Isn’t It High Time To Stop the Hurt?
Imagine waking up one morning with the worst pain you could ever dream up.
Now take the word “pain,” and turn it into an acronym that stands for: “Persistent, Agonizing, Incapacitating Nonstop” (PAIN) pain.
Next, picture a sadist driving a sledgehammer down on a man’s fingers, hard and repeatedly. That’s what intractable pain feels like, only it never lets up.
If you were behind the wheel and suddenly saw someone doubled over in pain on the side of the road, would you STOP or CONTINUE DRIVING? If anyone has even half a conscience, without a doubt they would quickly choose to stop driving, get out of the car, and help that person — probably by calling 911 on their cell phone or Smartphone.
Got an abrasion? You apply a thin layer of Neosporin ointment on the wound, then cover it up with a Band-Aid. If it’s a deeper cut, you go to an urgent care center and get stitches. If it’s an appendicitis, you undergo an appendectomy in the operating room.
Yes, pain is all about a matter of degrees. The higher the number on the pain scale, the worse the pain is.
With intractable pain patients, the pain is typically so severe, constant and daily, it’s off the charts. The pain literally stops people in their tracks, prevents them from coping, interferes with the ability to concentrate or process information, produces suicidal thoughts, prevents performing routine activities of daily life, disrupts sleep, and lowers energy levels.
Now let’s say you suffer pain that cannot be seen with the naked eye — such as Arnold-Chiari Malformation of the Brain, a rare congenital disease wherein the brain is often much larger than the skull, causing the brain to be squeezed hard like a sponge to the point where it herniates out — you have what’s called intractable pain, compressed nerve pain that’s unrelenting and occurs each and every day without fail. And because there’s no cure for that disease and no other long-term medications — whether anti-depressants, anticonvulsants, triptans or calcitonin peptides, can provide adequate pain control without also causing adverse side effects — the only class of medications that work are opiates.
Long-term opiates have been used for thousands of years safely, effectively, and without adverse side effects, and that’s why there will never ever be a substitute when it comes to stopping and relieving intractable pain.
Turn the clock back to before March 2016, before the Centers for Disease Control (CDC) published its “CDC Guideline for Prescribing Opioids for Chronic Pain,” and chances are, any patient who walked into the doctor’s office and complained of severe, acute and debilitating pain that never lets up would have been prescribed an opiate without the doctor ever needing to question it further.
Now turn the clock forward to the day that same CDC guideline was published, and all of a sudden, the world for more than 10 million intractable pain patients got turned upside down. Almost without warning, chronic pain patients found themselves abruptly cut off from their primary care physicians or tapered off their pain medicines without the patients’ consent and told to just suck it up and live with their pain. Why? Because doctors were afraid their practices were going to be shut down for good, they were afraid the U.S. Drug Enforcement Administration (DEA) was going to come knocking on their door and ask the doctor to surrender his or her license without justification, or, worse yet, raid their practice.
Granted, there had been a number of pill mills operating throughout the United States, and those practices needed to be closed for good, but just because there a few bad apples does not mean throwing out the whole basket. No, it was the CDC guidelines encouraging artificial 90-mg opiate limits and pushing for abrupt tapering of opiates that caused the vast majority of doctors to go running in the opposite direction with their tails tucked between their legs. All of a sudden, patients could no longer count on the doctor to make informed clinical decisions about whether or not to treat with opiates, because the CDC had succeeded in driving a big fat wedge between the doctor and the patient, causing the utter destruction of the doctor-patient relationship from that point on.
Despite the fact that the American Medical Association “underscores that patients with acute or chronic pain can benefit from taking prescription opioid analgesics at doses that may be greater than the guidelines or thresholds,” doctors stopped interpreting the CDC guidelines as optional, and started viewing them as unbending, hard-and-fast mandatory rules that tolerate no wiggle room, whatsoever. As a result of this gross misinterpretation of the CDC’s unauthorized and myopic guidelines, millions of intractable pain patients found themselves without a doctor. That’s because many doctors fearing the DEA was looking at them through a microscope had given their patients only two choices: either taper off opiates or be dismissed for good. Clearly, the CDC guidelines harmed chronic pain patients severely by rendering doctors unable to care for them.
Contrary to the 2016 CDC guidelines stating that, “If patients do not experience improvement in pain and function at ≥90 MME/day, or if there are escalating dosage requirements, clinicians should discuss other approaches to pain management with the patient, consider working with patients to taper opioids to a lower dosage or to taper and discontinue opioids, and consider consulting a pain specialist,” and contrary to the guidelines stating that, “Established patients already taking high dosages of opioids, as well as patients transferring from other clinicians, might consider the possibility of opioid dosage reduction to be anxiety-provoking, and tapering opioids can be especially challenging after years on high dosages because of physical and psychological dependence….should be offered the opportunity to re-evaluate their continued use of opioids at high dosages in light of recent evidence regarding the association of opioid dosage and overdose risk,” the truth of the matter is, less than one percent of four patients per thousand carries the dreaded addiction gene, meaning the vast majority of patients take their opiate medications exactly as prescribed and are never at risk for addiction or overdosing.
And that’s exactly why, despite the fact that fewer opioids were prescribed in 2020 than ever before, the number of U.S. drug overdose deaths continues to soar, driven predominantly by illegal street drugs, such as heroin, cocaine, fentanyl and methamphetamines, not prescribed pain medications.
Therefore, the blame lies squarely on the shoulders of federal agencies (e.g., the DEA, CDC, and the Department of Justice) and the media, who continue to point the finger at doctors for “overprescribing opiates,” when the real culprit all along has been street drug abuse. Contrary to what the mass media has been shouting for more than four years, we don’t have an opioid epidemic in the United States at all. What we have is a street drug epidemic, plain and simple.
That’s why it’s so incumbent on the CDC to rectify the harm it has unwittingly inflicted on the more than 50 million chronic pain patients in the United States by throwing out its misguided guidelines and leaving it up to the U.S. Food and Drug Administration (FDA) to publish an accurate and reliable set of guidelines that do not encourage arbitrary opiate thresholds and that promote the use of opioids only when the benefits outweigh the risks and only for patients who suffer from moderate to severe pain.
Moreover, we need national and state intractable pain laws that protect both doctors and patients from the unwarranted, overreaching legal scrutiny of the DEA and that ensure that patients with serious and often debilitating medical diseases get adequate care without delay.
Force tapering and leaving people to suffer in pain are not the answers.
Once and for all, the insane war on drugs must come to a screeching halt, because we don’t have a prescription drug overdose crisis; what we have is a street drug overdose crisis, and restricting legitimate patients from access to opiates is not going to end our country’s street drug overdose epidemic.
Only opiates stop intractable pain, and only doctors have the power, the good judgment and compassion to prescribe. It’s high time for doctors to live up to the Hippocratic Oath they took and stop the hurt.