Sherri’s Story: A Final Plea for Help

By Pat Anson, Editor

“I’ve been thinking about ending my life if I don’t get the help I need.”

Those are chilling words for anyone to hear. And in the last two years of her life, Sherri Little said them often to family, friends and doctors.  After decades of struggling with chronic pain from fibromyalgia, inflammatory bowel disease, severe colitis and other conditions, the 53-year old California woman was desperate and depressed when she checked into the emergency room at Cedars-Sinai Medical Center in Los Angeles on July 3, 2015.

What happened over the next four days is not entirely clear, but we know that Sherri took her own life. Her body was found in the bathtub of a hotel room across the street from Cedars-Sinai on the morning of July 7, with several prescription bottles and an empty bottle of wine nearby. Sherri had been sober for many years.

“I attest this is the first drink of alcohol in 16 years -- just to give me the courage to end my life alone,” Sherri wrote in a suicide note found in her hotel room.

“Several documents found inside the location underscored her pain, suffering and suicidal ideations,” reads the coroner’s report. “A check of the decedent’s laptop also contained a pictured document written by the decedent titled ‘Why I Killed Myself’ by Sherri Little.”

We’re telling Sherri’s story --- with the help of her mother, friends and patient advocate – not in a ghoulish attempt to recreate her final days, but to lend a name, a face and a voice to the untold number of chronic pain sufferers who have also been overwhelmed by pain, depression and loss of hope.  Like Sherri, many felt abandoned by a healthcare system that was unwilling or simply unable to treat them.

sherri little

Over 42,000 Americans killed themselves in 2014 according to the CDC, but experts believe the actual number is higher. Many suicides go unreported or are misclassified as accidental, covered up by grieving family members or accommodating medical examiners.

Sherri’s death was no accident, but it’s taken several months for her mother to come to terms with it.

“I’ve got to get her story out there,” said Lynda Mannion, Sherri’s mother. “She got to the point in the last year or so she could hardly eat solid food at all. She was just drinking her nutrition. I guess she must have lost 20 to 30 pounds in the last year.

“She would say, ‘I can’t go on living like this. If I can’t get some help, if somebody doesn’t believe me, I just can’t go on living like this.’ She didn’t seem to be extremely afraid of dying, considering the alternative, living with the pain she was in. But I never expected her to do it.”

A few months before she died, Sherri gave an interview to Tina Petrova in Toronto for a soon-to-be released documentary called Pain Warriors. 

“Sherri Little and I first became friends on Facebook, united by our common passion of pain patient advocacy. She initially reached out to me after hearing that I had a film in development I was producing on chronic pain and said, ‘Do I have a story for you!’ And indeed, she did,” says Petrova.

In this short clip, Sherri doesn’t talk about suicide and appears hopeful about her future.

But just weeks later, Sherri wrote the following in an email to Petrova:

“I was acutely suicidal last night after being verbally abused by a doctor who can't even get me any pain relief anymore,” said Sherri. “In a last ditch effort to save my life I am going to Cedar Sinai ER in LA with my patient advocate.”

Sherri was referring to Lisa Blackstock, a professional advocate who founded Soul Sherpa to help guide patients through the healthcare system. Blackstock had been a volunteer at Cedars-Sinai for several years and knew her way around one of the most respected hospitals in Los Angeles. 

The day before she went to the hospital, Sherri was still having suicidal thoughts.

“I woke at 3am today, ready to give up the fight and end my life. This is not dramatic or blaming of you, but just a statement of fact: my life has not been worth living for 2 years,” Sherri wrote in an email to Blackstock.

The two women went to Cedars-Sinai together and were in the emergency room for 11 hours before Sherri was finally admitted as a patient with severe abdominal pain on the evening of July 3rd.

Over the next two days, Sherri was examined by doctors and a psychiatrist, who concluded she was a “moderate” suicide risk because she had never actually tried to take her own life.

“Patient is at moderate risk of harm to self, but does not meet criteria for involuntary psychiatric treatment at this time,” the psychiatrist wrote in Sherri’s medical records, which were provided to Pain News Network by her mother.

cedars-sinai medical center

Sherri was scheduled for a colonoscopy on July 6, but never had the procedure.  For reasons that are not clear, she became frustrated with her treatment and left the hospital the night before.

“She left against medical advice,” Sherri’s discharge notes say. “Efforts were made to talk to her about the seriousness of her decision. She explained that she understood but, however, would like to leave against medical advice.”

Lisa Blackstock didn’t learn about Sherri’s release until it was too late.

“Despite a HIPAA release (patient release form) on file naming me as Sherri's contact, the doctor did not contact me and decided there was no reason to place her on a 72-hour involuntary hold,” Blackstock wrote in a letter to the coroner’s investigator. “Sherri was allowed to leave the hospital, in pain and suicidal, and the physicians responsible for her care failed miserably.

“I am a long-term volunteer at Cedars, and, until this incident, had great respect for them.  Changes in healthcare law have resulted in substandard care for many patients depending upon their insurance coverage types, as well as hospital administrators dictating care for patients rather than skilled physicians.”

A spokeswoman for Cedars-Sinai said the hospital was unable to comment and wouldn’t even confirm Sherri had been a patient there.

“State and federal privacy laws prevent hospitals from releasing information about patients without their consent, including whether an individual may or may not be a current or former patient,” wrote Sally Stewart in an email to PNN.

Cocktail of Medications

Long before she was admitted to Cedars-Sinai, Sherri was prescribed a potent cocktail of medications for her pain and depression; including the opioids tramadol and hydrocodone, as well as Lyrica (pregabalin), Ambien (zolpidem), and Klonopin (clonazepam).    

Lyrica, Ambien and Klonopin have all been linked to increased risk of suicide.  

Lyrica has an FDA warning label that states the drug “may cause suicidal thoughts or actions” and Ambien’s label warns that “depression or suicidal thinking may occur.”

Klonopin belongs to a class of sedatives known as benzodiazepines, which are increasingly being linked to overdoses, especially when combined with opioids. Klonopin’s label also warns of “suicidal behavior and ideation.”

Why were doctors prescribing these drugs to someone who was suicidal? And why did Cedars-Sinai release Sherri with the drugs in her possession?

“They discharged her with all of them at Cedars, which I found just incredibly irresponsible,” says Blackstock.

According to the autopsy report, the coroner found only trace amounts of opioids and Ambien in Sherri’s system, but apparently never looked for the other drugs. Her official cause of death is listed vaguely as “combined effects of medications.”

Were the same drugs that Sherri took for her pain and depression – which were ineffective in helping either – used as instruments in her death? 

We may never know the answer.

“I have fought to get help for the disease I am dying of – pseudomembranous colitis – for years without help from anyone,” Sherri wrote in her suicide note. “I do not want to be resuscitated. There is nothing left for me but to be tied to a hospital bed in great pain.” 

Sherri was divorced and did not have any children. But a close circle of friends and loved ones are anxious to have her story told and her memory preserved.

“She was beautiful from the time she was little. She was beautiful up to the day she died.  She looked 20 years younger than she was,” recalls Sherri’s mother, Lynda.

“She loved to help people. She wanted to help people and she couldn’t understand why nobody would help her. She would have been there for anybody.”

“Sherri was one of those rare people that could light up the room upon entering,” recalls her friend, Tina Petrova. “During the all too short time I knew Sherri, her key focus above all was advocating for pain patients, speaking up, getting involved. Her search for treatments for her own painful conditions took a back seat to her passion to help others.

“I can just see her high above us saying, “But you have to DO SOMETHING!’”

Sherri’s advocacy will continue, thanks to a website Petrova created to honor Sherri's memory and the documentary that she’s producing on chronic pain in North America.

What can the rest of us learn from Sherri’s struggle?

Perhaps those lessons are best learned through her own words -- and the advice that Sherri gave to other pain sufferers:

Childhood Emotional Abuse Raises Risk of Migraine

By Pat Anson, Editor

New research is adding to the growing body of evidence linking child abuse with migraines. In a large survey of young adults, nearly two-thirds who suffer from migraines said they experienced emotional abuse as children.

"Emotional abuse showed the strongest link to increased risk of migraine," said Gretchen Tietjen, MD, University of Toledo. “Childhood abuse can have long-lasting effects on health and well-being."

In the study, nearly 14,500 people aged 24 to 32 were asked the question: "How often did a parent or other adult caregiver say things that really hurt your feelings or made you feel like you were not wanted or loved?"

Of those diagnosed with migraines, 61% said they had been abused as a child. Of those who never had a migraine, 49% said they were abused.

The participants were then asked whether they had experienced emotional, physical or sexual abuse as children. Physical abuse was defined as being hit with a fist, kicked, or thrown down on the floor, into a wall, or down stairs. Sexual abuse included forced sexual touching or sexual relations.

Nearly half of the participants answered yes to emotional abuse, 18% said they were physically abused, and 5% sexually abused.

Those who were emotionally abused were 52% more likely to have migraine than those who were not abused. But those who were sexually or physically abused were not significantly more likely to have migraine.

“Multiple studies have shown a strong link between childhood trauma and subsequent risk for developing chronic pain in adulthood, for instance, fibromyalgia. This study appears to be showing a similar association in migraine,” said Beth Darnall, PhD, Clinical Associate Professor at Stanford University and co-chair of the Pain Psychology Task Force at the American Academy of Pain Medicine. 

“The collective findings suggest that childhood emotional trauma has a lasting impact on emotional and sensory experience throughout life, and underscore trauma as an important therapeutic target to reduce chronic pain and its impact, and to possibly prevent chronic pain.”

A similar study published last year found that children who witnessed domestic violence between their parents were significantly more likely to experience migraine headaches as adults.

Researchers at the University of Toronto surveyed over 12,000 women and 10,000 men who participated in the 2012 Canadian Community Health Survey-Mental Health. Participants were asked if they experienced physical abuse, sexual abuse or if they witnessed parental domestic violence as children.

"We found the more types of violence the individual had been exposed to during their childhood, the greater the odds of migraine. For those who reported all three types of adversities -- parental domestic violence, childhood physical and sexual abuse -- the odds of migraine were a little over three times higher for men and just under three times higher for women" said Sarah Brennenstuhl, PhD, first author of the study.

Previous research has also shown the risk of depression and suicide ideation is about twice as high for migraine sufferers. People with migraine under the age of 30 have six times the odds of depression compared to migraineurs aged 65 and over.

Migraine is thought to affect a billion people worldwide and 36 million adults in the United States, according to the American Migraine Foundation. It affects three times as many women as men. In addition to headache pain and nausea, migraine can also cause vomiting, blurriness or visual disturbances, and sensitivity to light and sound.

Why I Keep Writing About Myself Online

By Crystal Lindell, Columnist

The other month I was chatting with this guy on Tinder. To protect the guilty, we’ll just call him Jerk I Should Have Swiped Left On — or Jerk for short.

All he knew about me was my first name, that I hate the Green Bay Packers, and that I write for a candy magazine. But it was all he needed.

Jerk: Hey. Sorry I took a minute to text back. I was just reading about a hurricane.

Me: What? There’s a hurricane? WHERE? OMG?

Jerk: No, I found your column.

He was talking about this column:  “Surviving the Hurricane of Chronic Pain.”    

You know, the one where I share all the intimate details of being in chronic pain for the last three years. 

Where I allude to things like suicidal thoughts with lines like: “I spent almost six months on the verge of drowning. And eventually I just got so tired that I wanted nothing more than to close my eyes, fall back into the water, and let it all go.”

And I talk about how many drugs I take. And how I live with my mom. And how I only barely survived the last few years.  

I had never even met this man and yet he was already getting a glimpse into incredibly personal parts of my life story.  It kind of made me mad, if I’m being honest. I mean, yes, I put it all out there. But I wasn’t expecting Jerk to go looking for it all so quickly. 

I was a writer long before I woke up with rib pain in February 2013. And since then, I’ve turned to the written word to try and make sense of it all. I always say: Writing is just a part of my soul, and when I go through things, I can’t not write about it. 

Of course, choosing to share those writings with the world is another thing altogether. And it’s a choice I make with great care. 

I try to be raw, visceral and real, but at the same time there are actually some things that are off limits. There are some pieces of my writing that only my best friend has ever read because I decided they were just a bit too personal for the internet. 

But even with that filter, there’s a lot about me out there for all the world to read. And all of it includes my real name. 

Anyone with three minutes and Google can find out about my long-term health problems, my opioid use, and my struggles with suicidal thoughts. And while it kind of sucks when a Tinder guy I think I might like finds all that stuff, it’s probably worse when people I know professionally see all of that as well. 

But then, I get the emails. And the private Facebook messages. And the comments. And I remember why I keep putting everything out there. 

I get emails that say things like:

“[Chronic pain] is a tough thing to live with for sure and I've felt so much of what you've written. It’s nice to know it's not just me to be honest.”

And private Facebook messages like:

“I've not openly shared my story like this before, just beginning to live a more transparent life, sharing and caring with others. You inspire me, by being so open with your story and the writing. Soon I will be working on my YouTube channel doing just this, sharing my testimony and journey in hopes to share connect helping one another. Peace.”

And Cat, who runs an intercostal neuralgia support group on Facebook, links to my column about my Painniversary, with comments like:

“So, I've never actually met someone with my condition face to face. But this is my friend Crystal who lives in USA, and has intercostal neuralgia like me. She is a writer and this is her pain blog. We 'met' through the support page I started 4 years ago.

My Painniversary is the 1st of October 2010. My pain hasn't improved. It's changed a bit though. I don't feel like I'm being stabbed as often, and I don't get the ‘needle of icicles’ down my nipple so much either, but the 24/7 relentlessness is always there. Weird to say, but it's comforting to know there are others like me who get what I'm going through.

Pain cannot be explained only experienced, but I totally get what Crystal is saying. I understand x.”

I read all this and it stops me in tracks.

I’ll be at my sister’s basketball game or waiting for a Tinder date to show up, and I’ll get a little notification or I’ll see a comment and I’ll just stop. I promise you, I read every single comment, every single email, every single Facebook message. And every single one of them touches my heart in a way that I can’t even explain. And I have to say, thank you to every single person who has ever taken the time to read my work, and then felt compelled to comment. Seriously. Thank you.

So yes, it actually really is annoying and frustrating when Jerk on Tinder finds out way too much about me before we even share a glass of wine together. But I’m going to keep putting myself out there, sharing way too much information about my life.

Because if I literally only help one person know that they aren’t alone and they aren’t crazy, then it’s more than worth it. Even if it means that ultimately, things don’t work out with Jerk from Tinder.

Crystal Lindell is a journalist who lives in Illinois. She loves Taco Bell, watching "Burn Notice" episodes on Netflix and Snicker's Bites. She has had intercostal neuralgia since February 2013.

Crystal writes about it on her blog, “The Only Certainty is Bad Grammar.”

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

Study Finds Errors in Drug Websites

By Pat Anson, Editor

Nearly six out of ten Americans adults have gone online for health information in the past year, usually to identify medical conditions and treatments, according to the Pew Research Center. But just how reliable is the information they found?

A research study led by drug maker Purdue Pharma found that several websites where physicians and consumers get information about medications contain misinformation that could potentially jeopardize patient safety.

Purdue and 10 other pharmaceutical companies evaluated five websites; Medscape, Lexicomp Online, Epocrates Online, Drugs.com and RxList, which are referred to as online drug information compendia (ODIC).  

The sites typically offer information on side effects, warnings, safety, and dosages for thousands of brand name and generic drugs. Medscape, for example,  calls itself “the most authoritative and accessible point-of-care medical reference available” on the Internet.

Although the content is “informative and easily accessible,” researchers say the websites contain misinformation that could lead to drugs being misused.

"This is an important study that highlights the need for HCPs (healthcare providers) and consumers to use multiple sources when seeking drug information, as there were a surprisingly large number of errors, including inaccuracies and outdated information, across various drug summaries in online drug information compendia," said lead author Amarita Randhawa, Senior Manager of Medical Services at Purdue Pharma, which makes OxyContin.

"As ODIC use expands, it is crucial to ensure drug summaries are up-to-date, accurate and complete. Purdue Pharma has implemented an ongoing compendia review process, which served as the model for this collaborative initiative." 

The 11 participating companies evaluated 270 drug summaries on the five websites and found a median average of 782 errors. Dosage and administration, patient education, and warnings and precautions were the categories with the greatest number of errors. Most of the errors invbolved information that was incomplete, inaccurate or omitted. 

The study, which is being published in the Annals of Pharmacotherapy, does not identify what drugs were evaluated, only that they are used to treat a variety of different conditions, including pain, diabetes, infectious diseases and cardiovascular problems.

“Boxed warning information for product B was incomplete because the warning regarding addiction, abuse, and misuse was not provided,” was one of the errors cited.

“The warning that product F may cause dizziness and somnolence and impair the ability to drive or operate machinery as described in the Medication Guide was missing,” was another error.

The two consumer oriented websites, Drugs.com and RxList, had fewer errors on average than the other three websites, which are mainly designed for physicians and healthcare providers.

“Although the intent of this study was not to compare one compendium with another, it should not be surprising that HCP-ODIC contained a greater number of errors compared with consumer-ODIC because of the detailed and indepth nature of HCP-focused drug summaries,” the researchers said.

The Consumer and Patient Health Information Section (CAPHIS) has compiled a list 100 health websites it considers trustworthy. The list can be accessed by clicking here.

The National Institutes of Health also has tips on finding reliable health information online.

Living with Chronic Blood Clots

By Martin Lemieux, Guest Columnist

My story starts when I was 18 years old, almost 20 years ago, when I had my first deep vein thrombosis (DVT), a blood clot in my lower left leg.

At first doctors thought it was due to a back sprain that had forced me to lie down for a long period. But when I started getting a blood clot about once a year thereafter, they investigated further.

When I was 21, I was diagnosed with Factor V Leiden – a blood clotting disorder – which meant I would be prone to clotting for the rest of my life. At that age, it was a scary thought. I knew people died from blood clots every single day and I later learned that clots are the third leading cause of death by disease.

My mom was especially afraid for my well-being and would constantly want me to be careful. But being extra careful all the time isn't living; it's like being in prison for the mind.

About 9 years ago, a reddish/black round spot appeared on the ankle of my left leg. After a physical day of work, I came home, took off my work boots and this spot ripped off with my sock, causing a great deal of pain and bleeding. Panicking, I went straight to the hospital. Even after extensive tests, no one had any answers. I was given outpatient wound care, which went on for awhile.

martin lemieux

The wound itself became larger, more inflamed and caused a great deal of pain. I was referred to a leading dermatologist in Canada, who determined that these chronic wounds could be due to a condition called Rheumatoid Vasculitis, a diagnosis that later proved to be false.

Not knowing for sure what is wrong with you is hard to go through, especially when answers are swirled around you for years. My family took it the hardest, since all they wanted were some answers that might one day help heal my wounds.

Any form of Vasculitis is rare. I was treated with prednisone for almost two years with no effect. I didn't want to be on prednisone anymore because of the major side-effects and the fact that my wounds were not healing. My specialists agreed, which raised the possibility that it could be another even rarer condition called Livedoid Vasculopathy (LV).

There's very little documentation on this condition and even less on ways to treat LV. I've tried many treatments, including daily injections of low-molecular weight heparin (a blood thinner) and even a daily 6-week treatment using hyperbaric oxygen tank therapy to induce oxygen where it counts most.

Unfortunately, due to my underlining conditions, any treatment we've tried has had little to no effect.

Both of my legs have been wrapped with Coban 2 layer compression bandages, Biatain ibu wound dressings, and other dressing materials for almost 9 years straight.

I've unfortunately become somewhat of a professional wound care specialist and try to educate and help others whenever I can. I've been to many wound care clinics giving presentations to new ER nurses and long-term wound care clients looking to be more independent with their own care from home.

One day at a mall, I was standing in line to get a coffee when suddenly I felt a "pop" from my right leg. A few seconds later, my foot felt extremely warm. Looking down at my leg, I was shocked to see that my foot was now standing in a pool of blood. Stunned, confused and somewhat embarrassed, I started walking down the hall to try to reach an exit in order to hail a cab to go to the hospital.

I had no idea I was leaving a trail of blood as I walked, and a few pedestrians followed my every step. I eventually collapsed from the blood loss and woke up sitting on the floor with a kind man who had wrapped his shirt around my leg to prevent more blood loss.

This was probably one of the scariest moments in my life. I was surrounded by people who were helping me while I was sitting in a pool of blood and I didn't know a single person (still don't to this day). It amazes me when people say the world is a mean place, because I've found that there are kind individuals everywhere I look. It's all in the mentality on how you chose to live, which surrounds you with what you believe in.

To date, these conditions have changed my life drastically in ways most people can't fathom. We’ve also discovered after extensive tests that I was born with one kidney, my arterial system is extremely abnormal and I have an elongated bladder. Like most people suffering from these conditions, I am forced to take an assortment of medications to help with blood clots, inflammation and pain. I have to be very careful of the type of foods I eat to enhance my energy, healing and well-being. My life has become very specific to daily tasks and necessary precautions.

One day I hope to meet a specialist willing to take a little risk here and there. At this point, I'm open to any suggestions that could provide me with some form of possibility for a better life.

Nowadays my time is dedicated to helping others, gaining knowledge and connecting with like-minded individuals who are an inspiration to myself and all who know them.

Martin Lemieux is from Ontario, Canada. Martin dedicates his time to helping patients who cannot advocate for themselves. He is currently writing two books on health care, patient care and how to be your own healthcare ambassador. Martin can be reached on Twitter at @Martin_Lemieux.

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 represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Spider Venom Could Take Sting out of Chronic Pain

By Pat Anson, Editor

Researchers in Australia have isolated a toxin in the venom of a tarantula that shows promise as a pain reliever. The discovery could accelerate development of a new class of natural painkillers that are not addictive and more effective than opioids.

Thrixopelma pruriens, more commonly known as the Peruvian Green Velvet Tarantula, is native to South America.  The spider’s bite isn’t potent enough to kill humans, but researchers at the University of Queensland say its venom inhibits pain receptors.

"Our group is specifically interested in understanding the mode of action of this toxin to gain information that can guide us in the design and optimization of novel pain therapeutics," said Sónia Troeira Henriques, senior research officer at the University of Queensland's Institute for Molecular Bioscience.

The peptide toxin – known as ProTx-II – inhibits pain signals by binding to the membranes of nerve cells.

image courtesy yale university

"Our results show that the cell membrane plays an important role in the ability of ProTx-II to inhibit the pain receptor. In particular, the neuronal cell membranes attract the peptide to the neurons, increase its concentration close to the pain receptors, and lock the peptide in the right orientation to maximize its interaction with the target," said Henriques.

Henriques and her colleagues were the first to discover the importance of membrane-binding properties of ProTx-II in inhibiting a human pain receptor known as Nav 1.7. Previous research has shown that people born without Nav 1.7 channels due to genetic mutation are indifferent to pain – so blocking those channels in people with normal pain pathways has the potential to “turn off” pain.

University of Queensland researchers have studied the venom of over 200 spider species and found that 40% of the venoms contain at least one compound that blocked Nav 1.7 channels. But they’ve only scratched the surface. There are over 45,000 species of spiders, many of which kill their prey with venom that contain hundreds - or even thousands - of protein molecules that block nerve activity.

Based on the group's findings, they're now designing new toxins with greater affinity for the cell membrane and fewer side effects.

"Our work creates an opportunity to explore the importance of the cell membrane in the activity of peptide toxins that target other voltage-gated ion channels involved in important disorders," said Henriques.

Researchers are also studying the potential of venom in cone snails for its potential for blocking pain signals in humans. German scientists at the Pharmaceutical Institute of the University of Bonn say one advantage of the peptides found in snail venom is that they decompose quickly and are unlikely to cause dependency.

A pharmaceutical drug derived from cone snail neurotoxins has already been developed and marketed under the brand name Prialt. The drug is injected in spinal cord fluid to treat severe pain caused by failed back surgery, injury, AIDS, and cancer.

E-coli Bacteria Used to Produce Morphine

By Pat Anson, Editor

While politicians and regulators in the U.S. try to decrease access to opioid pain medications, scientists are developing new techniques to mass produce them.

The latest development is at Kyoto University in Japan, where researchers have learned how to tweak E coli bacteria so that they pump out thebaine, a morphine precursor that can be modified to make opioid pain relievers.

The genetically modified Escherichia coli – a common gut microbe -- produces 300 times more thebaine than a recently developed method involving yeast.

"Morphine has a complex molecular structure; because of this, the production of morphine and similar painkillers is expensive and time-consuming. But with our E coli, we were able to yield 2.1 miligrams of thebaine in a matter of days from roughly 20 grams of sugar,” said lead author Fumihiko Sato of Kyoto University.

"Improvements in opiate production in this E. coli system represent a major step towards the development of alternative opiate production systems."

Sato’s study is published in the journal Nature Communications.

 Escherichia coli

Morphine is extracted from opium poppy sap in a process that typically takes up to a year. Morphine can then be converted to opiates such as codeine, hydrocodone or even heroin.

Scientists at Stanford University last year engineered the yeast genome so that it produces opiate alkaloids from sugar. The genetically altered yeast cells grow so rapidly they convert sugar into hydrocodone in just three to five days. That raised fears that opioids could be produced cheaply and easily, provided that one has access to the necessary yeast strain.

With E coli, Sato says that such a production risk is unlikely.

"Four strains of genetically modified E coli are necessary to turn sugar into thebaine," explains Sato. "E coli are more difficult to manage and require expertise in handling. This should serve as a deterrent to unregulated production."

In 2011, Sato and colleagues engineered E coli to synthesize reticuline, another morphine precursor. In the new system, the team added genes from other bacteria and enzyme genes from two strains of opium poppies, Coptis japonica, and Arabidopsis.

"By adding another two genes, our E coli were able to produce hydrocodone, which would certainly boost the practicality of this technique," Sato said. "With a few more improvements to the technique and clearance of pharmaceutical regulations, manufacturing morphine-like painkillers from microbes could soon be a reality."

Opioid pain medications are widely available in the United States, where the focus is often on their potential misuse. But the World Health Organization estimates that 5.5 billion people worldwide have little or no access to opioids because of their limited supply and high cost.

Survey Finds Medical Marijuana Safe and Effective

By Ellen Lenox Smith, Columnist

Recently HelloMD, an online “telehealth” service that provides consultations with doctors who can write prescriptions for medical marijuana, conducted an extensive survey of 1,400 of patients. Patients were asked to complete a questionnaire consisting of 31 questions dealing with their marijuana use.

The survey results (which you can see by clicking here)  really caught my attention and are very exciting.

The survey found that the most common conditions that medical marijuana was being used to treat were chronic pain, anxiety, stress and insomnia. Eight out of ten patients (84%) strongly agreed that cannabis provides them with relief from their symptoms.

Medical marijuana may be legal in 23 states, but many of those states have yet to certify chronic pain as a condition marijuana can be prescribed for. Yet we have 100 million in our country suffering from pain! Let’s hope surveys like this will help to educate those states.

“There were few to no reports of negative consequences of cannabis use, with over 96% of users either somewhat likely or highly likely to recommend cannabis use to friends, family or others seeking improved wellbeing,” according to the HelloMD report.

This statement does not surprise me at all, for we have not seen negative consequences of marijuana use since 2007, when my husband and I first started helping patients wanting to try cannabis. Those of us that have felt the benefits of cannabis talk and encourage others to consider trying it all the time when we meet someone who is suffering.

I also do not believe this was any select group surveyed by HellloMD, but are typical cannabis users that realized how gentle, safe and effective this medication is.

The survey found that middle aged and elderly patients were more likely to use marijuana for pain management, while younger age groups were using it to treat stress, anxiety, mental-health disorders, nausea and issues with appetite. I love this finding. That is exactly what we are observing in the different ages we deal with.  

HelloMD also found that social perception of cannabis use is moving into the mainstream of society, as more and more states pass legislation allowing medical marijuana.

“Amongst those that use medical marijuana, 82% are open with family members about their use with 44% strongly agreeing. 15% still hide their use from family members (perhaps their children, although this is unclear from our data). 59.5% of patients are open with their close friends and a further 35% with all friends (close and otherwise). Only 5.3% do not admit to friends that they use medical marijuana,” the report found.

How exciting that we are now able to feel comfortable sharing the truth of our lives and the benefits we are gaining by being allowed to use this medication. As the report points out, there has never been a death from overdose attributed to cannabis and the safety record of cannabis is superior to that of pharmaceutical pain medications. This reinforces what we have been observing and I am thrilled what we have been saying is mentioned here!

“Our data indicates that 78% of those using cannabis for health and wellness are above the age of 25. In stark contrast to the stoner stereotype, these people are highly educated working professionals. Many are parents. They could be your friends, your colleagues, or your neighbors. All of them have legitimate health issues. All of them are seeking alternatives to traditional prescribed medication considered toxic and laden with the potential of negative side effects,” the report concludes.

Thanks to surveys like this, we can continue to work to get the education out there for people to understand that those of us using cannabis for pain are not all getting high or stoned. The brain receptors react to marijuana and we simply get pain relief! However, anyone can take too much of any medication and have a negative reaction.

I hope we will see even more surveys about medical marijuana, along with research, so that more will get on board and understand the advantages of this plant.

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis. Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their website.

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.

Hospital Study Calls Chest Pain ‘Opportunity for Savings’

By Pat Anson, Editor

Reducing the cost of healthcare is a major goal for insurers, providers and patients, but some physicians say the state of Rhode Island is taking things too far by discouraging some patients from getting their pain treated.

The state’s Executive Office of Health and Human Services has issued a report that identifies $90 million in annual savings “by preventing non-emergency visits” to hospital emergency rooms. Chest pain is listed as “the greatest opportunity for savings” while back pain, abdominal pain and headache are considered “potentially preventable" reasons for emergency room care.

“While many people associate ‘chest pain’ with ‘heart attack’, a truly emergent and serious condition, the majority of those who present to the emergency room with chest pain and are not admitted to the hospital are not experiencing a heart attack,” the report says.

In Rhode Island, 46% of emergency room visits were considered potentially preventable for privately insured patients and 70% of the visits for Medicaid patients.

“A potentially preventable emergency room visit is when a patient goes to an emergency room for a health condition that could have been treated in a non-emergency setting or prevented by keeping them healthier earlier on. Treatment in an emergency room is generally more expensive than a primary care visit,” according to the report.

The average cost of an emergency room visit in Rhode Island varies considerably, from $368 for a Medicaid recipient to $1,154 for someone with private insurance.  

The American College of Emergency Physicians (ACEP) calls the report irresponsible and flawed, because it relies on data about patients’ final diagnoses, not their presenting symptoms. That analysis does not take into consideration the national "prudent layperson" standard in the Affordable Care Act (ACA), which says emergency visits must be covered by insurance companies based on the patients' symptoms, not their final diagnoses.

"It is very alarming that a report like this is being issued that directly undermines language in the ACA and patients' responsible use of the emergency department," said Jay Kaplan, MD, president of ACEP. "Patients never should be forced into the position of self-diagnosing their medical conditions out of fear of insurance not covering the visit. This applies 20/20 hindsight to possibly life-threatening conditions — such as chest pain — and it violates the national prudent layperson standard designed to protect patients' health plan coverage of emergency care."

Data in the Rhode Island report also does not correlate with the latest national data on emergency visits from the CDC, which found that 96 percent of emergency patients needed medical care within two hours.

"A report like this only serves to potentially scare patients away from the emergency department when they may need it most," said Christopher Zabbo, DO, president of ACEP's Rhode Island Chapter. "Both harmless and deadly conditions often have the same presentations. Asking patients to make that determination while at home, anxious, and with inadequate information, is a recipe for disaster."   

“I do all I can to stay away from our hospitals unless it is a planned surgery. I arrive with all my records, educated on my condition and find they (doctors) are immediately turned off due to my complications,” said Ellen Lenox Smith, a Rhode Island resident who suffers from Ehlers Danlos syndrome and is a columnist for Pain News Network. Ellen recently wrote about some of her bad hospital experiences and how she learned to avoid future ones. (see”How to Stop Hospital Horrors”).  

According to the CDC, stomach and abdominal pain were the number one reason for patients to visit an emergency room in 2011, followed by chest pain, fever, headache, cough and back pain.

Law Enforcement and Pain Patients

By John Burke, Guest Columnist

I first need to tell you that I spent 48 years in law enforcement and recently retired in 2015 after commanding a large enforcement initiative in southwestern Ohio. I have extensive experience in  prescription drug abuse as it pertains to law enforcement and have written a monthly article for the past 15 years in Pharmacy Times magazine on the topic of drug diversion.

I am the past national president of the National Association of Drug Diversion Investigators and current president of the International Health Facility Diversion Association. In short, I am no stranger to the issues surrounding the abuse and diversion of pharmaceuticals.

I am also a self-declared pain patient advocate who strongly believes that the vast majority of controlled substances that are consumed in the U.S. are taken by legitimate pain patients.  Pain patients have no real lobbying group that can apply pressure on politicians – who are often oblivious to the plight of pain patients as they scramble to get reelected!

In 1990, I was fortunate enough to be assigned to form and command the Cincinnati Police Department’s Pharmaceutical Diversion Unit (PDU). In the early 1970’s I had seen prescription drug abuse on the streets and knew that it was a much bigger problem than was being hailed by the news media. In starting PDU, I made a point to try and educate the media on the subject, and we were very successful in doing that as it was a brand new issue as far as they knew and they flocked to our press conferences.

JOHN BURKE

In addition to the arrests, we provided community education on prescription drug abuse, but sadly we said very little about a victim I got to know well -- the chronic pain patient. I can’t honestly say that pain patients entered my mind in those days, as we stayed focused on those illegally diverting pharmaceuticals. We also specialized on the diversion of medications inside healthcare facilities, a huge problem that exists still today.

We entered a time in the 1990’s when pain patients were deemed to be undertreated, new opioid medications were developed and marketed, and as we entered the 21st century, pain pill abuse started to skyrocket. Most of this century has seen a concentration on pharmaceutical diversion issues, with the spotlight on OxyContin until Purdue Pharma successfully marketed an abuse deterrent formulation in 2010. Since then, heroin has exploded onto the illicit drug scene, accelerating the overdose death rate as even the smallest of communities cry for help.

I saw a chronic pain patient up close and personal about 10 years ago. She was my mother-in-law and she came to live with my wife and I in our home. She had been a pain patient since elementary school. Her leg was permanently fused together and over the years she fought doctors who insisted that amputation was the best route to take for her welfare.

One day, her husband came to me and said that his wife was experiencing a particularly bad time with her pain relief and was moaning most of the night, unable to sleep. Since I had participated in dozens of continuing education programs with renowned pain specialists, I did know a little about pain management -- at least enough to ask if they had told her doctor so that her pain medication could be adjusted.

The answer was that she doesn’t take any pain medication due to the fact that her former doctor, several decades deceased, had told her never to take anything stronger than an aspirin or she would get addicted! I was shocked at this and advised him to go back to her current doctor and request some pain medication for a person who had suffered with daily pain for over 60 years at this point.

Her young physician told her that she was unable to prescribe a controlled substance, something that was blatantly false, but was nonetheless a reality for this almost lifetime pain patient. I then assisted them in finding a pain specialist and after one visit she was prescribed a pain patch and immediately started using something she should have had access to years before.

Her relief was incredible. Although not pain free by any means, she came crying to me that it was by far the most significant pain relief she had ever had in her life. No doubt it was, when aspirin was the only analgesic she was taking for chronic pain. This pain had flourished for decades due to the advice of a well-intentioned, but misinformed physician, who warned her about addiction issues when her pain was becoming unbearable.

I offer no apologies for the aggressive prosecutions of criminal doctors and those who prey on drug addicts by prescribing or dispensing controlled substances merely to line their pockets rather than to provide quality pain care. These people had no intention to provide pain relief to patients, and in the end did great damage to legitimate patients by giving the public the erroneous thought that virtually all people on pain meds are nothing more than addicts!

Every presentation I give, I make it a point to remind the audience that the vast majority of pain medications are prescribed by competent caring prescribers, dispensed by caring pharmacists, and end up in the hands of those who desperately need these drugs to perform every day functions we take for granted.

Right now there is incredible pressure by uninformed politicians to suggest some drastic changes in how opioids are prescribed and dispensed in this country. Law enforcement has plenty of good laws to go after the outliers vigorously, and I strongly urge we continue to do that, but with the full realization that the plight of pain patients’ needs to be protected in the meantime. Balance is important in most things in life and this issue is certainly no exception.

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.

Australians Lead Global Pain Survey

By Pat Anson, Editor

Australians have more aches and pains than anyone else in the world, but are least likely to complain about it.

Germans say their pain stings, the Chinese have a dull pain, in Japan it throbs, and the Poles say they’re numb from it.

And the Italians? Those Latin lovers are least likely to let pain interfere with their sex lives.

Those are some of the odder facts that emerged from a consumer research survey of 7,000 people in 14 countries conducted by GlaxcoSmithKline (GSK), a British pharmaceutical company.

The so-called Global Pain Index found that overall body pain – defined as aches in your muscles, tendons, ligaments and joints – truly knows no borders and is widespread throughout the world, but it affects people differently depending on where they live.

The survey found that Australians (97%) are most likely to report pain, followed by Russia (95%), China (94%), the UK (93%) and the United States (90%).

Swedes and Germans (88%) are least likely to feel pain.

The Chinese are most likely to complain about their pain (71%), followed by Mexicans (69%), Brazilians (57%) and Italians (55%). Only about a third of Australians complain about their pain.

People in the UK are most likely to see pain as just another part of life, even though it affects them negatively in a variety of ways. Over half (55%) say they cannot have sex because of body pain, two-thirds say it disrupts their social life, and 62% say pain has hurt their work performance.

Only about half (53%) the people in the UK know what is causing their pain.  

“Many people in the UK are taking the attitude that body pain is something you can ignore and hope it goes away, but this approach isn’t working. The findings of the GSK Global Pain Index have shown us that the UK is one of the countries where most people report feeling pain, but it also illustrates that we need a better understanding of our pain and how to treat it,” says Dr. Sarah Davis, a general practitioner in London.

“Pain is hurting every aspect of our lives in the UK, stopping people from enjoying time with friends and family, from enjoying the hobbies and sports they enjoy and hurting their prospects at work.”

The survey was conducted by the research firm Edelman Berland from November 2014 through January 2015 in Australia, Brazil, Canada, China, Germany, Italy, Japan, Mexico, Poland, Russia, Saudi Arabia, Sweden, UK and the United States.

Senate Confirms Califf as FDA Commissioner

By Pat Anson, Editor

The U.S. Senate has overwhelmingly confirmed Dr. Robert Califf as commissioner of the Food and Drug Administration after months of controversy over his ties to the pharmaceutical industry and criticism of the agency’s regulation of opioid pain medication.

The vote was 89-4 for Califf, a cardiologist and medical researcher at Duke University, who pledged earlier this month to use tougher language in warning labels for extended release opioids and to prioritize development of non-opioid alternatives for pain. Califf also endorsed the CDC’s controversial opioid prescribing guidelines, even though some of the FDA’s own experts believe the guidelines lack scientific evidence.

"If addiction to opioids and misuse of opioids is the enemy, then we underestimated the tenacity of the enemy," Califf told The Associated Press after his nomination was confirmed. "We've got to adjust."

Califf was pressured into changing the FDA’s opioid policies after his nomination was held up by Democratic presidential candidate Sen. Bernie Sanders of Vermont, and Sens. Joe Manchin of West Virginia (D) and Ed Markey of Massachusetts (D).

DR. ROBERT CALIFF

Manchin, Markey, Sen. Richard Blumenthal of Connecticut (D) and Sen. Kelly Ayotte of New Hampshire (R) voted against the nomination. Sanders was on the campaign trail and did not vote on the nomination.

"FDA stands for Food and Drug Administration, but over the last 20 years it really stands for ‘fostering drug addiction,' " Markey said in a speech on the Senate floor.

Both Markey and Manchin have vowed to “change the culture” at FDA to combat what they call a “pandemic” of opioid abuse and overdoses.

“I just think he’s the wrong person at this time of need for the position that we need to shake it up,” said Manchin. "The FDA needs new leadership, new focus and a new culture."

Califf founded Duke University’s Clinical Research Institute, which primarily works with and is funded by pharmaceutical companies. He listed over a dozen drug makers in a conflict-of-interest disclosure for a recent article he wrote in the New England Journal of Medicine.

“Dr. Califf has demonstrated a long and deep commitment to advancing the public health throughout his distinguished career as a physician, researcher, and leader in the fields of science and medicine.  He understands well the critical role that the FDA plays in responding to the changes in our society while protecting and promoting the health of the public,” said Dr. Stephen Ostroff, the FDA’s chief scientist, who has served as acting head of the agency for the past year.

How to Get the Most out of Your Doctor’s Appointment

By Barby Ingle, Columnist

In my last column, I wrote about using a patient checklist to organize your thoughts and questions before going to the doctor. Now it's time to put that checklist to work and get the most out of your doctor's appointment. 

The process of finding and choosing a physician is, in some respects, comparable to the process of making a decision about investing in a particular stock or mutual fund. After all, you would not invest your hard-earned money in a stock without first doing research about the company’s past performance, current financial status, and projected future earnings. You’d spend a considerable amount of time and energy doing research before investing.

The same general principle applies to the process of finding and choosing a physician. Finding the right medical team requires a considerable investment in terms of both time and energy, but the potential payoff can be well worth it. After all, what is more important than your health and well-being?

It’s appointment day with my healthcare provider. I have prepared my checklist, got myself dressed enough to leave the house, put on my flip flops, and am ready to go. Most of my provider’s offices are at least one hour away from my house. I pack the car with comforts like pillows, blanket, and bottled water. The better we are prepared, the better our appointments will go.

Especially for new patients, be ready to answer a series of questions such as exactly where does it hurt? Have you had similar pain in the past? Is the pain sharp, dull, aching, burning, or does it have some other characteristic? Is the pain constant or does it come and go?

What makes the pain better? What makes the pain worse? Are you able to sleep through the night or does the pain keep you awake? How much does pain interrupt your daily activities, such as bathing, eating, dressing, and getting around?

How often does the pain interfere with your ability to think clearly, your appetite, energy, mood, or relationships with other people? How many days over the past week have you been unable to do what you want because of your pain? Is there an obvious reason for the pain, such as a sprained ankle or an arthritic joint? 

For longtime patients, or as providers say “thick case file” patients, be ready to give your doctor an update on any changes since your last visit and to ask questions of your own. This medication is not helping anymore, what else is there? Are there any new options for non-drug treatments? Do you recommend any specific diet changes?

Remember to leave the checklist with the doctor to put in your records, so if something comes up they can refer to it and better remember what you may need if an emergency comes up. Keep in mind that doctors have hundreds or even thousands of patients, so they sometimes need reminders. It does not mean that they do not care about you. Taking control of your healthcare team will facilitate communication, better treatment, and quality pain care.

Be sure that you are keeping all of your healthcare providers abreast of your condition, goals, progress and setbacks. This team includes all doctors (primary, neurologist, pain management and other specialties), physical therapists and caregivers.

Waits are getting longer and longer at my providers' offices. This past year doctors have kept me waiting at least 20 minutes. My heart doctor was over 2 hours late one time. That’s another reason to be totally prepared so you can get the best of your 10 or 15 minutes with the provider. It is important that we stay on track and focused at doctor appointments.

Many times I forget what the doctor even told me to do within five minutes of leaving the office. What I do to combat this is bring someone with me when possible to take notes. If there is no one who can come with me, I record the conversation. When I get home I can turn to my notes or caregiver to remember all of the new directions, goals and plans I should be working on between appointments.

A doctor’s appointment for me is really draining; the drive, waiting in the office, poking, testing, blood draws, etc. By the time I get home I have to rest. Since my notes are done I don’t have to worry about forgetting what to do.

Barby Ingle suffers from Reflex Sympathetic Dystrophy (RSD) and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics.

More information about Barby can be found at her website.

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.

Race and Economic Insecurity Play Key Roles in Pain

By Pat Anson, Editor

Two new studies are adding to the growing evidence that links pain with economic, social and racial differences in the United States.

Researchers at Indiana University-Purdue University say African-Americans use coping strategies that often make their pain worse; while researchers at the University of Virginia found that people who feel that their financial outlook is shaky experience more physical pain.

“The past decade has seen a rise in both economic insecurity and frequency of physical pain. The current research reveals a causal connection between these two growing and consequential social trends,” wrote lead author Eileen Chou of the University of Virginia in the journal Psychological Science.

Chou and her colleagues looked at six different studies and found that economic insecurity produces physical pain, reduces pain tolerance, and predicts consumption of over-the-counter pain relievers. The researchers believe economic insecurity also leads people to feel a lack of control in their lives, which activates psychological processes associated with anxiety, fear, and stress.

Data from a consumer panel of nearly 34,000 individuals revealed that households in which both adults were unemployed spent 20% more on over-the-counter pain relievers than households in which at least one adult was working.

Smaller studies also found that unemployment was correlated with reports of pain. And people who recalled periods of economic instability reported almost double the amount of physical pain than those who recalled economically stable periods.

“Overall, the findings show that it physically hurts to be economically insecure,” Chou said.

Financial stress and economic insecurity were also blamed in a recent landmark study by Princeton University researchers who found that nearly half a million middle aged white Americans died prematurely in the last 15 years. The rising death rate for whites was also attributed to drug and alcohol poisoning, suicide, chronic pain and disability.

Blacks and Whites Cope with Pain Differently

The researchers at Indiana University-Purdue University also used a meta-analysis (a study of studies) to reach their conclusion that black and white Americans cope with pain differently. The review of 19 studies, which included 2,719 black and 3,770 white adults, is the first to quantify the relationship between race and the use of pain-coping strategies.

"Coping" was broadly defined as the use of behavioral and cognitive techniques to manage stress.

Blacks were significantly more likely to use prayer and hoping as pain-coping strategies than whites, according to researchers. Blacks were also more likely than whites to think about their pain in a catastrophic manner.

"Our findings suggest that blacks frequently use coping strategies that are associated with worse pain and functioning," said Adam Hirsh, a clinical health psychologist. "They view themselves as helpless in the face of pain. They see the pain as magnified -- the worst pain ever. They ruminate, think about the pain all the time, and it occupies a lot of their mind space."

While that kind of coping might be considered a negative approach to pain, Hirsch says it also may have benefits.

“It may also be a potent communication strategy -- it tells others in a culture with a strong communal component that the person is really suffering and needs help. Thus, it may be helpful in some ways, such as eliciting support from other people, and unhelpful in other ways. In future studies, we will give this more nuanced investigation," said Hirsch, whose study is published in the Journal of Pain.

Ignoring pain rather than allowing it to interfere with the task at hand was the only coping strategy employed by whites more than blacks. Several studies reviewed by researchers found that ignoring strategies are associated with less pain, whereas praying, hoping and catastrophizing are associated with higher pain levels.

"How people think about their pain matters," said Hirsh. "For example, religion can be used as a passive coping strategy -- asking a higher authority to take the pain away -- or as an active coping strategy -- asking to be given strength to manage pain.”

Blacks reported higher levels of pain than whites for a number of conditions including arthritis, post-operative pain and lower-back pain. Blacks also experience greater pain in both clinical and experimental studies. Blacks reported less-effective pain care, are unable to return to work for a longer time due to pain, and have worse functional outcomes.

Hirsch says understanding how different racial groups cope with pain may improve pain care and support individually tailored treatment.

It’s Time for Pain Patients to Speak Up

By Emily Ullrich, Columnist

By definition, journalists are ethically bound to present both sides of a story; to be unbiased, objective, fair and equal. Stories that are not labeled as opinion should leave it up to the consumer to determine the truth or which side of the controversy they agree with.

But since the media have become obsessed with the so-called opioid epidemic, these necessary fundamentals seem to not apply. We, as consumers of media, need to ask why they have fallen short on this topic.

The government is also supposed to consider all sides before making laws which will potentially be detrimental to the lives and health of its citizens. But the CDC only furthered the anti-opioid hysteria by not including chronic pain patients or the doctors who treat them in the initial drafting of its opioid prescribing guidelines.

In fact, the witch hunt has gotten so bad, that we have a bipartisan majority of U.S. senators who have organized to dictate the quality of medical care for the 100 million Americans who suffer from chronic pain. (see “Senators Seek to Silence Pain Patients”)

If senators from both parties came together to speak out for or against any other hot-button issue, like gun control or abortion, there would be absolute mayhem. But, not only do people not challenge the senators’ insensitive, unilateral, and fascist attack on pain patients, we sit quietly in fear.

These lawmakers propose that pain patients should not even be allowed to give their opinions regarding pain control when filling out hospital satisfaction surveys. Now our freedom of speech is under attack, too?

Elimination of pain patients’ rights has become the new American genocide. Patients and doctors alike sit in fear, watching as we are stripped of our right to happiness, our right to adequate medical care, and our ability to treat our pain in the ways we and our doctors see fit. When will enough be enough?

On top of the inequality, there are often discrepancies in the overdose and addiction claims of the CDC, government, and media. There are blatant attempts to hide the sources, research, and financial motives of those involved in the anti-opioid hysteria. There is a significant lack of research and evidence to support this drastic upheaval of our healthcare. Still, no one speaks.

There are so many things that obviously don't add up. No one is asking the right questions and no one is challenging this shady behavior. For some time now, I have been pointing out that the media and government both continuously lump pain patients and addicts together, call our pain medication “drugs,” and lump our meds together with heroin.

This is not accidental. By brainwashing the public to believe that all pain patients are drug addicts, and that pain medicine and heroin are one in the same, they have created an atmosphere of fear. No one wants to sound like they're pro-heroin. No one wants to be seen enabling addicts to get their fix.

There is a desperate need for more mental healthcare and addiction treatment in this country. Instead of addressing this need, the government and media (both funded by the pharmaceutical companies that make the medications deemed to be the “preferred” treatments over opioids) have diabolically created this carefully planned, malignant strategy to eliminate pain patients by making them addicts instead of pain patients. They will make more money by forcing us into rehab and putting us on drugs that will ensure that they keep making far more money than pain medicines ever would, all while making people believe that it's all for our own good.

Many of these “preferred” medications have not been around long enough to determine their long-term safety. They have side effect profiles a mile long and they will only keep us sick; thereby making us lifelong pharmaceutical consumers. Anti-opioid and addiction special interest groups stand to benefit from all of this.

The few times pain patients have been included in the discussion, they are immediately treated like criminals. Boston’s NPR station recently put the onus on a patient to defend herself with questions like, “How is a doctor to know the difference between someone who is addicted and someone with chronic pain that needs to be treated?”

Since when do patients have to defend the reality of their illness? When did being a patient become a defendant? And, if that is the case, what happened to innocent until proven guilty? What happened to doctors (not government and media) determining what is best for their patients?

It is an absolute outrage that our own government officials are dismantling our constitutional and human rights. Yet the stigmas of chronic pain and pain medication run so deep in this country that we keep quiet, knowing it's wrong, but afraid to be lynched for our insubordination.

Our disabilities often prevent us from having the physical fortitude to organize, march, and protest. They are counting on that. Our bodies may be weak, but our minds are strong. Our voices are ONE HUNDRED MILLION STRONG! We need to face our fears and SPEAK UP!

Emily Ullrich suffers from Complex Regional Pain Syndrome (CRPS/RSD), Sphincter of Oddi Dysfunction, Carpal Tunnel Syndrome, Endometriosis, chronic gastritis, Interstitial Cystitis, Migraines, Fibromyalgia, Osteoarthritis, Periodic Limb Movement Disorder, Restless Leg Syndrome, Myoclonic episodes, generalized anxiety disorder, insomnia, bursitis, depression, multiple chemical sensitivity, and Irritable Bowel Syndrome.

Emily is a writer, artist, filmmaker, and has even been an occasional stand-up comedian. She now focuses on patient advocacy for the Power of Pain Foundation, as she is able.

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.