DEA’s Latest Attempt to Punish Chronic Pain Patients

Now the DEA’s newest proposal targets drug manufacturers by giving them quotas as to the number of controlled substances they will be allowed to produce. Here we go again … another attempt to bully and force decreases in the manufacturing of pain medications – which hurt millions of Americans suffering with some form of chronic pain. But there is little empathy toward chronic pain patients suffering from back issues, hidden illnesses, and even surgeries.

And the number of patients who have been refused pain prescriptions for diagnoses they’ve lived with for decades continues to increase as will the suicides by these patients who can find no other form of relief. Following this is the comment I submitted to the DEA and I urge you to send your story to them ASAP. In the article, “DEA Wants to Target Drug Manufacturers in Opioid Supply, by Ed Coghlan and found in the National Pain Report dated April 21, 2018, click on the article title which will take you to the proposal docket  with instructions on submitting your comments. This is opened to the public until May 4th so please send your comments in today.  Thank you.

To Whom It May Concern:

I am pleading with you to cease, overthrow, and forget about the proposal to decrease the manufacturing of controlled substances, namely, opioids.

Scoliosis, Spinal Stenosis, herniated discs, and six fusion surgeries on my back due to Scoliosis have left my spine with 2 inches of bone-free fusions. It was decided not to fuse that area because of assumed increased complications. My back pain increased resulting in quitting my job and stop instructing, choreographing, and dancing line dances, restricted my love of gardening, house cleaning, and shopping due to the impact of pressure forced on those 2 inches of my spine.

Since July 2012 I have been on disability, spent the year of 2013 contemplating suicide and wallowing in a sea of depression as new health issues arose. Less than six months ago I was diagnosed with Restrictive Lung Disease and am now on oxygen 24/7 along with the myriad of medications to address my severe chronic back pain, restless leg syndrome, fibromyalgia, depression, and lack of sleep.

Taking Percocet at the dosage of 7.5/325 mg four times a day allows me to walk on the treadmill at 2.0 mph for 30 minutes (3-4 times weekly), dress myself, make the bed, and wash dishes. I go shopping with my husband at least once a week to get out of the house and unfortunately, we come right home after the first stop because the back pain will not allow me to spend an afternoon of shopping. I walk with a cane and sometimes ride in a wheelchair. And I’ve tried to dance a little bit for exercise but the oxygen tubing gets in my way.

If I didn’t take the Percocet four times a day my day would look like this: Wake up, go to the bathroom, sit back on the recliner with heating pad and moan in pain – and this is where I would spend my day. Activity increases my pain, therefore, physical activity is gone. Going out to shop is out of the question. Household chores including picking up items around the house, making the bed, or washing dishes is out of the question because the back pain travels down both legs and stirs up the RLS … forcing me to get back on the recliner. I’d get fat. I’d be depressed. And I’d be thinking of other options that would take away the misery of my painful life.

It was revealed that the CDC inflated the numbers of opioid suicides in its report per this article: (https://www.painnewsnetwork.org/stories/2018/3/21/cdc-admits-rx-opioid-deaths-significantly-inflated) And there have already been a few suicides by pain patients who were refused pain medication, leaving the patients with suicide as their only option to relieve their pain.

Controlling substance quotas isn’t going to remove suicides amount the citizens of this country – it is going to escalate suicides. For some reason people who do not live with chronic pain, believe it can be remedied with physical therapy, acupuncture, massage therapy – all great options, but they do not last. And they are expensive.

I cannot live a semi-normal life without Percocet. I’ve tried cutting down and find myself eventually taking the required number because the pain escalates quickly. How am I suppose to live? How am I suppose to enjoy visiting my son and his family including two grandchildren? How do I face a day without pain relief?

PLEASE, I BEG you to remove this proposed rule and reconsider your actions. This rule will escalate suicides, remove quality of life, and force pain patients to spend their days and nights in bed. Is this the society you are striving for?

Respectfully,

Carolyn Robinson

Relief Options for Chronic Pain

PART 3  –  OPIOIDS

Except for Marijuana, controversy surrounds Opioids more than any of the previous medications discussed in Parts 1 and 2. Suicides, accidental overdoses, and misuse of Opioids by prominent celebrities fill the headlines and invoke a strong media reaction. This escalated attention cautions healthcare physicians to seek other options for their patients.

The American Academy of Pain Medicine, National Institutes and Health, American Chiropractic Association, and American Society of Addiction Medicine provide chronic pain and prescription opioids statistics. These statistics cover the United States only:

Chronic pain statistics indicate more people suffer from pain than the combination of diabetes, heart disease, and cancer. Excluding acute pain conditions and children suffering from pain, 50 million to 100 million adults suffer from chronic pain. Of those adults, 27% seek treatment for lower back pain, 15% for severe headaches to migraine pain, and another 15% for neck pain. Alarmingly, these numbers continue to grow daily.

Research of the prescription pain pill epidemic for 2015 shows 20,404 people died from Opioids overdoses. Prescription opioids account for substance abuse disorders by two million people. Increased national crime, pharmacy burglaries, and overdose deaths were tied to Opioids abuse.

Since the rise of prescription drug overdoses, especially prescription Opioids, views have changed among healthcare providers for prescribing Opioids for the treatment of chronic pain. However, Opioids are prescribed in cases of short-term to help patients recover from fractures or post surgery.

Your primary care physician will no longer prescribe Opioids for moderate to severe chronic pain. Instead, you’ll be referred to a Pain Management Facility where specialists evaluate and monitor prescriptions of Opioids.

Many chronic pain patients find themselves suffering more and receiving little or no assistance of treatment for their pain due to the abuse and misuse epidemic. As the fear of overdosing heightens many physicians, including specialists, seek other options to treat chronic pain. Physical therapy, minimally invasive procedures, and lifestyle changes are the preferred options. However, these options, exhausted by most chronically ill patients, bring little to no relief.

So, how do chronic pain patients find relief? If Opioids are the only option available for severe chronic pain then understanding the risks involved with these drugs is mandatory. The specialists associated with Paindoctor.com (and most pain management specialists) treat chronically ill patients using a 12-step Opioid Checklist to ensure patient safety. (You can find the risks of Opioids listed after the checklist.)

Taking Opioids is a risk. But most chronic pain sufferers take that risk to acquire a fraction of the quality of life they enjoyed prior to the onset of chronic pain.

What are Opioid medications?

As the oldest known class of drugs in the world, Opioids refer to either morphine or other opium poppy-based medications – narcotics. Opioids suppress the pain perception by reducing pain signals as they are transmitted through the nervous system.

Below are some types of Opioids (and their generics) used for chronic pain treatment. ALL of these medications require a prescription.

–Hydrocodone (Hysingla ER, Zohydro ER)

-*Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)

–Hydromorphone (Dilaudid, Exalgo)

–Oxycodone (Oxycontin, Oxecta, Roxicodone)

-*Oxycodone and Acetaminophen (Percocdet, Endocet, Roxicet)

–Oxycodone and Naloxone (Targiniq ER)

–Morphine (Astramorph, Avinza, Kadian, MS Contin, Ora-Morph SR)

–Meperidine (Demerol)

–Methadone (Dolophine, Methadose)

–Fentanyl (Actiq, Duragesic, Fentora)

–Codeine (only available in generic form)

(*Includes Acetaminophen in the compound. Avoid other products containing acetaminophen (ex: Tylenol) due to increased risk of liver problems.)

For pain relief all day and through the night your doctor may prescribe specific doses of your pain medication. However, there is a chance you may experience “breakthrough” pain. Breakthrough pain is a flare of pain experienced even though you receive round-the-clock pain medication.¹ In this case, you may be given a prescription with “as needed” instructions.

Regular visits to the pain specialist are a requirement of care if you are prescribed Opioids. These visits include questions asked by your specialist:

1. 1. 1. 1. 1. Are you responding to the Opioid?
            2. Are you experiencing any side effects?
            3. Have you developed a medical condition or potential interaction that may increase the risk of side effects?
            4. Are you taking the medication as directed?²

NOTE:  Never change the dosing of any Opioid medication without first checking with your physician. If your pain isn’t managed by the medication prescribed, your physician may change the dose or try another Opioid drug.

Opioids can be dangerous if taken with 1) antidepressants, 2)antihistamines, and/or 3)sleeping pills. Be sure your doctor knows all medicines you are taking. Other prescription drugs, over-the-counter drugs, and herbal supplements may cause additional problems when taken with Opioids.

When you’re ready to quit the Opioids, your pain specialist will advise a slow weaning off from the Opioids to help your body adjust to the removal of the pain medications. Withdrawal symptoms occur if you stop the Opioids abruptly.

As reviewed in Parts 1 & 2 of this series, most medications have side effects and Opioids are no different. Common side effects include:

*Constipation                       *Sedation

*Fatigue                                 *Nausea

*Vomiting                              *Confusion

*Dry Mouth                           *Constricted pupils (miosis)

*Itching (pruritis)

However, there are more serious side effects including:

**Urinary retention              **Hearing loss

**Respiratory depression    **Hallucination

**Hypothermia                       **Delirium

**Hyperalgesia (increased sensitivity to pain)

**Abnormal heartbeats (arrhythmias)

LARGE doses can induce:

***Serious respiratory problems              ***Depression

***Oxygen deprivation                                ***Unconsciousness

***Overdose                                                   ***Death

Taking Opioids for the long-term may cause tolerance, dependency, and/or addiction.

Tolerance occurs when the need for Opioids causes increasing the dosages.

Dependence is a physical or psychological effect. A physical dependency occurs when you (abruptly) stop taking your Opioid medications resulting in a withdrawal syndrome. Psychological dependency occurs as an emotional need for the drug when there is no physical need.

A small percentage of patients who use Opioids long-term may suffer from addiction.³ The characterization of addiction is a constant pattern of inappropriate Opioid use and may include the following serious problems:

• • Loss of control of using Opioids
  • A preoccupation of acquiring more Opioids even though pain relief is achieved
  • Although adverse physical, psychological, or social consequences may occur, the patient continues using Opioids
  • Overdose and death increases as an adverse effect

Should you take Opioids? If you suffer from moderate to severe pain, Opioid drugs can make a significant difference in your pain levels. However, you must take them safely and follow your doctor’s instructions carefully to avoid the negative effects of Opioids.

Next week, we’ll explore Marijuana and its treatment of chronic pain. Have a great week!

1Opioid (Narcotic) Pain Medications article, WebMD, LLC, 2017

2Opioid (Narcotic) Pain Medications article, WebMD Medical Reference, Minesh Khari,MD, April 30, 2017

3“What are Opioid Medications? Article, paindoctor.com

 

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More Info About “Patients Like Me”

Good morning!

If you haven’t signed up for “Patients Like Me” this post will give you more in-depth information about this unique website. As a patient with chronic back pain, Fibromyalgia, and joint inflammation and pain I have found Patients Like Me (PLM) offers a way to track my daily symptoms, conditions, and treatments. Let me explain.

The goal of PLM is to help patients become involved in the care of their conditions – Fibromyalgia, chronic pain, Rheumatoid Arthritis, Lupus, Bipolar, or any health condition that involves symptoms that the patient may be dealing with. You (the patient) gives data to PLM and they (PLM) gets that data and processes it into information for You.

You (the patient) give data (your conditions, symptoms, treatments) to PLM and (PLM) gets your data, processing your information into “data points” These data points are combined with all the conditions, symptoms, and treatments of patients in their system. This information is then available for YOU to see and explore.

If you have chronic back pain you can look up how many patients have your chronic back pain, their symptoms of chronic back pain, what medications they take for chronic back pain, and how they cope.

1. Click on CONDITIONS at the top of your dashboard
2. If you have listed chronic back pain in the system you can find your condition from “My Conditions” at the right of the form. Or you can “look up” chronic back pain in the space provided.
3. Type in Chronic Back Pain.
4. You will find Chronic Idiopathic Back Pain which is pain that lasts for 3 months or more.
5. Below Chronic Idiopathic Back Pain are an Overview of the patients in PLM by age, sex, and the start date of this condition.
6. Look at the table on the left and you’ll find sections on “How it affects people,” “How people treat it,” and “Compare treatments.”
7. Click on “how people treat it”
8. As of the date of this post, there are 79 treatments for Chronic Idiopathic Back Pain listed by patients.
9. You can shorten the list by the “Top 10 treatments”
10. Click on Hydrocodone (for example) and you’ll find an overview of the drug. Below is a chart of the reported purpose and perceived effectiveness
11. 1166 patients take Hydrocodone for pain. As you scan through the chart you’ll see the other conditions Hydrocodone is taken and how effective it is for patients

You can look up your conditions and symptoms in the same manner. This information may not seem relevant, but once you are able to compare the evaluations of other patients you find you aren’t alone is this battle to cope with your condition. You can even find info about how other patients take a medication, with food or without food.

Explore the site to see if it is the right fit for you. I’ve found it’s a great way to track my progress by submitting my daily info. Charts show me if a medication is working, how my symptoms change, and a detailed chart I can take to my next appointment with my pain management doctor.

I was amazed that she wanted the info to put in my chart. She found it interesting and a great tool for her to see how I progress. Take a moment to check out PLM. It might be a good fit for you or you may feel you just don’t have the time to submit your information. But look at it this way. If you submit your information you are contributing to PLM’s research and their commitment to sharing people’s information to clinical trials, the FDA, AstraZenaca, Takeda Pharmaceuticals, and M2GEN (cancer patients research team.)

Thanks for reading and let me know if you join PLM. I wish you a day with very little pain so you can enjoy doing the things you love to do!

Warmly,

Carolyn

 

Does Your Environment Increase your Chronic Pain?

Good morning!

It’s Friday, March 10th and one week from today we’ll be in our new home. It seems as though this journey has taken forever since we first moved to the NC mountains on December 1, 2016. But that is because our environment was less than normal. Living in my brother-in-law’s home was full of tension, irritation, and bad vibes. A very stressful four months.

Another aspect of tension and worry has been the present President and his administration. Whether you voted for him or not, it is clear that corruption, instability, and overspending are evident in this administration.

As a chronic pain and fibromyalgia sufferer, I’ve found that almost everything I read about the current administration inflames my pain throughout the day. Why would this person and his proposals affect me in this way?

It boils down to stress and the fact I allow my environment to stress me out. And because stress affects every aspect of our bodies – our sleep patterns, attitudes, and pain levels – it can be difficult to control.

But, I did find an article by Helen White, a contributor to the Huffington Post. Diagnosed with hypermobility syndrome of the joints (HMS), a condition that features joints that easily move beyond the normal range expected for a particular joint. It is a benign condition per medicinenet.com, Ms. White has first hand experience with chronic pain and learned ways to tolerate and cope with her pain. (You can read more about this illness when you click on the highlighted typing.)

Ms. White’s article, “5 Things Living with Chronic Pain has Taught Me”, provided me with tools to live my life a little more stress-free and I briefly share her tips here:

LISTEN to your body and PACE yourself!

Without a doubt this is the hardest thing to do! I’m getting better at it, but I’m still not at the point to stop when my body gently gives the warning signs. No, I wait until the pain is full blown. Then it takes twice as long to control the pain.

Ms. White suggests “taking frequent breaks for gentle exercise and try to take things a bit slower.” She has a morning and evening yoga routine and listens to meditation CDs.

2-Have EMPATHY for others                                                                                                                                            

If your friend suffers from a Chronic illness, please don’t make suggestions on treating their pain. This isn’t helpful because unless you experience a Chronic Illness, you have no idea what your friend is experiencing.

I went through this experience in 2013 when my world literally fell down around me. As one who loves to dance, I began walking with a cane to alleviate my back pain and help with my balance. It was devastating and my bitterness came across on FB and toward my friends and family. And especially when someone tried to give advice about my pain meds and what I should do.

Thoughts of suicide were entertained – not one of my finest moments. However, by the end of that year, I realized I didn’t like myself. I vowed in 2014 I would change my attitude about my present condition and begin accepting my “new normal.”

3-PATIENCE!

First, you know your episode of pain will eventually ease off with your pain meds. It takes my pain medicine up to 90 minutes to kick in if I’ve gone past the next recommended dosage. However, I stay on top of my pain if my medicine is taken as prescribed. Don’t be a hero! Because you are feeling better and believe you can work longer, your pain will sneak up on you. Don’t wait until it is full blown to rest and take your next dosage. It takes longer for your medicine to take effect and you’ll be miserable.

4-KINDNESS – to yourself and others

Don’t beat yourself up if you have to take a day of rest. The chores will be there tomorrow. Your body comes first and as normal humans, we feel selfish about taking rest periods throughout the day, or even taking a whole day to relax to rest our bodies. Being a “get it done” person, I throw thoughts of unpacked boxes and rooms in disarray out of my mind. I relax and stop worrying. There is no time limit on getting the house in order.

For your family and friends who experience chronic pain, surprise them with their favorite cookies, a small potted plant, or a bunch of flowers on their “low” days. All it takes is a visit to let them know you are thinking of them. When in my lowest mental state due to chronic pain and a friend stops by to visit or phones, it brings me up and helps me forget my pain for a while.

5-Live in the PRESENT

Fully enjoy the moments when your pain is under control or tolerable…while at work, home, or with others. Every second counts when you have these moments so live life to the fullest! Oh, but don’t “over-do!”

You can read Helen White’s full article by highlighting the article title above. She goes into a little more detail for each plan of action and I’m sure you’ll enjoy her writing. She writes “down to earth” and I love a writer who doesn’t infiltrate their articles with words I don’t understand!

Thank you for your patience with this blog post. Over the last few weeks I’ve had a respiratory infection and then to make things just hunky-dory, developed walking pneumonia last week (March 31st to be exact!) Our little house is coming together, but the small extra “bedroom/office” has become the holding station for any unopened box. Ms. White’s article put me to the test because I must rest to get better. Of course, every time I get up I’m back in the recliner because I’m out of breath. The extra room will get done, maybe not as quickly as I hoped, but it will!

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Have a wonderful week and please contact me with ideas, suggestions, and questions on future blogs. I’d love to write what you are interested in about chronic pain.

Carolyn