Opiates that Treat Chronic Pain and the DEA’s War on Doctors
In my experience, usually the first thing the doctor will ask someone complaining of chronic pain is: “Are you depressed?” Anyone that has ever suffered chronic pain will understand that this is probably one of the most inane questions that can be asked at this point. It just isn’t realistic to think that person would not feel a loss, and sometimes depression that suffers pain on a daily basis.
Some Examples of Diseases That Cause Chronic Pain
Myalgic Encephalomyelitis- In short, ME affects numerous systems within the body including the central nervous system. Along with a myriad of other symptoms, there is severe pain associated with ME.
Reflex Sympathetic Dystrophy (RSD)- A neurological condition that can affect bones, joints, muscles and even skin. Along with other symptoms, patients suffer severe pain.
MS-MS is a disease that attacks the central nervous system the pain of MS can be felt in many different ways and for many different reasons.
Fibromyalgia and Chronic fatigue syndrome- Both widely misunderstood syndromes where the patient has widespread pain. Unfortunately there are no tests to determine either of these, it is a diagnosis of exclusion. Because of this, doctors are even more hesitant to treat the pain because there is nothing backing up the complaint of pain.
How Opiates Work On Chronic Pain
In layman’s terms, opiates reduce the feeling, or perception of pain because it slows the pain signal. Opiates also changes the patient’s emotional response to pain, making the pain seem more bearable.
Most people suffering from chronic pain will never have their pain completely alleviated by any medication. The goal is to get the pain under control, and to allow the patient to resume at least some of their former quality of life back.
There is no doubt that there are risks when using narcotic pain relievers. When prescribed, and used properly though that risk drops significantly. There is a risk when using any type of pain reliever at all. All medicines both prescribed and over the counter carry associated risks. To clarify this, I will use two common over the counter medications people use every day as examples:
“Approximately 30,000 hospitalizations are associated with acetaminophen overdose in the United States annually…approximately half of them resulting from unintentional overdose. Acetaminophen is also a leading cause of acute liver failure in the United States.”-Janet Woodcock, MD.
b) NSAID’s (Ibuprofen, etc.)
New England Journal of Medicine states: “103,000 individuals are hospitalized for serious gastrointestinal toxicity from NSAID use, and an estimated 16,500 will not survive the complication.”
Treatments To Be Used Along With Opiates
While Opiates are very effective in treating chronic pain, other actions need to be taken in order to achieve full benefit. Physical therapy, hydrotherapy, are both important in retaining mobility and range of motion. If a patient is in too much pain to comply with physical therapy, they are at risk for atrophy, death of the muscles. Pain relievers make it easier to comply with the physical therapy orders. There are many other complimentary therapies now being used. Acupuncture is gaining popularity among doctors and is regularly suggested for patients with FM. Many doctors will now “prescribe” certain dietary changes that will help the patient feel a little better.
My Experience Of What is Lost When Chronic Pain Isn’t Treated
Little things that most people don’t even think of and take for granted have to be thought out by the pain sufferer. Opening a soda, buttoning a blouse, playing with the kids, hiking in the woods, the list is endless. When my pain began four years back, I would explain how the pain was so severe getting out of bed was painful. Sometimes even breathing caused intense pain. My doctor at the time’s response was to inform me that I was getting older. I was thirty five at the time. My grandfather enjoyed tennis twice a week, golfing, skiing in the winter, squash and plenty other activities into his eighties. So I was pretty sure this wasn’t the normal aging process.
I used to work sixty to seventy hours a week, now I no longer work outside the home. I worked through most of it as it has been almost a year now since I stopped working. First it was missed days due to the pain. Then, it was a demotion because of the missed days. Then, when my body could no longer hold up while working, I finally quit. So yes, I can tell people with all certainty the losses when chronic pain is not treated. That’s just my own personal experience, just imagine what the other estimated 70 million people suffering have to say.
Doctor’s Fears Of Treating The Chronic Pain Patient
It was in the 1980s when it became more common for doctors to treat non-terminal patients using opioid drugs. Then, with the up-rise of people starting to abuse these prescription drugs came a change. It didn’t help that Hollywood star’s addictions and deaths were widely publicized. Of course I am not saying that there should not be precautions taken against abuse of opiates, or any drug for that matter, but unfortunately the war on drugs turned into the war on doctors. The DEA bragged that they pulled funding from the war on drugs in the streets, and applied it to doctors treating pain. US Attorney Gene Rossi is quoted as saying: “Our office will try our best to root out (certain doctors) like the Taliban”. The Assistant U.S. Attorney Randy Ramseyer said: “the number one drug pushers in our community are the doctors…” The war on doctors became so out of control and publicized that many doctors feared that they would be next, and stopped prescribing any pain medication altogether.
The fear comes in because there is no way to really set what is appropriate and medically necessary. Someone who has chronic pain will from time to time need the dosage of their prescription raised, as the body gets used to the prescription pain medicine. Also, many patients suffer flare-ups, where a higher dose would be necessary to control the pain.
Side Effects Of A Fearful Doctor
So afraid of prescribing effective pain medication, doctors prescribe medications that are actually more toxic and dangerous than the opiates. They don’t do it out of inadequacy, they do it because they really are trying their hardest to relieve the suffering of their patient, but feel that their hands are tied when it comes to narcotic pain relievers. A one point when my pain was completely out of control, the doctor I was seeing at a very reputable hospital prescribed a quite deadly mix. Luckily I knew a little about each medicine, and did not fill and take them. The “cocktail” was prozac, 25 mg amitriptyline three times a day and ten mg flexeril three times a day. I know that anti-depressants are used to treat fibromyalgia, but why they came up with the prozac is beyond me. None of these drugs are supposed to be used together, let alone all three.
Outrageous Arrests And Sentences For Doctors Treating The Chronic Pain Patient
Randall Lievertz, M.D., of Indiana received a twenty year sentence and a one million dollar fine. The reason for his arrest was that he prescribed more oxycontin to patients than any other Indiana doctor. Perhaps this would be because there are so few doctors that will aggressively treat pain, or treat pain at all, so of course his numbers would be higher.
Dr. Richard Garcia Munoz is a doctor who lost his licence because he prescribed methadone for a thirty year old man who had been suffering migraines and severe back pain since adolescence.
Frank Fisher, M.D was a medical director at a community health center. He was charged with five counts of murder. The judge dismissed the murder charges after a twenty one day preliminary hearing. The Attorney General’s office would not give up though and proceeded to try to charge the doctor with less serious charges against the doctor. They did this even though there was much evidence that he was innocent. On the first day of his trial, after four years of prosecution, all charges were dismissed. The reason for the dismissal was that the government confessed it did not have any evidence.
The Cost To The Government Due To The Undertreatment Of The Chronic Pain Patient
In 1998 NIH reported that “economic toll of chronic pain was estimated at $100 billion a year in the United States”- NIH. This is much higher now in 2009. The cost is so high because there are an estimated 70 million Americans suffering from chronic pain. This puts a huge toll on disability programs like SSI and medicaid. If the pain was treated properly, many of those people could resume at minimum part-time work. At best, in many cases pain can be controlled enough so that with proper training, people could resume working full-time, and support themselves. Contrary to popular belief, people suffering chronic pain are not lazy, and don’t want to just “stay home”. They would much rather reclaim their lives.
In conclusion, I do know and understand the need for caution when treating chronic pain with opiates, but there has to be a middle ground here. Lawmakers are now realizing what a burden this is on the patient, the doctor, and the government, and are now looking into changing these laws. As a matter of fact, in a huge step forward for patient advocacy, a patient sued, and actually won a case where he was under-treated for his pain. Just as with anything in life, common sense needs to be applied both in treatment of pain sufferers and in lawmaking and enforcement.
http://www.regulations.gov/search/Regs/home.html#submitComment?R=0900006480a34d5a http://www.narcotic.explainingmedicine.com/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317050/ http://www.theacpa.org/tips_more.asp?id=66 http://www.neurologychannel.com/rsd/index.shtml http://www.nationalmssociety.org/about-multiple-sclerosis/symptoms/pain/index.aspx http://www.personalconsult.com/articles/fearfulpharmacists.html