT allotment on a hip replacement therapy, and then you fall and break your shoulder, tough luck.
Less medication accompanied by less available alternative treatment makes makes so little sense that it seems purposefully cruel.
21
So,as that elderly population got older they had more issues leading to severe pain? This is a problem because?Yet another case of throwing the baby out with the bathwater, brought to you from the Ivory Tower. We've gone from the days when patients dying from cancer in horrendous pain couldn't have their pain meds because, "it's not 4 hrs yet" to treating people humanely and back to withholding relief from those that really need it. Is it difficult to weed out abuse in patients, yes. Is it fair to punish the elderly for this, a resounding NO.Who is it that decided to limit payment for so many "alternative" therapies?How can we expect anyone to follow a regime they can't afford? It's great Ms. Cohen can go to the gym but that won't help someone who can't have a knee replacement because of a serious heart issue. And, SURPRISE, not everyone has access to a YMCA or senior center offering exercise class or a way to get there. You want to limit pain meds in the elderly ? Make sure everyone of them has access to exercising in the water, which takes pressure off all your joints and allows your muscles to work, and make it affordable.I watched my elderly mother,active,healthy until she hit 80, suffer for years when she was taken off her pain meds.She would lie in bed, saying over and over,"Please, God, let me die." She didn't eat,could't sleep. There are side effects to pain meds, but what's the point in living if all it is, is pain ? I know we can warehouse them in Nursing homes.
23
“Older adults don’t metabolize drugs as well as a 30- or 50-year old, so the medication stays in a person’s system longer,” Dr. Reid said.
I can find no scientific evidence to support this statement.
I can find no scientific evidence to support this statement.
5
The author says that long time use of opioids can cause kidney and cardiac damage. There are many, many side effects and problems with opioids, but those two problems are new to me. Can the author or another NYTimes commenter please provide more information about those two potential side effects of opioid use?
11
I definitely understand the precautions that are being taken, making patients jump through more hoops in order to get their medications. However, I'm not sure restricting it is the best approach. Many elderly people and people who have had severe traumas rely on these drugs for normal human living. I think those who want to abuse these drugs will find a way to get them, regardless of the hoops needed to jump through. So in that case, it may be necessary not to restrict from the people who "truly" need these drugs.
10
During the 15-year period where 165,000 people died from overdoses, how many users, friends and families of users had their lives destroyed by opioids? We are now counting the dead and it is horrible, but wait until we start counting the casualties, these numbers will be far greater and will hit the middle class hard.
2
This is obscene. I guarantee you no one in the Washington DC "establishment" will have to jump through these hoops to get painkillers. In their doctor's offices they can get whatever they want. "Vicodin, Senator? Coming right up!"
These regulations, like Washington's laws, are only for the "little people."
These regulations, like Washington's laws, are only for the "little people."
25
I do not qualify as an "older adult," BUT...
Following an accident that destroyed my L5 vertebrae and left me with bulges pressing into nerves and herniated discs, I have been in chronic pain for five years. I am not overweight. I eat well. I perform cardio exercise six days a week. I meditate, and I do core work daily. I have tried massage, acupuncture, etc. Regardless, there are approximately 10 days and nights a month during which I cannot sleep or work without taking Percocet. Usually, these ten days are not consecutive, which allows for some time away from Percocet, but any way you cut it 10 days is still one third of every month. One third of my life. (Sometimes, as with the past two months, it's simply constant.)
New laws have made it extremely difficult to get prescriptions filled. Pharmacies won't tell you if they have your medication over the phone, and I am sometimes forced to walk from pharmacy to pharmacy to pharmacy until I locate one that has my medication. At that point, I am treated as a likely criminal, regardless of ID, and have lost a day of work.
Opiate overdoses ARE on the rise. Addiction is real. But what if I were a paraplegic vet who'd just returned from my last tour of duty? What if I lived in unbearable pain, were in a wheelchair, and didn't have much money?
Honestly? I'd probably locate the nearest heroin dealer.
So, instead of persecuting those in real pain, perhaps we could set up a system that better identifies such people?
Following an accident that destroyed my L5 vertebrae and left me with bulges pressing into nerves and herniated discs, I have been in chronic pain for five years. I am not overweight. I eat well. I perform cardio exercise six days a week. I meditate, and I do core work daily. I have tried massage, acupuncture, etc. Regardless, there are approximately 10 days and nights a month during which I cannot sleep or work without taking Percocet. Usually, these ten days are not consecutive, which allows for some time away from Percocet, but any way you cut it 10 days is still one third of every month. One third of my life. (Sometimes, as with the past two months, it's simply constant.)
New laws have made it extremely difficult to get prescriptions filled. Pharmacies won't tell you if they have your medication over the phone, and I am sometimes forced to walk from pharmacy to pharmacy to pharmacy until I locate one that has my medication. At that point, I am treated as a likely criminal, regardless of ID, and have lost a day of work.
Opiate overdoses ARE on the rise. Addiction is real. But what if I were a paraplegic vet who'd just returned from my last tour of duty? What if I lived in unbearable pain, were in a wheelchair, and didn't have much money?
Honestly? I'd probably locate the nearest heroin dealer.
So, instead of persecuting those in real pain, perhaps we could set up a system that better identifies such people?
41
I have experienced referrals to pain specialists (anesthesiologists), which is a relatively NEW specialty, from internists and neurologists. These pain specialists "push" lucrative injections and other spinal treatments. They do not prescribe less profitable Percocet, Vicodin, etc. ... Hmm. I want internists to prescribe my pain meds.
14
Of the 165,000 people who died from overdoses during the 15-year period, what percentage were older people in chronic pain with legitimate prescriptions?
31
It is nice for regulators, reporters and researchers to condemn the use of opiates, when on the standard scale of 0 to 10 their pain level is at zero. I am near 84 years old with an inoperable and untreatable day m age to my spinal chord. Motrin gave me a bleeding stomach ulcer: I wound up in an ER with blood pressure of 40/20! Thanks to a great gastroenterologist, I survived. Percocet did not help, finally a smart pain management physician put me on Fentanyl patches. A not-too-large dosage (50 mcg/hour) keeps me at a barely insufferable p ain level of 8-1/2. I don't worry much about addiction: at my age, the horizon is a short one. Now, thanks to all well-meaning peddlers, I have to pay each month for car services to take me to the pain management doctor, just to get a new prescription. Of course, his time is not free: the bill goes to Medicare. I think it is time that all the well- meaning people realize that us nearing the end of our lives deserve some relatively pain-free time without worrying about us getting g addicted.
48
Gee, I hope everyone in pain can get by on 120 pills a year, too, and just suck it up and endure.
But I bet instead a lot of them will find a way to get the pain relief they need on the street instead of from the doctor. I hope they can find relief somewhere because telling them they need to endure agony because somebody else might overdose seems awfully cruel.
But I bet instead a lot of them will find a way to get the pain relief they need on the street instead of from the doctor. I hope they can find relief somewhere because telling them they need to endure agony because somebody else might overdose seems awfully cruel.
30
Let's cut to the chase. These new rules or guidelines are just another example of our government attempting to fix a problem that's staggeringly complex with a pretty simple solution. It never works out well. Abuse of opioids is complex. Pain management is complex. It's really disheartening to see that they learn nothing from the continued 1-dimensional, linear thinking track. These issues are hard, and require advanced study and the acceptance of humans as unique creatures with individual needs. We also need to stop applying Calvinistic, Puritanical judgment to things that provide relief or even just relaxation. We need to stop trying desperately to persecute people with drug problems, whatever the source.
25
I have suffered from trauma-induced chronic pain since 1980 (I'm 62 now). The pain ultimately disabled me because it ruined my ability to keep a schedule and be consistently productive, even when treated. In the early 80s my neurologist and I finally tried opiates and they worked better than anything else. Periodically since then--every five yrs or so--I have weaned myself completely off the opiates, stayed completely off for months after that grueling process, and, under my doctor's close supervision, tried whatever new therapy seemed promising or retried older therapies hoping they might be more effective the 2nd (or 3rd) time around. I've always ended up back on the opiates because they are, overall, the most effective treatment for my constellation of pain. I don't see how I could have been, or could become, more responsible in my use of these powerful medications.
Lately, with my son as my "shaman," I started trying high CBD/low THC medical marijuana, and it is showing real promise in reducing my reliance on opiates. I'm also psyching myself up for more exercise, which is a tough one for me because I have exercise-induced migraines. Such is life sometimes!
I'm relating this all because I know I am not alone in working hard to deal positively with my constant pain, and to encourage others similarly situated, but younger and earlier in their journey, to keep hopeful, creative, and flexible in their thinking about pain. Oh, and sometimes a good cry really helps.
Lately, with my son as my "shaman," I started trying high CBD/low THC medical marijuana, and it is showing real promise in reducing my reliance on opiates. I'm also psyching myself up for more exercise, which is a tough one for me because I have exercise-induced migraines. Such is life sometimes!
I'm relating this all because I know I am not alone in working hard to deal positively with my constant pain, and to encourage others similarly situated, but younger and earlier in their journey, to keep hopeful, creative, and flexible in their thinking about pain. Oh, and sometimes a good cry really helps.
21
One thing that bothers me in the discussion of presumably necessary new limitations on opiate prescriptions is this notion that the uptick in prescriptions over the past 25 years has been a complete failure. Reporters almost always use the word "skyrocket" or some such other hyped-up, emotionally charged word to describe how narcotic prescriptions have risen since the early '90s.
My personal opinion is that pain in the late '80s was under-treated and that has something to do with the increase in prescriptions that began in the early '90s. I'm not ruling out that opiates were probably over-prescribed at some point in the early 2000's. Certainly the pain clinics in Florida that were shut down in, I believe 2011, had perverse incentives for physicians to prescribe drugs they made money on - knowing full well many of their patients were gaming them. I've also read stories of professional athletes who became addicts after being prescribed as many as 120 Vicodan or Percocet at one time.
I fear we're at a point right now where we're going backwards, though. It looks to me like doctors are already fearful of reprisals. It's not a hard stretch of imagination to believe they will knowingly under treat pain patients or not treat them at all in the future out of self-preservation.
There's a lot about the recent death of Prince to be sad about. The cause of his death is another one - and not just for the most obvious reasons.
My personal opinion is that pain in the late '80s was under-treated and that has something to do with the increase in prescriptions that began in the early '90s. I'm not ruling out that opiates were probably over-prescribed at some point in the early 2000's. Certainly the pain clinics in Florida that were shut down in, I believe 2011, had perverse incentives for physicians to prescribe drugs they made money on - knowing full well many of their patients were gaming them. I've also read stories of professional athletes who became addicts after being prescribed as many as 120 Vicodan or Percocet at one time.
I fear we're at a point right now where we're going backwards, though. It looks to me like doctors are already fearful of reprisals. It's not a hard stretch of imagination to believe they will knowingly under treat pain patients or not treat them at all in the future out of self-preservation.
There's a lot about the recent death of Prince to be sad about. The cause of his death is another one - and not just for the most obvious reasons.
15
Prone as I am to ulcerative colitis, I am not able to take most OTC analgesics. Like many of us elderly, I am also subject to chronic pain. Federal policy in this area is insane unless one classifies sadistic cruelty to be a benchmark of sanity.
18
MEDICAL MARIJUANA. I have been offered every drug imaginable for chronic pain associated with a leg I shattered years ago. Due to my fear of addiction, I have resisted all of these and gone on to use medical marijuana. I am still functional in my late 50s. I work full time, I have an active social life, and, when I'm not reading the political news in this country, I'm happy. Why aren't more doctors looking at this wonderful alternative? Cannabis works! And it's possible, with new strains such as Charlotte's Web, ACDC, and a new Israeli-developed strain, to get marijuana that is 99% pain killing and almost no THC (the component often associated with getting "high"). Why aren't we getting behind this for the elderly?
10
I agree medical marijuana. How could the article not at least mention this as an alternative? https://www.youtube.com/watch?v=VneCaYJUHNE
3
I'm off of everything now, but a year ago was when it hit me: I had been taking hydrocodone since 2003 without incident for chronic, severe achilles tendon damage. In June 2015 I walk into my appointment to discover my primary care doctor is retiring. In not so many words, I was told 'good luck getting these from anyone ever again - we are being watched so closely that people with advanced HIV aren't even getting painkillers.' I knew this was the end. And I was physically dependant.
There were four doctors in town who retired - so that meant half the city who was getting painkillers prescribed had to figure something out. Next available appointment to see a primary care doctor in this town is January 2017. So not only is there no access to pain medication; there's no access to a local doctor even. That, in desperation, sent me out to the streets to find oxycodone. I might as well have set $400 on fire - having no experience with street dealers, I was ripped off. And that is what's going to happen to thousands of others who are sent into the same scenario.
I'm happy to be off these prescriptions, as I was forced to learn how to survive without them. I now work out a lot. However, I am still angry about the way I was 'disconnected' from them. I was at the whim of my doctor, who retired, only to find that was the end of the road. No choices, no alternatives, no nothing. We deserve better than to be carried to the top of the mountain and then left there.
There were four doctors in town who retired - so that meant half the city who was getting painkillers prescribed had to figure something out. Next available appointment to see a primary care doctor in this town is January 2017. So not only is there no access to pain medication; there's no access to a local doctor even. That, in desperation, sent me out to the streets to find oxycodone. I might as well have set $400 on fire - having no experience with street dealers, I was ripped off. And that is what's going to happen to thousands of others who are sent into the same scenario.
I'm happy to be off these prescriptions, as I was forced to learn how to survive without them. I now work out a lot. However, I am still angry about the way I was 'disconnected' from them. I was at the whim of my doctor, who retired, only to find that was the end of the road. No choices, no alternatives, no nothing. We deserve better than to be carried to the top of the mountain and then left there.
38
Regarding the 78-year-old woman who must literally beg for pain meds, why bother? At that age, she has one foot in the grave. If she becomes addicted, again at that age, so what?
20
I'm older that the woman in question, and I don't appreciate the idea that I have "one foot in the grave"! My mother was 91 when she died.
With that said, I am truly concerned that if I have severe pain, I may not be able to find anyone to help me legally.
With that said, I am truly concerned that if I have severe pain, I may not be able to find anyone to help me legally.
10
I'm a senior too and would rather be dead than living in pain because some doctor or government agency refuses to give me the pain medicine I need to lead a reasonably comfortable life. By the way, everyone from the moment we are born begin the road to death. Most people feel that they have one foot in the grave when their life is no longer one that brings even a bit of joy.
6
Wow - this is real sadism, intentional or not, on the part of the government and medical providers masquerading as "preventative medicine". Do those bright minds who are denying elderly pain patients a modicum of relief really believe that they are stopping all those recreational drug users in their tracks? Are they refusing to acknowledge that the recreational people have already transitioned to heroin, which is actually considerably cheaper and much easier to acquire than pills anyway.
If I sound bitter, it is because I just lost a good friend to suicide due to untreated pain. She could no longer stand the agony from a rare auto immune, degenerative disease that has no cure nor remission. After she was cut off opiates by her pain clinic because they had no CDC or whatever agency published guidelines for prescribing them in connection with her very rare disease, her life was reduced to just enduring endless agony. I even offered to get her heroin to try, but she wouldn't let me take the risk. In retrospect, I wished I had forced the issue.
If I sound bitter, it is because I just lost a good friend to suicide due to untreated pain. She could no longer stand the agony from a rare auto immune, degenerative disease that has no cure nor remission. After she was cut off opiates by her pain clinic because they had no CDC or whatever agency published guidelines for prescribing them in connection with her very rare disease, her life was reduced to just enduring endless agony. I even offered to get her heroin to try, but she wouldn't let me take the risk. In retrospect, I wished I had forced the issue.
37
I am so sorry about your friend. I had endometriosis in my 20's and in my support group, several women killed themselves because there was no treatment and their docs were stingy with their medications. I have a feeling we're going to see more suicides as a result of this messed-up crackdown on opioids. I hope the addicts straighten themselves out, because all of this is happening at the cost of legitimate pain patients.
10
In this and other articles about the treatment of chronic pain, I search in vain for some mention of medical marijuana as an effective alternative to opioids. Medical marijuana has been a life-saver for this chronic-pain sufferer. I often use a strain that has very low THC, so I'm not "high," but I am pain free for many hours. I can go about my daily tasks much more effectively. I’m lucky to live in a state where medical marijuana is legal. The Times could do a great service to the ongoing discussion about whether medical marijuana should be legalized in other states by investigating and reporting on its effectiveness in treating chronic pain, as an alternative to opioids or over-the-counter medications like ibuprofen and acetaminophen.
30
I agree --- and I just posted a note to that effect. SO much better than everything else!
2
After a stream of Times' articles suggesting that opioids need to be restricted and that those of us who need them are little better than junkies, I am delighted to see the Times finally publish an article admitting that some of the people using opioids legitimately need them to control pain.
18
"Acupuncture, chiropractic and hypnosis proved ineffective, but she finds a weekly massage essential."
Why does this sentence appear in the 4th to last paragraph? Hands-on medical massage therapy is a real, time- and study-tested method of relieving pain. I have to ask why insurance does not choose to support it.
Why does this sentence appear in the 4th to last paragraph? Hands-on medical massage therapy is a real, time- and study-tested method of relieving pain. I have to ask why insurance does not choose to support it.
17
Medical insurance won't cover massage because 1) it basically goes on forever, which the green-eyeshade types and stockholders resist, and 2) it tickles a prejudicial residue of Puritanism that associates massage with (horrors!) physical pleasure.
8
Pain killers do not give me back my physical mobility to do daily work. Instead it dulls my thinking and prevent me from making the right long term judgement. Weight loss is hard becaucse excercise is hard when my body is in pain and diet means thinking only about food all the time.
What works for me is a low sugar vegan diet - no animal protein or fat and low sugar. Nuts and mixture of rice, bean, and other grains for daily proteins. Vegetable and fruits for fibers and fats. It helps me losing 1/2 pound a week without any real exercise effort and I can eat as much as I feel like. Losing 10 lbs so far helps dull the pain, sharpen my mental, and improve the flexibility of my joins. The idea that vegan diet as a short term solution for back pain and sciatic nerve pinch pain after I realized that quite a few famous people do it, for example, President Bill Clinton and Mr. Tom Sosnoff.
What works for me is a low sugar vegan diet - no animal protein or fat and low sugar. Nuts and mixture of rice, bean, and other grains for daily proteins. Vegetable and fruits for fibers and fats. It helps me losing 1/2 pound a week without any real exercise effort and I can eat as much as I feel like. Losing 10 lbs so far helps dull the pain, sharpen my mental, and improve the flexibility of my joins. The idea that vegan diet as a short term solution for back pain and sciatic nerve pinch pain after I realized that quite a few famous people do it, for example, President Bill Clinton and Mr. Tom Sosnoff.
4
I normally tend to bleep over these sorts of anecdotes, but as I'm coming into another try-something-new phase of my chronic pain journey, I may just give this a whirl. Tai Chi looks intriguing, too.
2
This surprises me... only because after three years of high dose oxycodone and four inpatient hospital ketamine treatments for neuropathy, I finally stumbled on the same thing.
I think it's basically a ketogenic diet - so I include a lot of vegetable fats and oils (avocados, coconut oil). And you have to severely restrict the carbohydrates. (That part really isn't fun.)
There was a Harper's article called, if I remember correctly, "Fasting Your Way to Vigor", that discussed the ketogenic diet, its origin and effectiveness for controlling epilepsy.
I think it's basically a ketogenic diet - so I include a lot of vegetable fats and oils (avocados, coconut oil). And you have to severely restrict the carbohydrates. (That part really isn't fun.)
There was a Harper's article called, if I remember correctly, "Fasting Your Way to Vigor", that discussed the ketogenic diet, its origin and effectiveness for controlling epilepsy.
2
That sounds like an anti-inflammatory diet. It's a good plan.
1
Why the snarky comment about fibromyalgia in parenthesis? Are you absolutely sure without any doubt? As someone who has taken these drugs, I have watched with growing alarm at the demonization of those who say these drugs work for them. I have had the same prescription for nine years and still use them as needed. I am drug tested monthly swim five miles a week and do ALL that my doctors tell me. I look the picture of health. Yet these "horrible drugs" still work. I question myself, I question my doctor. But mostly I question those in power who seek one size fits all solutions and those who speak for them.
(Parenthesis Indeed!)
(Parenthesis Indeed!)
29
John, I'm with you 100%. It's really too bad the problems so many are having properly managing these medications have become politicized because that makes self-righteous, ignorant, one-size-must-fit-all thinking not only more prevalent but more attractive to dim-bulb legislators (not all of them lack intelligence and compassion, of course, but enough...). Pain management is the very poster child of the need for individual, nuanced treatment options that should remain exclusively the province of patients and their doctors.
6
My codeine is now ordered by computer. No more paper.
May all those who think addiction is worse than a life in chronic pain suffer themselves; then they'd understand. And the proper term is, "dependence," not addiction. Even your vocabulary exposes your misunderstanding of our dilemma. But I have to go out today, so I will take the pill.
May all those who think addiction is worse than a life in chronic pain suffer themselves; then they'd understand. And the proper term is, "dependence," not addiction. Even your vocabulary exposes your misunderstanding of our dilemma. But I have to go out today, so I will take the pill.
21
Pain is subjective, determining opioid addiction is subjective, I don't see a happy ending to this story.
10
Opioids have some use for chronic pain, but only in low dose; i.e. one or two pills per day. They mitigate pain, they don't, and can't eliminate it.
The reason for continuing at low dose is simplicity itself: double the dose and in a few weeks, the effect is just the same as the original dose, but now the dependency is greater. Don't even start down that path in the first place.
The reason for continuing at low dose is simplicity itself: double the dose and in a few weeks, the effect is just the same as the original dose, but now the dependency is greater. Don't even start down that path in the first place.
My wife had a car wreck where her legs were crushed and nearly amputated. Then during her convalescence she developed a sever case of rheumatoid arthritis. Her pain was so terrible that little helped until she was given opioids. She found life to be livable with them. Then the government took away some of her meds so she suffered terribly. She cried for days at a time and would often beg me to kill her. I talked to the pain clinic, my Senator, my representatives and so forth but they all could do nothing. Finally I set her in the pain clinic's waiting room for almost an entire day to let her cry and scream until they increased her meds to a point where she gets some relief.
>
I thought I knew what she was going though and then I suffered a crushed spine. I had absolutely no clue what chronic debilitating pain was and anyone who thinks they do without suffering from it does not either.
>
If a person suffers from a disease or an accident, then they are a victim. They did not ever choose to become what they are. Those who overdose choose to overdose. It is their choice. Why must victims be forced to suffer because of the choices that addicts make? Also, having worked with addicts, I can tell you that they will always find ways of getting their drugs so all these new laws only affects the lawful, those who suffer. Where is the morality in forcing the 95% who suffer just to protect the 5% who choose to abuse the medicine from themselves?
>
I thought I knew what she was going though and then I suffered a crushed spine. I had absolutely no clue what chronic debilitating pain was and anyone who thinks they do without suffering from it does not either.
>
If a person suffers from a disease or an accident, then they are a victim. They did not ever choose to become what they are. Those who overdose choose to overdose. It is their choice. Why must victims be forced to suffer because of the choices that addicts make? Also, having worked with addicts, I can tell you that they will always find ways of getting their drugs so all these new laws only affects the lawful, those who suffer. Where is the morality in forcing the 95% who suffer just to protect the 5% who choose to abuse the medicine from themselves?
81
I suffer from severe chronic pain as I a pedestrian, was struck by a car which resulted in 23 fractures including damage to my spine. I take Methadone which has given me blessed relief for 15 years. There is no high just an ability to do whatever needs doing. I do suffer the side affects known to go along with this medicine which I gladly accept.
I have twice taken 17 days, under a doctors care, to see if I could substitute a different regimen to no avail except excruciating pain and not being able to function at all. I do not understand why the public at large would trust politicians to make medical decisions for their constituents, might as well have a mechanic do it as they have equal training for the job.
Meanwhile, those of us who are not overweight and have tried every known pain treatment with no result should be denied the one medicine which allows a productive and enjoyable life. Politicians have caused the Heroin epidemic and they wish to blame the doctors who, for the most part are already very cautious in dispensing opioids.
I have twice taken 17 days, under a doctors care, to see if I could substitute a different regimen to no avail except excruciating pain and not being able to function at all. I do not understand why the public at large would trust politicians to make medical decisions for their constituents, might as well have a mechanic do it as they have equal training for the job.
Meanwhile, those of us who are not overweight and have tried every known pain treatment with no result should be denied the one medicine which allows a productive and enjoyable life. Politicians have caused the Heroin epidemic and they wish to blame the doctors who, for the most part are already very cautious in dispensing opioids.
8
So your wife discovered what addicts know. If they make a big enough scene in doctors' offices they'll get the drugs they want.
And I'll bet that if drug addicts didn't know about your wife's doctor they'll soon be in his or office doing the same thing.
And I'll bet that if drug addicts didn't know about your wife's doctor they'll soon be in his or office doing the same thing.
Cleetus's comment absolutely deserves to be a NYT Pick. Thanks faceless moderators, whoever you are! And to the comment itself I, as a sufferer from chronic pain, say, "Amen!"
5
I have to say I found this article confusing. In one paragraph it seems to say that opioids are not effective against fibromyalgia but the next suggests that Percocet gives the patient relief. Which is it?
4
The difference is that studies on opioids for fibromyalgia have found they provide little benefit for this.
A patient saying she needs Percocet is something very different.
A patient saying she needs Percocet is something very different.
1
I have a relative with chronic opioid use. I call it that rather than chronic pain, because all indications are that the bulk of the pain is from withdrawal. Yes, he has reasons to hurt, but those reasons can be alleviated in many cases with regular physical therapy. And his pain clinic doctor--a.k.a pusher--and psychiatrist never attempted to discern whether he was also using alcohol too and were hostile or non-responsive to taking information about it, even from someone legally authorized to talk with them. At my relative's age, I don't think there's any we can do to stop the cycle, but I sure wish there were. Meanwhile, we need to make sure that the next generation doesn't get hooked.
5
I was with you until your last sentence because it implies that all doctors are pushers and all users of opiates junkies. Shame on you for thinking the frustrations you've experienced in your unfortunate experience should inform and govern the entire medical enterprise.
5
Two of my neighbors who were in their 80's, one suffering from unrelieved pain and the other who did not want to live without his wife, just committed suicide two weeks ago. Certainly providing her with sufficient pain relief so that they could both still be here would have been preferable.
36
And you know for certain that what she needed for her pain was opioids. I ask this because many of the most common types of pain suffered by senior citizens don't respond to opioids.
1
Steve-
Of course he does. Didn't you know that everyone on this forum is an expert on when and how opiates should be prescribed?
why do we even bother to send people to medical school if everyone is such an expert on this?!? I wasted my time going. I could have been an expert like any of these people.
Of course he does. Didn't you know that everyone on this forum is an expert on when and how opiates should be prescribed?
why do we even bother to send people to medical school if everyone is such an expert on this?!? I wasted my time going. I could have been an expert like any of these people.
Hey Steve, yours and many other's posts including several MDs seem to be pretty negative with the thinking that pain shouldn't be treated with opioids because they all assume the rebound effect is in play. I am a middle aged person originally diagnosed with fybromialgia in the 90s, but last year found out I have Ehlers-Danlos Syndrome (EDS) which is a heritable genetic syndrome related to faulty connective tissue of which is the basis for the entire body. I can stretch funny and find that I have a micro-tear and the pain stays with me as all my connective tissue is constantly being traumatized. Folks that have extreme hypermobility along with EDS are in even far worse shape than I. And guess what? There's no cure - not until someone like J. Craig Venter can map out a way to reconfigure DNA of this syndrome to lead to a cure. But until that time, I & many (many don't even know they have it!!) will continue to suffer wthout a form of pain medication like opioids helping to cope from the myriad of problems involved. So don't jump to a conclusion that the over-diagnosed 'fybromyalgia' (for want of a better diagnosis since most doctors aren't even familiar with EDS!!) doesn't respond to opioids unless you're willing to do serious research and publish your paper on PubMed for the rest of us to do a peer review on.
12
I've never used my full regimen of prescribed pain killers for any of the surgeries, or ailments my body has come up with. I'm aware that my Fibromyalgia my be less intrusive than others, but I discontinued the pain killers for that, years ago. Is there such a thing as an addictive personality? I don't know. I just know that I plan to stay alert for the time I have left in this world. For me, that means taking the least possible pain killers. I manage pain with exercise and involvement in the world around me. Drugs make me someone I don't like to be, so I avoid them. I have genuine empathy for those who must use painkillers, however, and would be slow to criticize or to limit their ability to get them. Let them make that decision with their doctors consultation.
12
Codger, thank you for an anecdote that you compassionately refused to generalize to everybody. You're a great example of the kind of attitude that is most helpful.
2
As an older person who was totally healthy until a cardiologist pushed a statin drug on me, this article is doubly infuriating. At age 69, I carried 30 opioid pills to Nepal, trekking in the mountains, just in case of injury. I returned with all 30 pills.
At age 70, after 7 months on low-dose statin, I was in constant pain and couldn't walk around the block. Now I do need pain relief. Ironic? Maybe, but not uncommon.
1/4 of Americans over 40 are on statins. 1/4 of this number (about 8 million Americans) complain of muscle pain.
No one knows about causality, since there would be no profit from knowing, but the growth in statin use exactly parallels the growth in opioid use. No one seems to know or want to know if those on statins take more opioids than the general population.
There are lots of medications that American doctors need to prescribe less, statins at the top of the list. Statinvictims.com
At age 70, after 7 months on low-dose statin, I was in constant pain and couldn't walk around the block. Now I do need pain relief. Ironic? Maybe, but not uncommon.
1/4 of Americans over 40 are on statins. 1/4 of this number (about 8 million Americans) complain of muscle pain.
No one knows about causality, since there would be no profit from knowing, but the growth in statin use exactly parallels the growth in opioid use. No one seems to know or want to know if those on statins take more opioids than the general population.
There are lots of medications that American doctors need to prescribe less, statins at the top of the list. Statinvictims.com
18
I tried statins twice, both times the pain I developed was prohibitive and I stopped taking the Statin. I got pursed lips in response. I do take opioids at a low dose, responsibly, don't get constipated because I modified my diet, hydration. I think shrieking that the opioids are the devil is just the newest craze, and that we should be humane and rational in our approach to pain relief.
18
I live in WA state, which cracked down on opioid prescriptions several years ago. After I was in a car accident I had 3 1/2 years of medical treatments - multiple surgeries, physical therapy (that made me scream in pain), etc. My docs refused to give me opioid 'scrips several times and told me they were afraid for their licenses. Not because I was drug-seeking, which I wasn't, but because their prescriptions were being monitored - even my pain specialist did this!
A few years on now, I have chronic pain and migraines from this accident. Fortunately, both Medical Marijuana and Recreational Marijuana are legal in WA state. With the help of wonderful people at my preferred dispensary, we created a regimen that resolves 80-90% of my pain. I take a concentrated CBD tincture (derived from Hemp, so there's no THC) in the morning and use marijuana via a vaporizer 3-4 nights a week to get the synergistic effect. I'm not high during the day and I can function pretty normally.
It is cruel to withhold opioids from those who truly need them without offering something else to patients. We need to take marijuana off Schedule 1 status so it can be researched and used medicinally by people who need pain relief.
A few years on now, I have chronic pain and migraines from this accident. Fortunately, both Medical Marijuana and Recreational Marijuana are legal in WA state. With the help of wonderful people at my preferred dispensary, we created a regimen that resolves 80-90% of my pain. I take a concentrated CBD tincture (derived from Hemp, so there's no THC) in the morning and use marijuana via a vaporizer 3-4 nights a week to get the synergistic effect. I'm not high during the day and I can function pretty normally.
It is cruel to withhold opioids from those who truly need them without offering something else to patients. We need to take marijuana off Schedule 1 status so it can be researched and used medicinally by people who need pain relief.
67
Either you have foolish doctors or you're fudging what they told you.
Studies have shown that it is rare for doctors to be sanctioned for prescribing opioids and in virtually all the cases they were selling them for money or sex. So unless your doctors were doing this, they are fools.
On the other hand, they might have been practicing based on science as there is a lack of evidence that opioids are beneficial for chronic pain but there is a great deal of evidence they can cause major problems if taken chronically.
Studies have shown that it is rare for doctors to be sanctioned for prescribing opioids and in virtually all the cases they were selling them for money or sex. So unless your doctors were doing this, they are fools.
On the other hand, they might have been practicing based on science as there is a lack of evidence that opioids are beneficial for chronic pain but there is a great deal of evidence they can cause major problems if taken chronically.
3
Since you don't live in WA state, you cannot possibly know what happened. My doctors were not foolish, and I am not "fudging" what they told me. I had six doctors - all highly regarded specialists in their fields who were not overprescribing opioids. I did not have chronic pain at that point, it was acute.
In 2011, five years before the US government cracked down on opioid prescriptions, WA state. Since you live in NY, I will cite an article from this very paper on the subject:
http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions...
In 2011, five years before the US government cracked down on opioid prescriptions, WA state. Since you live in NY, I will cite an article from this very paper on the subject:
http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions...
5
I live in WA state too. I use medical marijuana and love it! I'm happy to meet another person who is a believer/user! Totally agree with your points sgirlie!
2
My husband successfully manages life-long chronic pain using an intrathecal pump filled with dilaudid. The surgically placed subcutaneous pump releases the medication at a constant rate, 24/7, directly into his spinal cord. Because it requires special equipment and access code, only an authorized medical professional can turn the pump on, turn the pump off, add medication or change the dosing.
Ten years ago, when the pump was installed, my husband worked with his doctor to find a dilaudid dose that allowed my husband to comfortably manage his pain. He has not build up a tolerance to that dose nor experienced so-called 'rebounds' nor suffered from the usual opiate side effects; the dose today is the same as it was 10 years ago.
We have vivid memories of doctors, hospitals and pharmacies believing that my husband was 'faking pain' as an excuse to feed an opiate addiction. As every chronic pain patient knows, the humiliation, judgement and lack of care my husband was subjected to was inhumane.
We were once haunted by the cloud of coping with chronic pain: trying to figure out if he has enough medication or if the doctor will write for more medication or if the ER will only give him aspirin or will the pharmacy fill the prescription. Now pain management is a monthly doctor visit to refill and monitor the pump.
We've discovered that very few medical professionals know about the pump; it's sad that so many chronic pain patients are needlessly suffering.
Ten years ago, when the pump was installed, my husband worked with his doctor to find a dilaudid dose that allowed my husband to comfortably manage his pain. He has not build up a tolerance to that dose nor experienced so-called 'rebounds' nor suffered from the usual opiate side effects; the dose today is the same as it was 10 years ago.
We have vivid memories of doctors, hospitals and pharmacies believing that my husband was 'faking pain' as an excuse to feed an opiate addiction. As every chronic pain patient knows, the humiliation, judgement and lack of care my husband was subjected to was inhumane.
We were once haunted by the cloud of coping with chronic pain: trying to figure out if he has enough medication or if the doctor will write for more medication or if the ER will only give him aspirin or will the pharmacy fill the prescription. Now pain management is a monthly doctor visit to refill and monitor the pump.
We've discovered that very few medical professionals know about the pump; it's sad that so many chronic pain patients are needlessly suffering.
24
Lee-
The medical community does not believe that intrathecal pumps are good in general. and they don't deliver pain medication "directly into his spinal cord",
The medical community does not believe that intrathecal pumps are good in general. and they don't deliver pain medication "directly into his spinal cord",
2
Doctors know about them. It's just that they are meant for short term use such as those with severe cancer pain who are terminally ill and not for chronic pain.
And a question. If he has been using it without interruption how do you know he still needs it?
And a question. If he has been using it without interruption how do you know he still needs it?
1
For many years I worked as a physician in a pain management clinic at a city hospital. Frankly, it is impossible to know for certain which of the patients are misusing or diverting their opiate medication, even among the elderly. A decent, kindly elderly person who is dependent on a relative to drive her for shopping just might be using her medication as the only form of payment that she can make. Or she might easily fall in to the same trap of addition that affects younger patients.
10
The relationship between age and use of opioids for chronic pain is speculation. General population survey data for Massachusetts in 2011 and 2013 found that chronic pain was related to greater age, but prescribed opioid use and self-perceived prescription opioid dependence were not. The relationship appeared to curvilinear, with the oldest cohorts using less opioids than the middle aged cohorts.
3
I think she made this point in a round-about way by referring to "boomers," who might be more inclined to use drugs because of their more tolerant view of using substances, such as marijuana, when younger. The "old old" which would be at the upper end of the curve you describe have been more hesitant to use drugs, in general. It remains to be seen what happens as more and more "boomers" age in to older adulthood.
2
Sounds like speculation to me: "Addiction and overdoses have historically been lower among older users, but public health experts have long wondered whether those patterns will change with the baby boomer cohort.
“The problem may grow worse with people who grew up in a culture where drugs were something to experiment with,” Dr. Reid said."
In my 2011 data the decline begins with the 55-64 cohort continues in the 65+ group. Most of them are boomers. Generalizing from non-medical patterns of use to medical use often leads to incorrect predictions. Only time will tell.
“The problem may grow worse with people who grew up in a culture where drugs were something to experiment with,” Dr. Reid said."
In my 2011 data the decline begins with the 55-64 cohort continues in the 65+ group. Most of them are boomers. Generalizing from non-medical patterns of use to medical use often leads to incorrect predictions. Only time will tell.
1
I'm just like Irene Cohen. I use my script as needed and exercise regularly. I have been on this regimen for at least 5 years and have not needed to increase my dosage or noticed any decrease in efficacy. I am 10 years younger than her and do not like that I am in chronic pain at this age, but am really grateful to have access to narcotics. It does not affect me mentally and the only caveat is the Tylenol in the pill that is possibly more harmful than the hydrocodone. If I lose access I don't see a positive future for myself. I think there may be a lot more responsible users than this article suggests.
65
I drank about 8 oz of white wine last night with my pork chop and I had more of a buzz on than I have ever had in 13 years of opioid use. Never even got light headed with darvon or vicoden. The world has gone completely nuts.
26
They have variants that are free of the tylenol or have ibuprofen in it instead.
5
dogpatch-
And those variants are even worse of an abuse problem
And those variants are even worse of an abuse problem
1
This just happened to me last week. I couldn't believe it - I was treated like a drug addict when trying to get my prescription filled to address my chronic back pain. Four pharmacies in my area decided not to carry these drugs anymore due to increased paperwork. I do everything I can to be as healthy as possible but also rely on opioids to be a functioning working person. Would people rather I stop working and lie around the house all day? That's what it will come to. I have tried all the other options over the years.
71
"Something had to be done". No matter how counterproductive. The government "cracks down" on the legitimate avenues of opiate distribution through doctors and pharmacies. In a surprise to the drug warriors, addicts did not magically become clean and sober. They sought their opiates elsewhere. Since legitimate opiates are now impossible to get and fantastically expensive on the black market, the drug cartels moved in with synthetic fentanyl. Made in labs in Mexico and China and now responsible for the majority of overdoses. Our brilliant drug policy causes people in pain to suffer, while addicts die by the thousands of Mexican fentanyl. Moonshine anyone?
37
War on drugs started by Nixon passed by that Congress failed by late 1970s. New laws only make it worse for everyone.
Time to go with a Portugal Style system combo with Harm Reduction! It works! DEA is failing & making matters WORSE for addicts & those with real pain problems from diseases such as MS, Cancer etc....
Time to go with a Portugal Style system combo with Harm Reduction! It works! DEA is failing & making matters WORSE for addicts & those with real pain problems from diseases such as MS, Cancer etc....
29
I don't even take any opiods,maybe I never will. But I do have both acute and chronic lower back issues of multiple causes. I may need surgery some day. And, as a late middle-aged divorced woman, I live alone, and am not exactly floating in money. I could only wish that the most self-righteous among these "care givers" are someday subjected to the same pain, humiliation, desperation, loneliness, and substandard quality of life that they advocate so easily for others. The utter lack of empathy is stunning.
75
If an oncologist tells a patient that further cancer treatments will not provide any benefit and that the patient is terminally ill does that mean that doctor is not being empathetic and doesn't give a damn about the patient's suffering. Or does it mean that he or she is being honest with the patient about the extent of medical knowledge.
Doctors tell patients thing they don't want to hear everyday. That doesn't mean they lack empathy for those patients.
Doctors tell patients thing they don't want to hear everyday. That doesn't mean they lack empathy for those patients.
4
Thank you Steve for a voice of reason. To your comment I would like to add that no doctor is under any kind of obligation to prescribe opioids to anyone, and the entitlement amongst the commenters in this article is astounding
1
"no doctor is under any kind of obligation to prescribe opioids to anyone"
Well, if you follow that line of reasoning to its conclusion, no doctor is under any "obligation" to set your child's broken leg or perform CPR on your spouse, either. If they do any of these things it's because they've (hopefully) made a medical judgement that it's the right thing to do.
Jeez, I thought the Puritans died out a long time ago. Do your really want someone to die screaming in pain because some other person might be getting stoned and enjoying themselves?
Well, if you follow that line of reasoning to its conclusion, no doctor is under any "obligation" to set your child's broken leg or perform CPR on your spouse, either. If they do any of these things it's because they've (hopefully) made a medical judgement that it's the right thing to do.
Jeez, I thought the Puritans died out a long time ago. Do your really want someone to die screaming in pain because some other person might be getting stoned and enjoying themselves?
3
One of our clients, in a state where medical marijuana is legal, have found its use has helped him greatly without the opioid side effects he experienced before. He takes it in a vapor form as he is a non-smoker.
17
I have sinus tachycardia, an arrhythmia which is usually harmless. I tried marijuana to control pain and my heart rate went up to 135 beats per minute. Not everything is for everybody. Marijuana is not a cure-all. Even if healthy, I hate the stuff which feels like someone stabbed my lungs with a hot sword.
3
I guess being young and having a debilitating disease means I have to suffer; that is my understanding because I must be a drug user, due to being 25. Well, here's the truth: I've had a degenerative type of arthritis since age 11 (called ankylosing spondylitis). Long acting pain meds have made it possible for me to work, to take walks with my husband, and to do the normal tasks of everyday life.
I've participated in years of physical therapy, injections, as well as taking neuropathic pain medications and disease modifiers (Enbrel).
I know people who are addicted to pills, and heroin; it saddens me to watch them stuck in this cycle, but I am not one of them.
It really angers me when the assumption that being young means your pain isn't real--want to take a walk in my shoes and see how it feels to have your spine degenerating, your muscles weakening, neuropathy burning your legs? Please tell me how I'm undeserving of living a life that is somewhat comfortable because I'm only 25.
I've participated in years of physical therapy, injections, as well as taking neuropathic pain medications and disease modifiers (Enbrel).
I know people who are addicted to pills, and heroin; it saddens me to watch them stuck in this cycle, but I am not one of them.
It really angers me when the assumption that being young means your pain isn't real--want to take a walk in my shoes and see how it feels to have your spine degenerating, your muscles weakening, neuropathy burning your legs? Please tell me how I'm undeserving of living a life that is somewhat comfortable because I'm only 25.
81
There is no medical evidence to show chronic opioid therapy works for chronic pain, in fact the opposite is true. Opioids are great for acute pain, chronic use only buys the cons from this wonderful 'catch 22' drug class. Chronic opioid use lowers immune function, testosterone, increases depression and disrupts the sleep cycle. Beware those who support opioid use chronically, they have an ulterior motive $$$.
4
That is no true Justin. I have been on opioid pain medication along with non opioid pain medication for over 5 years. I have had no need to increase my dosage either. In addition there is not one single long term study that proves pain medications aren't effective for long term pain. I am tired of people like you spouting off this nonsense. Please cite your sources if you can even find one that shows pain patients don't benefit from opioid pain medications long term.
46
You mean like the anterior motives of those who support antidepressants and antiseziure meds chronically while the real studies found them barely more effective than placebo plus all the side effects they have worse than any opiate? Difference here is you're about 10 years behind as opiate patents have run out and the antiseziure and antidepressants are the main money makers now and being pushed along with FAKE diagnosises of fibro just to Rx them.
8
To C.C.
Based on your view, pharmaceutical companies should be able to keep drugs on the market without any evidence that they work until someone proves they don't. And that doctors should be able to do any procedures they wish without evidence they work until someone proves they don't.
Obviously you have a view opposite to what most people consider good science.
Based on your view, pharmaceutical companies should be able to keep drugs on the market without any evidence that they work until someone proves they don't. And that doctors should be able to do any procedures they wish without evidence they work until someone proves they don't.
Obviously you have a view opposite to what most people consider good science.
1
As usual no reference to young people with degenerative disease like Ehlers Danlos because no one wants to admit that we're basically subjecting them to 40 years of pain and comorbidities and being unable to function or have a job all over the type of medication they need. Obviously someone needs to look at the bigger picture here and all the lost wages and young people forced on to disability and the costs vs prescribing a certain class of medications.
44
How come the comments have not pointed out that drug dealers have reacted to the reduction of prescription pain killers by making heroin available at a fraction of the cost? Is society trying to solve one problem by creating even worse ones? And how come no one mentions that all those nsaids being pushed as an alternative for pain relief are a leading cause of atrial fibrillation?
37
Obviously you have evidence that patients started on opioids for pain have turned to heroin. Would you please cite it so the rest of us can be informed of it.
4
@Steve: among others, see "Dreamland" by Sam Quinones and "Pain Killer" by Barry Meier.
2
I think prescribing opiods is highly dependent on the individual and most doctors probably err on the side of caution because they simply don't have the time to truly look into the patient's individual situation.
Two examples (and neither relate to the elderly, but I think they are still germaine).... earlier this year, my brother was passing a large and extremely painful kidney stone. For whatever reason (I can't remember the circumstances), he wasn't able to get a session with the ultrasound machine to break up the stone for about a week. His doctor refused to prescribe him painkillers, even though he was crying from the pain. He had to suffer for a week with pain so severe that he couldn't work, eat or sleep. Second example... several years ago, my friend's husband was dying from cancer. They felt very strongly that he should be at home, not in a facility, but that severely limited the amount of morphine he was allowed. It was terrible.
On the flip side, I had minor oral surgery last year and was given a TEN DAY supply of Percocet, of which I needed exactly none.
We need a sane approach to prescribing these very powerful and also very useful medications
Two examples (and neither relate to the elderly, but I think they are still germaine).... earlier this year, my brother was passing a large and extremely painful kidney stone. For whatever reason (I can't remember the circumstances), he wasn't able to get a session with the ultrasound machine to break up the stone for about a week. His doctor refused to prescribe him painkillers, even though he was crying from the pain. He had to suffer for a week with pain so severe that he couldn't work, eat or sleep. Second example... several years ago, my friend's husband was dying from cancer. They felt very strongly that he should be at home, not in a facility, but that severely limited the amount of morphine he was allowed. It was terrible.
On the flip side, I had minor oral surgery last year and was given a TEN DAY supply of Percocet, of which I needed exactly none.
We need a sane approach to prescribing these very powerful and also very useful medications
44
Pain is part of life. We need to accept that and live with it. The alternative is to use substances for relief and miss part of being alive.
1
Except that it's addicts that use drugs to escape life and chronic pain patients use these medicines to be able to participate in life instead of being bedridden. Two very different ends of the spectrum.
8
You have no right to tell anyone to "accept and live with" their pain.
I doubt you've known the sensation of full-blown shingles or post-operative knee surgery or severe adenomyosis or bone cancer. You would change your tune if you had such experience.
You don't know what real pain is until it has caused you to pass out after saying aloud, "please, God, make it stop..." only to wake up in a heap on the floor. If this is what you are demanding of others, you simply have no right.
I doubt you've known the sensation of full-blown shingles or post-operative knee surgery or severe adenomyosis or bone cancer. You would change your tune if you had such experience.
You don't know what real pain is until it has caused you to pass out after saying aloud, "please, God, make it stop..." only to wake up in a heap on the floor. If this is what you are demanding of others, you simply have no right.
35
"Pain is a part of life." Nope, not for everyone, but it is for many people. Do you really expect that those in chronic, severe pain from degenerative diseases or accidents, etc. will have quality of life long term? I guess the answer is, let them suffer, too bad. Some people cannot function, i.e., participate in everyday life like jobs, or interact with friends and family, have a hobby or two - you know, what "being alive" means for most people.
I am not a great proponent of medication in general, but, if someone needs it for chronic pain, they need it, and I should know since I have a genetic illness that has only gotten worse in time in terms of limiting my functioning in life due to increasing pain, etc.
If you are without pain yourself, or can live with a little of it, then fine, do that, otherwise, don't judge someone else until you have walked a mile in their shoes.
I am not a great proponent of medication in general, but, if someone needs it for chronic pain, they need it, and I should know since I have a genetic illness that has only gotten worse in time in terms of limiting my functioning in life due to increasing pain, etc.
If you are without pain yourself, or can live with a little of it, then fine, do that, otherwise, don't judge someone else until you have walked a mile in their shoes.
17
This reporter casually tosses off the "fact" that opiates don't work for fibromyalgia. Since when is a NYT reporter an expert? Or someone who throws out a claim without substantiation? More to the point, how is reporter Paula Span an expert on what works for different people with individual medical needs? My fibromyalgia of 19 years has been controlled with an integrated program that includes opiates, exercise, adequate sleep, stress management, & chiropractic care. Stigmatizing people who use legitimately prescribed opiates is like anti-abortion fanatics hassling women going into Planned Parenthood for PRIVATE, LEGAL, CLINICALLY APPROPRIATE interactions with their physicians. Spare me already.
34
It's well established in the medical literature that opioids are not appropriate for fibromyalgia. There are many other classes of drugs that have varying levels of support as treatments for fibromyalgia - opioids are not one of them. That's not just the opinion of a reporter, it's the conclusion of researchers who have reviewed numerous randomized, double-blind clinical trials studying the issue. It's also the opinion of the FDA, who have not approved any opioids for treating fibromyalgia. The problem with relying on someone's personal experience - no matter how honest and well meaning they are - to draw conclusions about a pain treatment is that one can't rule out the possibility that any reported relief is due to a placebo effect.
6
opioids DO work for fibromyalgia. I know because I suffer from it and that it what my doctor gives me.
4
How about we get some positive facts that people have suffered less because of narcotic pain killers. If we had the feedback of all the people in this country as to the help with life and the quality thereof due to pain relief it would surely outweigh the percentage of negatives in prescribing it. I don't need a doctor telling me my Vicoden doesn't help my pain or that I should use drugs that don't work first. How many lives have been saved because the person could endure a painful life? How many suicides were prevented due to pain relief? How many family members could be with their loved ones longer? Come on people let's hear about how pain pills helped and extended your lives!
24
Except what you say is the opposite to what research has shown. There is little evidence opioids are beneficial for chronic pain and a great deal they cause major problems when used chronically.
You don't have to believe in science but if you don't you might as well go all the way and become a Christian Scientist.
You don't have to believe in science but if you don't you might as well go all the way and become a Christian Scientist.
Like the differing responses to medications (some get moderate relief from acetaminophen while others get none) to tell someone to get acupuncture or relief from a massage or a chiropratic treatment are faced with the unfortunately wide spectrum of skills or training in those offering those services. I have had friends tell of trying massage therapy (which I'm fortunate enough to have discovered an exceptionally skilled practitioner who doesn't spend half the time trying to sell me his gizmos, herbs, supplements, etc.) that has been so beneficial, only to find that their treatments were from someone who couldn't pet a dog properly. The same with acupuncture. One person told me of spending many visits and had great expectations (no negative bias) and realized zero benefit, while others have had moderate relief good enough to make them go back in the future.
With all of these therapies being out of pocket expenses, and with a lot of poorly trained folks jumping into a lucrative market, the local attitude is to not even waste your time with them.
For someone who has had 'only' surgical pain or an injury type pain which can be helped with narcotics, to live week and months with constant pain which even interferes with sleep stealing the respite that sleep used to give, you cannot imagine the change in your attitude towards what constitutes a good day. And to watch youth scamper about with abandon and delightful agility rubs salt into the wound.
With all of these therapies being out of pocket expenses, and with a lot of poorly trained folks jumping into a lucrative market, the local attitude is to not even waste your time with them.
For someone who has had 'only' surgical pain or an injury type pain which can be helped with narcotics, to live week and months with constant pain which even interferes with sleep stealing the respite that sleep used to give, you cannot imagine the change in your attitude towards what constitutes a good day. And to watch youth scamper about with abandon and delightful agility rubs salt into the wound.
20
As a student in a graduate-level acupuncture program, which is 4 years long, I frequently see patients in clinic who, having exhausted medical options for pain relief, including opiods, expect that our treatment should relieve their chronic pain in a couple of visits. It would be great if that was the case, but it is not.
Our treatment protocols, IF based on the correct diagnosis, are amazingly effective. Our herbal formulas complement the treatment between (and sometimes beyond) the acupuncture visits. Our "potions, supplements and gizmos", in properly trained hands, can and do work wonders.
Our treatment protocols, IF based on the correct diagnosis, are amazingly effective. Our herbal formulas complement the treatment between (and sometimes beyond) the acupuncture visits. Our "potions, supplements and gizmos", in properly trained hands, can and do work wonders.
1
Yes, "something had to be done" - but not the invoking of frightening raw numbers to justify that earnest and suffering pain patients bear the burden from misuse and misappropriation of opioids by others.
The patients highlighted in this article are not a meaningful component of the targeted problems with deadly overdoses. By their very description, they can and have safely received relief from chronic pain with efficacious use of opioids.
As an MD, I prescribed opioids for thirty years and learned that, for many patients with life-altering pain, they are the only reliable source of relief. The alternative therapies mentioned, tried by most of these patients, are wonderful when successful, but unfortunately provide only marginal or temporary benefit for the large majority of serious pain patients. They return and ask for Percocet (or other opioid) because they discovered it works reliably, and, being human, desire to alleviate their pain.
The article offers no reason for them to suffer needlessly. The problem calls for regulation and control, but not wholesale restriction where these medications are needed.
Setting a low bar of making pain "tolerable" in the face of available relief is puritanical, punitive and cruel. Such pontification disregards that patients then go home to suffer, miss life events or the ability to enjoy them or lie awake in pain, all with a sense that suffering is somehow their honorable duty and with no guidance as to how much pain is too much.
The patients highlighted in this article are not a meaningful component of the targeted problems with deadly overdoses. By their very description, they can and have safely received relief from chronic pain with efficacious use of opioids.
As an MD, I prescribed opioids for thirty years and learned that, for many patients with life-altering pain, they are the only reliable source of relief. The alternative therapies mentioned, tried by most of these patients, are wonderful when successful, but unfortunately provide only marginal or temporary benefit for the large majority of serious pain patients. They return and ask for Percocet (or other opioid) because they discovered it works reliably, and, being human, desire to alleviate their pain.
The article offers no reason for them to suffer needlessly. The problem calls for regulation and control, but not wholesale restriction where these medications are needed.
Setting a low bar of making pain "tolerable" in the face of available relief is puritanical, punitive and cruel. Such pontification disregards that patients then go home to suffer, miss life events or the ability to enjoy them or lie awake in pain, all with a sense that suffering is somehow their honorable duty and with no guidance as to how much pain is too much.
90
Well said. After my car accident and then 16 years later I was finally able to have life altering back surgery and today have no pain. Had I not had pain medication I would have been unable to work, drive to work, care for my children, lost my job and become homeless without health insurance I continued my career to keep my insurance and live my life in a meaningful way. Woe to those who "pontificate" wait til you or a loved one is in pain, don't be so ignorant and arrogant. What about all of our Veterans shall we tell them go to war, get injured come home and live in pain as part of the deal, what a bunch of ideologues who write this nonsense in the NYT.
6
So are opioids over-prescribed in this country, or not? Is there a serious problem of opioid addiction that didn't use to exist, or not?
It's pretty clear that there is a direct connection between the two things.
It's pretty clear that there is a direct connection between the two things.
1
Restrictions on opioids invariably lead to looking for other solutions. I have tried yoga, meditation, acupuncture, message, physical therapy, injections and sheer grit. The only real alternative I have found is medical cannabis. It is restrictively expensive and leaves me with a foggy brain and lessened ability to function. The after effects I have from vicodin are much less and do not restrict mental functioning. Why we can no longer trust a doctor-patient relationship is baffling. Why not go after a solution which addresses the real problem of drug addiction among the non-medical users?
92
Why not go after a solution which addresses the real problem of drug addiction among the non-medical users? Because diversion of doctor prescribed opioids by the medical user into the illicit drug market is a major source of criminal "leakage."
Causal opioid prescribing practices by physicians, nurse practitioners, surgeons, physician assistants, oral surgeons and dentists have and continue to flood the medical user market with vast over supplies of opioids. The careless security and supervision of opioids by the medical user allows family, friends and even occasional visitors steal the opioids at random and most of the time without consequences. Stockpiling opioids for an acute pain management rainy day
makes you a target for home invasion and assault.
Causal opioid prescribing practices by physicians, nurse practitioners, surgeons, physician assistants, oral surgeons and dentists have and continue to flood the medical user market with vast over supplies of opioids. The careless security and supervision of opioids by the medical user allows family, friends and even occasional visitors steal the opioids at random and most of the time without consequences. Stockpiling opioids for an acute pain management rainy day
makes you a target for home invasion and assault.
1
Karin, you say that medical marijuana leaves you foggy, and as an MMJ user myself, I understand this. Have you tried focusing on higher doses of straight CBD without THC during the day? I use a hemp-derived CBD tincture in the morning and vape marijuana only at night for the synergistic effect. You can use a tincture, or if you need a higher doze, there are pills with CBD oil. It's worked for me and may work for you.
3
The criminal action is begun by those who steal the medicine not prescribed for them. The procedures to get opioids are not simple, you can't merely say 'hey doc I need 200 pills'. There are a few doctors behaving irresponsibly, I agree, but I think the majority of prescribers are thoughtful and responsible. I did not decide to have a lot of pain one day, but I ended up with a perfect storm of conditions that mean I fight everyday to stay ahead of it. I don't 'just' take opioids, I do every alternative therapy I can afford, as often as I can, if it works. Some people seem to think 'X' works for everyone. Such is not the case at all. People are individuals, and as such their plan to manage chronic pain is individual.
2
Super-regulating drugs that lead to addiction has and always will lead to a thriving underground purchase market. So let's all get behind the Feds and do our civic duty and follow along. By the way if you need some Vicoden or Percocet now they will be more affordable as gangs will undercut pharmacy prices when the demand grows big enough. Does this scare you? Shame on the government and states for supporting drug dealers and drug funded gangs!
22
Al Capone, whiskey and machine guns. The prohibitionists and drug warriors NEVER learn.
7
The DEA loves going after doctors and pharmacists. They generally keep good records and are easily cowed. Also the feds don't have to worry about gunfights.
2
To dogpatch,
Please cite your evidence that the DEA "loves going after doctors and pharmacists."
The studies have seen indicate that a doctor is about as likely to be sanctioned by the DEA or even investigated as he or she is of being hit by lightening.
Please cite your evidence that the DEA "loves going after doctors and pharmacists."
The studies have seen indicate that a doctor is about as likely to be sanctioned by the DEA or even investigated as he or she is of being hit by lightening.
1
With all the focus on Mohammad Ali it's worth noting that pain is a common presenting feature of Parkinson's Disease. Unfortunately the pain is often misdiagnosed as arthritis or simply ascribed to being secondary to the physical problems that are part of PD. In fact, it appears to be related to the underlying brain changes that cause the other symptoms of the disease.
4
CBD is one of the best painkillers nature ever invented. I have used CBD to get me off of oxycontin, ambien, adderall, and a bunch of psych meds. All those meds turned me into a crazy drug addict. CBD allowed me to get off of everything.
CBD is the future of treating chronic pain. Of course, no one funds it, and it's cousin THC is a schedule 1 drug while hydrocodone is a schedule 2 drug. The reason? Big pharma makes bank off of addictive opiates, and won't make bank off of cannabis.
CBD is the future of treating chronic pain. Of course, no one funds it, and it's cousin THC is a schedule 1 drug while hydrocodone is a schedule 2 drug. The reason? Big pharma makes bank off of addictive opiates, and won't make bank off of cannabis.
7
What is CBD?
Actually pharma makes more money off things like lyrica and cymbalta which hasn't had its parent run out yet and have much more dangerous long term effects than any opiate. Next to come for profit is bupe and derivatives which are for ADDICTION and they are trying to change rules so chronic pain patients will qualify as addicts which they never have. Some of us are allergic to mj and all derivatives and it doesn't work for everyone anyway.
4
Cognitive Behavioral Therapy. Good stuff, it should be in the toolbox, but like anything else, it doesn't help everyone.
Every single time I bought oxycontin, dilaudid, or even fentanyl patches with barcode on each patch, I bought my drugs from an old person.
Many older poor people know they can get multiple prescriptions for hardcore narcotics. They fill their prescription using medicare, and then sell half their pills so they can make money. Old people were by far the best suppliers of opiates, and when I was a drug addict I bought from many, many, old people.
I remember buying dilaudid from an old woman who was obviously in pain. She had like 600 different pills all scattered throughout her house. She had started injecting the pills, and her arm had a huge mass of blood and pus from using the needle wrong and too often.
There are definitely people who need medicine, but hardcore addictive drugs like oxycontin SHOULD be hard to get. Where do you think healthy young people are getting pills that are used mostly to treat pain in older people? I mean, it's obvious. Old people are dealing drugs because they cannot afford to survive without it. It's not really their fault, and they deserve help, but they should not have like 600 pills scattered around their house and a giant wound from needle injections, and only have a home because 300 of those pills go to young drug addicts constantly knocking on her door.
Many older poor people know they can get multiple prescriptions for hardcore narcotics. They fill their prescription using medicare, and then sell half their pills so they can make money. Old people were by far the best suppliers of opiates, and when I was a drug addict I bought from many, many, old people.
I remember buying dilaudid from an old woman who was obviously in pain. She had like 600 different pills all scattered throughout her house. She had started injecting the pills, and her arm had a huge mass of blood and pus from using the needle wrong and too often.
There are definitely people who need medicine, but hardcore addictive drugs like oxycontin SHOULD be hard to get. Where do you think healthy young people are getting pills that are used mostly to treat pain in older people? I mean, it's obvious. Old people are dealing drugs because they cannot afford to survive without it. It's not really their fault, and they deserve help, but they should not have like 600 pills scattered around their house and a giant wound from needle injections, and only have a home because 300 of those pills go to young drug addicts constantly knocking on her door.
24
It's not only "old" people privately selling scripts. Anyone in need of help financially could tap his or her pain killer supply!
2
What about the majority of people, who use the drugs legitimately? Are we the ones who should suffer for the bad behavior, the illegal activities, that you and some old people might choose to do? Why must I be the one to suffer for your choices? What ever happened to the concept of personal responsibility?
30
Here's a thought: treat patients like individuals. Those like myself who have used opioid drugs properly in the past for legitimate medical reasons should not have to forego their use for legitimate medical purposes in the future.
Restricting access to opioid drugs that are needed to treat intractable pain brought on by such conditions as cancer constitutes malpractice and borders on torture, and I doubt the advocates of so inhumane a practice have ever personally experienced severe untreated pain or they would not be so cavalier as to advocate for subjecting patients to such torment.
And here's a prediction that is already being borne out: reducing the supply of prescription opioid drugs across the board will lead to increased use of street drugs like heroin that are more likely to cause injury or death. This will only worsen as supplies dry up even further.
Pretending that opioid users, both legitimate and not, will simply say "oh well, I guess pain it is then" when they no longer can obtain pharmaceuticals is folly. Severely limiting access to these drugs will not solve the opioid problem but will just lead to more use of street drugs.
"Doctor-shopping" for multiple prescriptions can easily be addressed in the same fashion as is already done for purchases of Sudafed: create a central registry to determine over-use. But don't punish pain sufferers for the bad behavior of other people.
Again: treat patients like the individuals they are.
Restricting access to opioid drugs that are needed to treat intractable pain brought on by such conditions as cancer constitutes malpractice and borders on torture, and I doubt the advocates of so inhumane a practice have ever personally experienced severe untreated pain or they would not be so cavalier as to advocate for subjecting patients to such torment.
And here's a prediction that is already being borne out: reducing the supply of prescription opioid drugs across the board will lead to increased use of street drugs like heroin that are more likely to cause injury or death. This will only worsen as supplies dry up even further.
Pretending that opioid users, both legitimate and not, will simply say "oh well, I guess pain it is then" when they no longer can obtain pharmaceuticals is folly. Severely limiting access to these drugs will not solve the opioid problem but will just lead to more use of street drugs.
"Doctor-shopping" for multiple prescriptions can easily be addressed in the same fashion as is already done for purchases of Sudafed: create a central registry to determine over-use. But don't punish pain sufferers for the bad behavior of other people.
Again: treat patients like the individuals they are.
85
Well, cancer pain and chronic back pain are different things.
Opioids a generation and more ago were mostly unavailable, except for terminal illnesses and post-surgical pain. But the population didn't turn to the use of street drugs.
Opioids a generation and more ago were mostly unavailable, except for terminal illnesses and post-surgical pain. But the population didn't turn to the use of street drugs.
2
You are so correct. Unfortunately compassion and kindness are being squeezed out of the health care system. The physician patient relationship is moribund. We have been reduced to task oriented factory workers following orders dictated by corporate titans and mindless bureaucrats.
1
My situation and pain are similar to Mrs. Cohen, but the local yokels at Kaiser won't prescribe at all. It is inhumane. I have used these things sparingly since an auto accident in 2003. Others in similar straights are finding help from the local drug dealer, who is likely to be grateful for the business. And that is the troubling thing about the new scheme. Because it is going to be uncontrolled, not monitored, it is only going to enrich the drug dealers, result in more addiction, more overdoses and more death among the elderly. So perhaps this is all really the federal government's solution to the Social Security and Medicare cost problems: kill off the old folks.
26
totally AGREE
14
I take issue with the statement that opioids are ineffective for fibromyalgia pain. Have you investigated this? Have you confirmed this with physicians that focus on fibro?
Is this the columnist's misguided opinion or is it a direct quote from the physician?
The ambiguity is sloppy and and lazy science.
Is this the columnist's misguided opinion or is it a direct quote from the physician?
The ambiguity is sloppy and and lazy science.
21
Honi, the information came from Dr. McPherson, a professor of pharmacy and a palliative care specialist.
3
Pharmacists are not physicians- please don't cloud the issue with their private biases. Thank you.
8
Ms. Span is correct in this assertion. Repeated studies have shown that opioids have essentially no benefit for fibromyalgia pain and none of the drugs FDA approved for treatment of it are opioids. The approved drugs are either SNRI antidepressants or anticonvulsants.
3
So now people and doctors who have spent years responsibly using opioid drugs to control chronic pain without causing addiction will have to suffer because some others have not been able to do so.
Why not an approach that is less punitive and broad-brush? Why not focus more directly on those (patients and doctors) who are not using these drugs responsibly and not harass those who are.
Why not an approach that is less punitive and broad-brush? Why not focus more directly on those (patients and doctors) who are not using these drugs responsibly and not harass those who are.
46
Alternative approach. One week prescriptions. Or, treating addiction should it arise as a side effect, with therapies all its own. In 13 years, I have never had a craving, except for pain reduction, a high of any kind, or any adverse effects. NSAIDS are only pickling my liver and kidneys and will result in a shortened lifespan. And I do object to that.
2
One week prescriptions would be beyond doing for me. I am in a wheelchair and must pay for rides. The money, the effort of getting in and out of vehicles and the doctor and then the pharmacy would do me in. I have used 66 morphine pills in the last six months, for days where the pain is so acute that I am weeping in agony and sleep eludes me. I think that is responsible use and believe I should not be forced into your one week prescriptions plan.
7
To Guy,
I'm not sure where you got your facts but there are studies going back 25 years showing that as many as 25% of patients started on opioids for legitimate pain complaints ended up abusing them.
And going back further, if you truly believe addiction to prescription opioids is a new problem, you might watch some movies from the 1950s like "A Hatful of Rain" depicting this problem.
I'm not sure where you got your facts but there are studies going back 25 years showing that as many as 25% of patients started on opioids for legitimate pain complaints ended up abusing them.
And going back further, if you truly believe addiction to prescription opioids is a new problem, you might watch some movies from the 1950s like "A Hatful of Rain" depicting this problem.
1
For the past 15 years, I have contracted with nursing homes, assisted living facilities and hospice, providing acupuncture services to chronic pain sufferers. While acupuncture didn't help the woman in this article, my experience is that the majority of my patients recieve some to complete relief to their symptoms and other benefits from treatment including increased energy, improved sleep, better digestion and increased range of mobility and a sense of overall well-being which contributes to a better quality of life. Since repeat and regular visits are usually required to treat the chronic pain issues, espcieally in the elderly who have complex health conditions, the costs for treatments can be a barrier to receiving treatment. If Medicare reimbursed complementary health practitioners such as acupuncture then opoid overuse would be less of an issue and our elderly would be better supported. Most importantly, they would feel better.
5
Absolutely! Acupuncture relieved my sciatica much much better than even spinal steroid injections.
2
I tried acupuncture for about 6 months or so. It does help some, but $75 for each treatment is too much of an expense. Chiropractic is similar and even more expensive, but it did not work as well for me.
4
I am 69. I have a nerve in my pelvis which was badly damaged 5 years ago because of a botched (and unnecessary) operation. The pain from the damaged nerve has not diminished one iota since the nerve was first damaged. The list of activities I can engage in is pretty short. Most importantly, I cannot sit.
Some of the alternative therapies listed would only further damage the nerve. Things like meditation are do-able as long as I don't have to sit. None of these alternative therapies would minimize my pain. I will always have to take some form of pain killer.
The requirements re filling prescriptions are a major hassle. My MD practices 35 miles away. I can't drive 75 miles just to get a prescription when I can barely get out of bed. Consequently, we have worked out a deal where he mails me prescriptions one month and I see him the next month, this causes problems because sometimes the mail is lost or slow. Once I had to drive to his office in the middle of a blizzard to get refill prescriptions.
I have never been addicted to any drug (except caffeine and nicotine). During the hippie days I didn't do marijuana or any other recreational drug. I worked for 35 years as a lawyer. I have no history of drug abuse or drug seeking behavior.
I do not think it is fair for people in my situation to jump through all these hurdles meant to prevent drug abuse and suicide. There should be two sets of rules, one for older chronic pain sufferers, and on for everyone else.
Some of the alternative therapies listed would only further damage the nerve. Things like meditation are do-able as long as I don't have to sit. None of these alternative therapies would minimize my pain. I will always have to take some form of pain killer.
The requirements re filling prescriptions are a major hassle. My MD practices 35 miles away. I can't drive 75 miles just to get a prescription when I can barely get out of bed. Consequently, we have worked out a deal where he mails me prescriptions one month and I see him the next month, this causes problems because sometimes the mail is lost or slow. Once I had to drive to his office in the middle of a blizzard to get refill prescriptions.
I have never been addicted to any drug (except caffeine and nicotine). During the hippie days I didn't do marijuana or any other recreational drug. I worked for 35 years as a lawyer. I have no history of drug abuse or drug seeking behavior.
I do not think it is fair for people in my situation to jump through all these hurdles meant to prevent drug abuse and suicide. There should be two sets of rules, one for older chronic pain sufferers, and on for everyone else.
58
Nora Webster-
The crux of this whole discussion is that here is that there is absolutely no way for a doctor to tell who is a chronic pain sufferer and who is "everyone else."
Understanding that should be a prerequisite for engaging in any conversation about this topic.
The crux of this whole discussion is that here is that there is absolutely no way for a doctor to tell who is a chronic pain sufferer and who is "everyone else."
Understanding that should be a prerequisite for engaging in any conversation about this topic.
1
I've seen this argument before. Sure, if someone shows up at the ER with a painful condition, they may or may not be legit. But for many patients who have a relationship with their doctor, that doctor knows whether they're drug-seeking, or actually in pain. Understanding that should be a prerequisite for engaging in any conversation about this topic.
8
But your situation has nothing to do with the tens or hundreds of thousands in middle America who are abusing opioids. They have a lot of excuses, like their back pain and lumbago. But their parents and grandparents weren't using opioids.
2
As a physician specializing in pain management, I think a few points should be added and clarified.
1. As noted, the CDC guideline is recommended and not required so it isn't a "restriction."
As to that change in scheduling in Vicodin and other hydrocodone combination drugs, it should be noted that the previous scheduling was based on a false assumption. Hydrocodone alone was always on the more restrictive schedule. It was once thought that if there was another drug such as acetaminophen (Tylenol) combined with it, this would limit dosing because of the potential toxicity from this other drug. This never proved to be true; we simply ended up with people having problems with the opioids plus the liver failure due to acetaminophen toxicity.
2. With regard to other medications for pain, the writer appropriately notes that opioids are not beneficial for fibromyalgia. However, the only other medications she mentions are the NSAIDS.
It's worth noting that the most efficacious drugs for fibromyalgia, diabetic neuropathic pain and shingles, and many forms of cancer pain are the SNRI antidepressants and the anticonvulsants.
3. Finally it's worth repeating that there are no studies demonstrating the efficacy of opioids for chronic pain. And a recently published study found that these drugs appear to have minimal benefit for even acute low back pain, a common problem among the elderly, and none for chronic back pain.
1. As noted, the CDC guideline is recommended and not required so it isn't a "restriction."
As to that change in scheduling in Vicodin and other hydrocodone combination drugs, it should be noted that the previous scheduling was based on a false assumption. Hydrocodone alone was always on the more restrictive schedule. It was once thought that if there was another drug such as acetaminophen (Tylenol) combined with it, this would limit dosing because of the potential toxicity from this other drug. This never proved to be true; we simply ended up with people having problems with the opioids plus the liver failure due to acetaminophen toxicity.
2. With regard to other medications for pain, the writer appropriately notes that opioids are not beneficial for fibromyalgia. However, the only other medications she mentions are the NSAIDS.
It's worth noting that the most efficacious drugs for fibromyalgia, diabetic neuropathic pain and shingles, and many forms of cancer pain are the SNRI antidepressants and the anticonvulsants.
3. Finally it's worth repeating that there are no studies demonstrating the efficacy of opioids for chronic pain. And a recently published study found that these drugs appear to have minimal benefit for even acute low back pain, a common problem among the elderly, and none for chronic back pain.
9
Doctor King - Cancer is not a source of chronic pain? You are saying that morphine is not appropriate for someone with cancer? I hope that you are treating your patients as individuals rather as an idealization of some study. I find your post troubling, coming from a pain specialist.
10
Dr. King presents a slight over-simplification of treatments for Fibromyalgia. UpToDate has the most recent advice on multi-modal pain treatment for Fibromyalgia including:
"Clinicians with insufficient experience in the use of these
medications or drug combinations may wish to consult with an expert in the pharmacologic treatment of fibromyalgia, such as a rheumatologist. In patients who also have a comorbid psychiatric illness, we advise consultation with a psychiatrist for assistance in medication management and coordination of care. (See 'Consultation and referral' below.)
"In patients without an adequate response to these medications or with a temporary need for additional treatment during an exacerbation of pain symptoms, other agents such as acetaminophen, tramadol, and nonsteroidal antiinflammatory drugs (NSAIDs) are adjunctive or alternative therapies that may be helpful."
The approved drugs for Fibromyalgia do not work in all patients. There are some doctors who do propose "never" for even weak opioids like Tramadol, but that is a matter of religion and personal preference, not science. Few doctors have the resources for the truly multi-modal treatment that is considered the gold standard.
More:
http://www.uptodate.com/contents/treatment-of-fibromyalgia-in-adults-not...
"Clinicians with insufficient experience in the use of these
medications or drug combinations may wish to consult with an expert in the pharmacologic treatment of fibromyalgia, such as a rheumatologist. In patients who also have a comorbid psychiatric illness, we advise consultation with a psychiatrist for assistance in medication management and coordination of care. (See 'Consultation and referral' below.)
"In patients without an adequate response to these medications or with a temporary need for additional treatment during an exacerbation of pain symptoms, other agents such as acetaminophen, tramadol, and nonsteroidal antiinflammatory drugs (NSAIDs) are adjunctive or alternative therapies that may be helpful."
The approved drugs for Fibromyalgia do not work in all patients. There are some doctors who do propose "never" for even weak opioids like Tramadol, but that is a matter of religion and personal preference, not science. Few doctors have the resources for the truly multi-modal treatment that is considered the gold standard.
More:
http://www.uptodate.com/contents/treatment-of-fibromyalgia-in-adults-not...
6
I have chronic pain, in my back and opioids have worked just fine for me for 13 years. So don't freakin' tell me what works for me just because you have no definitive proof they work for 80% of other people in a clinical study.
5
This revealing article ends with the exceptional and ideal pain patient, faithfully exercising to reduce pain and using addictive opioids only when really needed. There is a limit to what medicine alone can do to treat many diseases or their symptoms including pain. In most cases, the patient must be an active participant on the road to recovery or pain control but our society is hooked on pills which are so much easier to take than physical therapy or yoga. And when the pills are highly addictive and the pain is severe, there is little chance of winding up like Mrs. Cohen. I hope she inspires others in her situation but I am skeptical as the baby boomer generation rapidly increases.
2
Exercise does help to decrease pain, but it hurts to do it. A good pain medication does not eliminate pain, but it makes it possible for me to exercise.
11
Great point, Janet. I have had to stop bicycling and hiking because when the pain comes on afterwards, I have nothing to relieve it anymore. So, I am gaining weight. That's not going to reduce my lifespan, too?
5
What they will tell you is 'No pain, no gain' or that you're a 'wimp' for wanting pain relief. Heard that directly from a Physical Therapist my spouse went to once.
1
Where fibromyalgia or other pain with no physical damage to body structure is ongoing, pain is often maintained by opioid -induced hyperalgesia. This is a sensitization of the central nervous system to benign incoming signals, which are interpreted as pain. Animal studies show that even tiny doses of opioids (narcotics) can maintain or reestablish this processing abnormality. Studies in the 1950s showed persistence of sensitization up to 9 years after stopping narcotic medications. Every small dose reestablishes the pain. Difficult problem.
8
That is theory at best, gained from rats. My experience proves the opposite. If opioids are effective for cancer patients, they are for chronic pain sufferers as well.
12
Yeah except you can't give rats fibro or our other illnesses like connective tissue or CRPS making the model a horrid example for OUR illnesses.
1
Why do you say:
"More than 165,000 people died from overdoses from 1999 to 2014."
which is completely meaningless if you,don't have a calculator handy? Wouldn't it be more informative to say something like;
"Between 1999 and 2014 an average of 11,000 people died each year from overdoses."
I know 11,000 isn't as compelling as 165,000. But please.
"More than 165,000 people died from overdoses from 1999 to 2014."
which is completely meaningless if you,don't have a calculator handy? Wouldn't it be more informative to say something like;
"Between 1999 and 2014 an average of 11,000 people died each year from overdoses."
I know 11,000 isn't as compelling as 165,000. But please.
21
Thomas, the information comes directly from the new CDC guidlines, which I've linked to in the column. Given the rising rates of opioid use and overdose, I thought dividing that number to give an "average" could have been misleading.
3
Dear Ms. Span,
Thank you for your explanation, however to simply repeat unclear and perhaps intentionally misleading data doesn't make it any easier for us readers. Why is a 15 year measurement ideal?
What happened in 2015 or 2014 is going to be much more relevant than what happened in 1999.
Please make all this gobblygook understandable, and relevant.
Thank you.
Thank you for your explanation, however to simply repeat unclear and perhaps intentionally misleading data doesn't make it any easier for us readers. Why is a 15 year measurement ideal?
What happened in 2015 or 2014 is going to be much more relevant than what happened in 1999.
Please make all this gobblygook understandable, and relevant.
Thank you.
5
Furthermore, some of those overdoses may have been deliberate, and could have occurred by other means if the drugs were not available.
6
"But not enough practitioners offer alternatives like cognitive behavioral therapy, and insurers (including Medicare) generally won’t pay for them. If the C.D.C. wants doctors to advocate a 'multimodal' approach to chronic pain (and it does), giving preference to nonpharmacological therapies, 'we need a system that can deliver it and can pay for it,' Dr. Reid said."
THIS x 10! If we are so darn worried about creating addicts, then we darn well better be prepared to pay for alternative therapies. The article rightly points out that there are no simple, easy answers to the problem of chronic pain in older adults -- or anyone, for that matter. My older adult patients report that they feel they are being treated like criminals now at the pain specialist's office. There is so much fear among doctors and other prescribers. I worry that the pendulum has already swung far in the other direction, leaving chronic pain patients stuck in the middle, worried about losing the medications that help them function.
Yes, let's develop a national, multi-modal approach to chronic pain. Let's fund that. But don't hold your breath waiting for that funding. Read what one pain researcher has to say: http://theconversation.com/what-is-chronic-pain-and-why-is-it-hard-to-tr...
THIS x 10! If we are so darn worried about creating addicts, then we darn well better be prepared to pay for alternative therapies. The article rightly points out that there are no simple, easy answers to the problem of chronic pain in older adults -- or anyone, for that matter. My older adult patients report that they feel they are being treated like criminals now at the pain specialist's office. There is so much fear among doctors and other prescribers. I worry that the pendulum has already swung far in the other direction, leaving chronic pain patients stuck in the middle, worried about losing the medications that help them function.
Yes, let's develop a national, multi-modal approach to chronic pain. Let's fund that. But don't hold your breath waiting for that funding. Read what one pain researcher has to say: http://theconversation.com/what-is-chronic-pain-and-why-is-it-hard-to-tr...
20
Absolutely. I have been through all the alternative hoo-hah. All it did was waste a year of my life. The only thing that worked was massage which the insurance companies won't pay for. Do the math. $300 per session X2 per week X 4 wks per month.
6
Exactly! I would give anything to get equal relief from a non opiate therapy that I do from opiates, but simply saying that suddenly opiates don't work simply doesn't make it so; also keep in mind most of these alt therapies were considered quackery until these regulations and guidelines came in. In the mean time taking our only form of working relief away BEFORE a suitable solution is found is cruel, puritanical, and uncalled for in a rational society.
7
As usual, no mention of Cannabis, which has been shown to decrease use of opioids and overdose deaths by such drugs.
6
Perhaps because there is little evidence that cannabis is of much benefit in the treatment of pain.
I'm not sure of the point of replacing one drug that has little benefit for chronic pain with another that also has little benefit.
I'm not sure of the point of replacing one drug that has little benefit for chronic pain with another that also has little benefit.
2
Steve, please do some research before you talk about medical marijuana. As a chronic pain patient, I, and tens of thousands of others have found MMJ to be extremely effective.
To your point that there is "no evidence" - marijuana is a Schedule 1 drug - considered the most dangerous, along with heroin per governmental regulations, no one can even research it in the US. For that reason, the information in the US as to marijuana's efficacy is all anecdotal, from patients themselves. However, there are companies in Europe who are using marijuana to create very effective medications for pain.
Please do some research before you make statements like you just did. You'd be surprised.
To your point that there is "no evidence" - marijuana is a Schedule 1 drug - considered the most dangerous, along with heroin per governmental regulations, no one can even research it in the US. For that reason, the information in the US as to marijuana's efficacy is all anecdotal, from patients themselves. However, there are companies in Europe who are using marijuana to create very effective medications for pain.
Please do some research before you make statements like you just did. You'd be surprised.
1
Its also hard to get in most states that have doctor prescribed cannabis. In my state the insurance companies won't pay for it so its like $500+ a month out of pocket.
1
I agree that opiods are over-prescribed, but as a 61 year old with 4 joint replacements, I had no way to get to Boston to get my refills for oxycodone after my replacements, which I needed desperately. I switched to Vicodin, even though it didn't work as well, because my doctor could call it in. Now I can't do that either. Since I will have to get someone to go to Boston for me anyway, I'll stick with the oxycodone. I don't know how I will get my medication throughout the 2 month period for my next replacement. I live almost an hour from Boston and I will not be able to drive in. Opiods are a requirement for joint replacement recovery. I guess I will have to find someone to drive to Boston for me in exchange for pills. They will be happy to pick them up for me! There's no way I will be able get them myself. The drug addicts will have no problem getting to the doctor, but what about the people who really need them? It just makes it harder for them.
43
Old people like you were the best drug dealers for people like me. You can get all the help you need filling a prescription if you trade pills. Someone would probably drive you to New York to fill your script if you gave then two pills. You can pay for your house if you sell pills, and I know several senior citizens that used prescriptions as their only form of income.
I'm sorry that you are having a hard time getting your pills, but PLEASE do not trade drugs for help driving you into town. I was a drug addict at MIT in Cambridge, and I was kicked out my senior year for being a drug addict. The places I got drugs were always old people selling pills.
I'm sorry that you are having a hard time getting your pills, but PLEASE do not trade drugs for help driving you into town. I was a drug addict at MIT in Cambridge, and I was kicked out my senior year for being a drug addict. The places I got drugs were always old people selling pills.
5
I have a simple solution for the 'opioid problem'; legalize them all ! Of course, I doubt that will ever happen since so many people make their living dealing with the 'opioid problem'. I am referring to police, jailers, detox and treatment centers & etc. Finally, think of all the murderers and thugs we can put out of business by removing the black market sales of drugs. Less regulation and more education. It's called 'harm reduction'.
16
Except that prior to the beginning of the 20th century when the first laws were instituted regulating opioids and cocaine when these were widely and legally available, abuse of and addiction to them were major public health problems. That's why the laws were instituted.
Actually the laws were a backhand way to attack Chinese immigrants in San Francisco. It was then as now a smokescreen. Please see the recent revelations that Nixon started the War on Drugs to trget Blacks.
6
Also the Chinese in the docks areas of London. Probably the Chinese everywhere in the US and Europe.
3
If opioids have been proven ineffective at treating physical pain after a few days, the prescriptions should stop.
Gradually lower the dosage and the number of pills taken for patients who are mentally addicted to them, but make it clear to the patients that there is an end point fast approaching.
Anyone who drives should not have a prescription for these drugs.
Older people are already physically impaired due to age; impairing them further endangers them and everyone else if they are driving.
Young people are impaired by their inexperience; impairing them further endangers them and everyone else.
It's hard to do the humane thing, the right thing, but it has to be done.
Gradually lower the dosage and the number of pills taken for patients who are mentally addicted to them, but make it clear to the patients that there is an end point fast approaching.
Anyone who drives should not have a prescription for these drugs.
Older people are already physically impaired due to age; impairing them further endangers them and everyone else if they are driving.
Young people are impaired by their inexperience; impairing them further endangers them and everyone else.
It's hard to do the humane thing, the right thing, but it has to be done.
1
Young people impaired by their inexperience... excuse me but I held a class a CDL and drove a semi for two years before my condition hit me, and have driven a stick shift for 8 years. No accidents. Maybe a few tickets. No tickets ever since I have been on any sort of med by the way. There's a reason those labels say use caution and pay attention to dizziness... so you don't drive if you have problems while on it (the majority of us taking them regularly however do not especially when we cut out doses on good days anyway) or find a replacement med as different people react differently to different opiates, just like people can have dizziness and confusion from and lots of other medicines. By your logic anyone who drinks alcohol at all ever or takes ANY med that can cause dizziness at all should never ever drive.
3
So if you're like my spouse and have chronic and degenerative arthritis in her knees and shoulders with pain that is excruciating they shouldn't bother with pain killers. They can't do yoga or tai-chi or whatever.
What can they do?
What can they do?
5
dogpatch-
Here's what they can do- not take narcotics.
Here's what they can do- not take narcotics.
The puritanical and sadistic "war on drugs" has spread pain and suffering throughout the world; this is just one more example. Perhaps if there was no profit in it, drugs could go back to being a medical, not police, issue.
54
Opioids are cheaper than other pain relieving therapies like physical therapy or massage. All the payers - Medicare, the insurance companies - are going to start screaming. It's becoming clear that the real drug pusher is the insurance industry, both private and public.
We've seen a rise in the death rate, which is likely to go higher as old people in pain decide to give up on life either passively or actively. More attentive care could make a difference, but is unlikely to be affordable.
We've seen a rise in the death rate, which is likely to go higher as old people in pain decide to give up on life either passively or actively. More attentive care could make a difference, but is unlikely to be affordable.
30
If I could get massage three times per week, I wouldn't need opioids, but Kaiser won't pay for it.
21
Same with chiropractic treatment which previously help when I received it because of an auto accident. But, no more.
Not a bad article but some corrections/additions are in order. An advisory committee of independent experts convened by the Food and Drug Administration in January 2013 voted 19 to 10 to reschedule hydrocodone combination products from Schedule III to Schedule II. The Drug Enforcement Administration acted to reschedule hydrocodone products after receiving the FDA’s recommendation. Secondly, although the statute prohibits automatic refilling of Schedule II prescriptions, in 2007, the Code of Federal Regulations was amended to permit “An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance” provided that written instructions are contained on each prescription (other than the first one) indicating the earliest date on which a pharmacy may fill the prescription(s). Yes, "calling-in" these prescriptions has been stopped but it's worth noting that the volume of hydrocodone prescriptions, including the ones that were called in, on an annual basis before the law was amended exceeded the total number of prescriptions written for all other opioids combined. Finally, doctor shopping is a major risk factor when opioids are prescribed and this includes the Medicare Part D population in which the GAO estimates that 170,000 enrollees have engaged in this activity. A single oxycodone tablet that may cost the patient a few cents in co-pay is worth as much as $25-$60 on the street.
10
Truth, my best dealer when I was a drug addict was a 60 year old woman with legitimate pain who lived off the money she made from selling half her pills every month.
1
Don't blame your addiction on others.
5
Telling older people to do yoga and tai chi and such for their chronic pain is something written by a 28 year old. The problem is that when you are older and in pain, doing such exercise is neither mentally nor physically possible. And once you finish, your pain is magnified. Telling someone who is old and in pain that they could get hooked on drugs is an oxymoron. So what? The alternative is what? A bullet? At that point of your life enduring daily and hourly pain is not something one wants to do. It doesn't build character and it is insulting to tell someone that they simply must endure pain because......the medical and law enforcement establishes believes some greater power deems that to be important as their life comes to an end.
136
This is also a common problem with young people who have pain. As they try to do the activities that they need to do to reduce the pain, the pain often acutely increases and they take this as a message they should do even less which gets them in a downward spiral. It's why they need instruction in appropriate movement and activities from physical and occupational therapists with experience in working with patients with chronic pain.
And as to those opioids, what's the use of taking medications that are not beneficial?
There are no studies demonstrating they providing any benefit for chronic pain.
And as to those opioids, what's the use of taking medications that are not beneficial?
There are no studies demonstrating they providing any benefit for chronic pain.
Right. We are not going to go home and live in pain for the next 20 years because some snot in a white lab coat says we must.
11
I bought most of my drugs from old people. Just because they are old doesn't mean they can't be a drug addict or a drug dealer. Opiates SHOULD be hard to get.
1
I hope someone will advocate for adequate insurance coverage of non-drug therapies. Most insurance plans are strictly limiting them. Mine offers a maximum of 20 physical therapy visits per year. My chiropractic visits are limited to 18 per year. These are not adequate for the patient who deals with pain, no matter the age.
66
Right, let's have the insurance companies or the government pay for exercise and "mindfulness".....
Calling it "cognitive behavioral therapy" means money, though.....
Calling it "cognitive behavioral therapy" means money, though.....
Also insurance coverage of medical massage therapy and acupuncture.
2
Obviously, the people that are trying to restrict these medications are not people that suffer pain on a daily basis.