I Was Fired for Being in Pain

By Deann Goudy, Guest Columnist

I'll start with all of my health issues, every one of which causes pain.  

I was first diagnosed with sciatic nerve pain, followed by scoliosis, degenerative disc disease, spinal stenosis, arthritis, and bone spurs in my neck. I also have ulcerative colitis, irritable bowel syndrome, and ulcers in my intestines, stomach and all the way up to my throat.  

The ulcers were caused by taking over-the-counter pain medication.  I was in constant pain at work and took bottles and bottles of Aleve and Advil. Sometimes I'd mix ibuprofen with Tylenol, hoping it would help the inflammation and pain.  Nothing helped.

I never realized anything over-the-counter could cause such damage to my stomach, until one day I fell out of my chair while at my desk, bleeding.  The next day I was in emergency surgery to get the bleeding to stop.  I was given orders to only take Tylenol.  I knew that would not help, so I went to a pain doctor to find out why I hurt so much. 

That is when they found my back and neck problems. Degenerative disc disease does not get better over time, only worse. 

I went through several steroid shots, physical therapy, and was put on hydrocodone.  The shots made matters worse. The pain management doctor would only give me shots in my cervical area and refused to help with my lower back.  Later I found out you are only supposed to have no more than 3 of those shots a year and if they do not work you should consider other options.  I was given 7 shots in one year. 

The shots accelerated the degenerative disc disease in my neck.  That is when the bone spurs grew and started pinching off the nerves in my neck, which were already being crushed by the spinal stenosis. 

DEANN GOUDY

DEANN GOUDY

I was put on every medication they could think of, including Lyrica, gabapentin, tramadol and Suboxone. I wanted to die due to the side effects, mostly from the gabapentin and Lyrica.  I passed out, saw colors, and felt dizzy and disorientated.  The tramadol gave me so much anxiety I thought my heart was going to burst.  I was shaking uncontrollably. 

I quit taking all of them and found another pain management doctor, who told me he would do one shot in my lumbar. If that did not work, then I would have to rely on pain medication. I went through with the shot and, as hopeful as I was, it still did not take. 

I was referred to an internal medicine doctor who actually listened to me.  He got me on a regimen of half the medications, mostly taking only hydrocodone and oxycodone for severe pain.  This finally gave me my life back.  I was able to go back to work.  I was no longer immobilized and struck down by pain so hard core I would lose control of my bladder. 

I was not completely out of pain, but it was tolerable, and I was finally able to have some quality of life. 

Then a pharmacist decided to cut my opioid medication in half without permission from me or my doctor. It took 3 months to fix this and find a pharmacy to fill my medication. I couldn’t control the pain and was recently fired for taking too many breaks while at work. All I was doing was getting up to walk and stretch to relieve some pain and pressure, and to calm the spasms down.

Now I’m being forced onto disability. It’s hard enough for a chronic pain patient to get a job without being discriminated against. 

I am not addicted or feel withdrawals or cravings, I am just in intense pain.  If my medications are taken away, I will not resort to the streets.  I will ask everyone in my family to not be selfish and let me go.  All I am doing is breathing and being a burden. I'd rather be dead and ask God to understand and forgive me. 

Our government has decided to play God and take away all our rights and pick on the weak and innocent.  They’ve demonized and tortured us.  For the first time in my life, I'm ashamed of the country I live in.  The corruption is everywhere, the money-making schemes, the fake opioid crisis, the lies and deception. 

I say get the facts straight before you make life altering decisions for thousands of chronic pain patients. Do a better study of where the problems are, not fake your data to make yourself look good and cash in on our lives.

Just remember lawmakers, you are only one accident away from this happening to you too.  What will you do when you’ve gotten rid of the medication that could save you?  Or do the same laws even apply to you?

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Deann Goudy lives in Texas.

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Painkiller Study Conducted at Poorly Rated Hospital

By Pat Anson, Editor

Over-the-counter pain relievers are just as effective as opioid medication in treating short-term acute pain in a hospital emergency room, according to a widely touted study published in the Journal of the American Medical Association (JAMA).

The study was relatively small – only 416 patients participated – and it was conducted at a New York City hospital with a poor history of pain care. Still, it's getting a lot of media coverage. “Milder pill may be best for pain” is the front page headline in the Los Angeles Times. “Drugstore pain pills as effective as opioids” said STAT News. “Opioids Not the Only Answer for Pain Relief” reported HealthDay.  

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Researchers said patients with moderate to severe acute pain in their arms or legs got just as much pain relief after being given a combination of acetaminophen and ibuprofen than those who took hydrocodone, oxycodone or codeine. The study only measured pain relief for two hours.

Patients with sickle cell disease, fibromyalgia, neuropathy or any type of pain that lasted more than seven days were excluded from the study because researchers only wanted to focus on short term pain.

"Although this study focused on treatment while in the emergency department, if we can successfully treat acute extremity pain with a non-opioid combination painkiller in there, then we might be able to send these patients home without an opioid prescription," said lead author Andrew Chang, MD, a professor of emergency medicine at Albany Medical Center.

"We know that some patients who are given an opioid prescription will become addicted, so if we can decrease the number of people being sent home with an opioid prescription, then we can prevent people from becoming addicted in the first place."

What Chang, JAMA and the news reports all fail to mention is that the study was conducted at one of the worst hospitals in the nation. In an annual survey of Medicare patients, Montefiore Medical Center in New York City was given only one star (out of five possible), placing it in the bottom 2.44% of hospitals nationwide.

Montefiore was rated poorly on a variety of quality measures, including pain care. Only 64 percent of the patients treated there said their pain was “always” well controlled, compared to the national average of 71 percent.

‘Worst Hospital in the Entire City’

Many of the online reviews of Montefiore’s emergency room are scathing.

“Please do not come to the ER unless you want to die or are used to unsympathetic health professionals,” warned Amanda G. on Yelp.  “I have severe abdominal pain and I'm walking home in tears right now. I came in told the nurse there my symptoms and she couldn't have made it clearer that she couldn't care less.”

“This has to be the worst hospital in the entire city. The nurses in the ER are rude and don't care about your well being. The ER is filthy. People stacked on top of each other,” wrote Robert in a Google review.

MONTEFIORE MEDICAL CENTER PHOTO

MONTEFIORE MEDICAL CENTER PHOTO

“The emergency room sucks. The doctors sit around on the computers gossiping. I even overheard a few doctors saying ‘why aren’t we picking up patients?’ Meanwhile there’s a room full of patients not being taken care of. There’s a patient screaming for help and no one hears him. All the staff members just walk by him,” wrote Zoe D. on Yelp.

“Somebody told me this place was the equivalent of going to a hospital in Manhattan. They lied! I went to the emergency room today for chest pains, I ended up sitting there for four hours never to be seen by a doctor. I ended up walking out and leaving still with my chest pains,” said Phonz R. on Yelp.

“Their ER department is horrible. I went to the ER with my mom via ambulance, we got there (a little) before 1pm. Fast forward 1:58 in the morning she still wasn't put in a room,” wrote J.L. Eaddy on Google. “This was the absolute worst ER I've ever encountered. And I NEVER want to come back again. I wish I had the option to give it negative stars.”

Unfortunately, complaints such as these are not unusual in busy, urban teaching hospitals like Montefiore.  And not all the reviews are poor. U.S. News and World Report gave high rankings to Montefiore in a number of areas, although it didn’t specifically rank its emergency department. Montefiore was recently given a lukewarm “C” rating by the Leapfrog group, a non-profit that grades hospitals on quality and safety.  

Many pain patients have poor experiences in hospitals. In a survey of nearly 1,300 patients by PNN and the International Pain Foundation, over half rated the quality of their pain care in hospitals as either poor or very poor. About two-thirds of the patients said non-opioid pain medications were ineffective.

The Hidden Dangers of Self-Medicating with OTC Drugs

By James Campbell, MD, Guest Columnist

The Centers for Disease Control and Prevention (CDC) recently unveiled guidelines for primary care physicians on the use of opioids for chronic pain. Not surprisingly, the guidelines urge physicians to first try non-pharmacologic and non-opioid treatments before resorting to opioid therapy.

If you’re one of the millions of Americans living with pain on a daily basis, it’s likely you’re not a stranger to over-the-counter (OTC), non-prescription pain medications such as naproxen (brand name Aleve), ibuprofen (Advil and Motrin), aspirin and acetaminophen (Tylenol).

In fact, most of my patients with chronic pain began their quest for relief with a cocktail of OTC pain relievers, muscle relaxants and even alcohol, before seeking professional help and eventually graduating to prescription treatments such as opioids, anti-depressants and anticonvulsants.

While OTC pain medications are generally safe when taken at their recommended doses, it’s all too common for patients to unknowingly put themselves at risk of a fatal accidental overdose or serious drug-drug interactions by mixing OTC pain medications or taking them in combination with prescription treatments for pain or other common health conditions.

Given the sheer magnitude of serious adverse events and fatalities associated with opioids, the hidden, yet preventable dangers of the pain medications on your pharmacy shelves are not often discussed.

Let’s take one of the most common OTC pain relievers: acetaminophen. When used as directed within the advised dosing guidelines, acetaminophen is safe and effective. However, if a person takes more than one medication that contains acetaminophen and exceeds the maximum recommended dose, they may be at risk of serious liver damage.

This happens so often that acetaminophen overdose is the leading cause of calls to poison control centers in the United States -- more than 100,000 instances per year – and are responsible for more than 56,000 emergency room visits.

In fact, in 2011, in an effort to reduce the risk of severe liver injury from acetaminophen overdose, the Food and Drug Administration (FDA) asked drug manufacturers to limit the strength of acetaminophen in prescription medications, including combination acetaminophen and opioid products, to no more than 325 mg per tablet, capsule or other dosage unit.

Then in 2014, the FDA recommended that health care professionals discontinue prescribing and dispensing prescription combination products that contain more than 325 mg of acetaminophen.

While the FDA’s efforts may help curb accidental overdose related to prescription medications that contain acetaminophen (Tylenol with codeine, for example), it does little to address the risks of OTC acetaminophen or other OTC pain medications such as ibuprofen, a type of non-steroidal anti-inflammatory drug (NSAID), which can cause gastrointestinal bleeding and injury, and cardiovascular side effects when taken on a chronic basis.

Drug Interactions

In addition to the risk of overdose, people taking multiple OTC and prescription medications for pain and other conditions are also at risk of serious drug-drug interactions. Simply put, any “drug” – whether it be a medicine, vitamin, supplement or even alcohol – that enters your body and alters your natural internal chemistry has the potential to interact or alter the intended effect or unintended side effect of other medications.

Even though most medications are accompanied by warnings about combining them with other drugs, most vitamins and supplements are not -- so, unless you’re a licensed medical professional, it’s virtually impossible to recognize the potential for drug-drug interactions.

If you’re using OTC medications, whether alone or with prescription medications, to cope with pain on a daily basis, here are three precautionary steps you can take to safeguard yourself against the risk of accidental overdose or drug-drug interactions.

1) Recognize that ALL medications, whether OTC or prescription, can cause harm if used improperly, and the fact that some medications are available without a prescription does not mean they are inherently safe. Read the labels that come with your medications. Tylenol, Advil and Vicodin are household names, so it can be easy to overlook their “generic” names (or the active ingredient in each).

For example, the generic name for Tylenol is acetaminophen, while that of Vicodin is acetaminophen hydrocodone. Without close examination of either label, a person taking Vicodin and Tylenol together could be inadvertently exceeding the recommended dosage of acetaminophen.

2) Consult a medical professional before you take more than one medication on a daily basis. If your chronic pain is being treated by a physician, be sure to tell them (even if it’s on your medical history) about any OTC or prescription medications you are currently taking. This includes vitamins and other supplements that may seem harmless, but could interact with your pain medications.

3) If you are independently treating your chronic pain, make a list of all the medications, vitamins and supplements you take on a regular basis and share them with your local pharmacist. Pharmacists can identify potential drug-drug interactions like taking acetaminophen and ibuprofen on a long-term basis, which can result in an increased risk of developing kidney problems.

The American Chronic Pain Association also recommends using the same pharmacy for all your prescriptions, so that the pharmacist can screen health information and current medications to avoid the pitfalls of overdose and drug interactions.

As a neurosurgeon with a special interest in pain for over 30 years, I’m empathetic to the daily struggle that patients face and their desperate quest for relief, seeking anything and everything that can simply make the pain stop.

For the patients who are fighting this seemingly endless battle with pain without the help of a medical professional, I hope I’ve provided some useful information and practical advice to help avoid serious risks associated with self-medicating. However, people living with moderate to severe chronic pain may benefit from a consultation with a licensed pain management specialist, who can help guide you toward steps that will help reduce your pain. 

James Campbell, MD, has spent the last 30 years pioneering efforts to improve the diagnosis and treatment of patients with chronic pain. 

Dr. Campbell is professor emeritus of Neurosurgery at Johns Hopkins University School of Medicine and is the founder of the Johns Hopkins Blaustein Pain Treatment Center - one of the largest pain research centers in the U.S. He is also a former president of the American Pain Society. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Education Campaign Launched for OTC Pain Relievers

By Pat Anson, Editor

You’ve probably seen the numbers. The Centers for Disease Control and Prevention estimates that over 47,000 Americans died of drug overdoses in 2014. Over 60 percent of them involved some type of opioid, a category that includes both prescribed pain medications and illegal drugs such as heroin.

Rarely mentioned by the CDC is the number of Americans harmed by over-the-counter (OTC) pain relievers such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Acetaminophen overdoses kill about 150 Americans every year and send 78,000 to the hospital.

With opioids becoming harder to obtain for chronic pain sufferers, many are turning to OTC pain relievers – often excessively. A recent survey of pain patients found that 43% knowingly took more than the recommended dose of OTC pain medicine and 28% experienced complications from an overdose.

To help consumers learn more about the risks posed by OTC pain medications, the Alliance for Aging Research has released two animated videos about how to safely choose, take, and store OTC pain relievers. They explain the difference between acetaminophen – which is widely found in products like Tylenol and Nyquil – and NSAIDs, which includes both ibuprofen and aspirin.

"With so many options, it is important for someone to choose an OTC medication that does the best job of treating their pain, while also being aware of its potential risks to their health," said Lindsay Clarke, Vice-President of Health Programs for the Alliance for Aging.

"For older adults, understanding their options is even more important, as age may increase the risk of certain OTC pain medication side effects. These films offer a great overview of what someone needs to know before taking their OTC pain medication."

The videos were produced with support from McNeil Consumer Healthcare, the maker of Tylenol and Motrin.

A survey of over 1,000 pain sufferers by the American Gastroenterological Association (AGA) found that many routinely ignore OTC medicine labels, putting them at risk of serious side effects such as stomach bleeding, ulcers, liver damage, and even death.

"Pain is incredibly personal, but taking more than the recommended dose of OTC pain medicine can cause significant stomach and intestinal damage among other complications," said Byron Cryer, associate dean at the University of Texas Southwestern Medical Center, Dallas.

Gastroenterologists say most patients who experience complications from overdoses of OTC medicine are trying to manage chronic pain or arthritis. Eight out of ten (79%) also report taking multiple symptom OTC medication in the past year for allergies, cold or flu symptoms – which can greatly increase their exposure to both acetaminophen and ibuprofen.

“It is a growing concern because people living with chronic pain and taking multiple medicines often don’t recognize the side-effects of taking too much,” explained Charles Melbern Wilcox, MD, professor of medicine in the division of gastroenterology and hepatology at the University of Alabama at Birmingham.