Pain Companion: Talking About Pain

By Sarah Anne Shockley, Columnist

A lot of us don’t like to talk about our pain, understandably. It often seems easier just to live with it in silence than to discuss it with anyone. Ever.

If others have never experienced long-term pain or are pain-avoidant, it can be nearly impossible for them to understand what we’re talking about. We may be answered with blank stares or outright disbelief.

Or, what often happens is that others feel they must try to fix us. We are offered all kinds of medical advice, given the business card of a favorite massage therapist, or web address for the latest miracle supplement. Or we’re told exactly what we don't need to hear: buck up, carry on, be more positive, grin and bear it. Fending off the well-meaning fixers can be exhausting, so we just keep quiet.

And, when we do talk honestly and openly about our pain, sometimes it feels like we’re walking right into the center of it. We become very present to it, and if it also feels like we’re not really heard or validated, we’ve added another level of emotional pain and disappointment to our physical pain. So why bother?

These are all perfectly understandable reasons for not talking about pain.

So why would we talk about it?

Because the alternative - never fully expressing to anyone what we are going through at the deepest levels - is much harder in the long run.  As you probably know quite well, living with pain can be extremely isolating. We are alone in our unique and deeply intimate experience of pain.

While we have very good reasons not to talk about our pain with everyone, if we never talk about it we can feel increasingly disconnected from others, from life, and from ourselves. And I know from personal experience that this can be a very difficult way to live.

For eight years, the only person who understood the full extent of the pain I was in was my neurologist. For all of the reasons listed above, I simply never told anyone else how bad it really was. And I can say at this point that living with pain doesn't get easier and life doesn’t get better by not talking about it. That choice only increases the feelings of invisibility, isolation, and disconnection.

However, talking openly about pain is a tricky business. Finding someone who can be with us and just listen is challenging because so many think they are being helpful by trying to distract us from our pain, or help us overcome, avoid, or downplay it.

People are so geared toward ending pain that they are not always prepared to just be with us and be a compassionate witness. And some people are living with their own unexpressed pain, whether physical or emotional, and they just don’t have the capacity to hear about ours.

So, I would not advocate talking about your pain to just anyone.  It requires a somewhat selective process. There are friends and family that you would like to be able to share with who will not be willing or able. Think about the people in your life that you consider good listeners and who you can trust to truly have your best interests at heart.

Even if there is no one you know who has experienced physical pain in the way that you have, there will most likely be someone who has experienced a deep loss or had to face very trying circumstances that will give them a deeper sense of compassion for what you are going through. They may have been dealing with their own private pains and you may be surprised to find out that they understand about hiding, isolation and loneliness. If you feel there is no one like that in your life, then a trained therapist can be a good choice.

Once you’ve ascertained that this person is an appropriate choice and they are agreeable, then help them understand that what you need is a pair of receptive ears and a receptive heart, and that talking about your pain won’t make it worse, but will actually help you.

Tell them that what you are going to share may be difficult for them to hear, but that you really need them to just be there and hear it without offering anything back for now. Ask them to please hear you out without trying to change anything, fix anything, offer advice, or console you.

Before you have your talk, see if they are willing to agree to the following ground rules:

• Listen to your story without interrupting
• Be present with you in your pain without pity and without fixing
• To not offer advice, just witness

Let them know that the most supportive thing they can do for you right now is not to try to make it all better or make it all go away, but to just be present with you and let you have your pain and not try to change anything for now.

You may want to tell several people, but you may also find that one trusted person who can see you, hear you, and be with you in it is enough. Then, of course, express your gratitude in whatever way you feel is appropriate and let them know what a great gift they have given to you.

And, perhaps when you are done telling your story to this person, on another day, you can offer receptive ears and a receptive heart to them.

Sarah Anne Shockley suffers from Thoracic Outlet Syndrome, a painful condition that affects the nerves and arteries in the upper chest. Sarah is the author of The Pain Companion: Everyday Wisdom for Living With and Moving Beyond Chronic Pain.

 Sarah also writes for her blog, The Pain Companion.

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.

Results of Cannabis Drug Study Cause Market Frenzy

By Pat Anson, Editor

A British pharmaceutical company has reported positive results from a Phase 3 clinical study of a marijuana-based medication for Dravet syndrome, a severe form of children’s epilepsy.

The study found that Epidiolex, a liquid formula containing a plant-derived cannabinoid (CBD), significantly reduced the number of seizures in children with Dravet syndrome. CBD is a compound in cannabis that does not produce the “high” caused by marijuana.

The study findings caused shares of GW Pharmaceuticals (NASDAQ: GWPH) to more than double in trading Monday, much of it fueled by speculation that the company’s cannabinoid products would eventually be approved by the Food and Drug Administration for pain relief.

“If they get this, doctors will say, here’s a cannabinoid prescription,” said CNBC’s Jim Cramer. “This will be the pure cannabis that a lot of people who have been waiting for, an actual painkiller that is not addictive. This will replace, I believe, the terrible, terrible wave of death that oxycodone has caused.

image courtesy gw pharmaceuticals

“If you want to prescribe actual medical marijuana, a real doctor is reluctant to do it because there are no uniform standards, and what you really want is the pure cannabinoid. There will be use of this galore.”

In a statement to CNBC, GW said it was not investigating Epidiolex for pain relief.

"Today's Phase 3 results of Epidiolex (cannabidiol) were not studying the medicine as a possible treatment for pain. Epidiolex is being investigated for Dravet syndrome, Lennox-Gastaut syndrome and Tuberous Sclerosis Complex (TSC), three rare, extremely debilitating epilepsy syndromes that begin in infancy or early childhood," the company said.

The Phase 3 placebo controlled study involved 120 children with Dravet syndrome, who were averaging about 13 seizures a month before the trial began. Seizures declined by over a third in patients treated with Epidiolex, with few side effects.

“The results of this Epidiolex pivotal trial are important and exciting as they represent the first placebo-controlled evidence to support the safety and efficacy of pharmaceutical cannabidiol in children with Dravet syndrome, one of the most severe and difficult-to-treat types of epilepsy,” said Orrin Devinsky, MD, of New York University Langone Medical Center’s Comprehensive Epilepsy Center.

“These data demonstrate that Epidiolex delivers clinically important reductions in seizure frequency together with an acceptable safety and tolerability profile, providing the epilepsy community with the prospect of an appropriately standardized and tested pharmaceutical formulation of cannabidiol being made available by prescription in the future.”

Epidiolex has both Orphan Drug Designation and Fast Track Designation from the U.S. Food and Drug Administration. There are currently no approved treatments for Dravet syndrome in the U.S.

“We are excited about the potential for Epidiolex to become the first FDA approved treatment option specifically for Dravet syndrome patients and their families,” said Justin Gover, GW’s CEO. “In light of this positive data, we will now request a pre-NDA (new drug application) meeting with the FDA to discuss our proposed regulatory submission.”

GW is recruiting 150 patients for a second Phase 3 trial of Epidiolex for Dravet syndrome and is currently conducting a Phase 3 study for Lennox-Gastaut syndrome. Another study of Epidiolex is scheduled to begin soon for a third form of epilepsy, Tuberous Sclerosis Complex.

The company is already marketing a marijuana-based oral spray called Sativex that is being sold in Europe, Canada and Mexico to treat muscle tightness and contractions caused by multiple sclerosis. Canada also allows Sativex to be used for the treatment of neuropathic pain and advanced cancer pain.

Sativex is not currently approved for use in the U.S. for any condition. It is estimated that over 400,000 cancer patients in the U.S. suffer from pain that is not well controlled by opioid pain medications. Two recent Phase 3 studies found that Sativex worked no better than a placebo in treating cancer pain.

Study: Opioids Not Always in Patient’s Best Interest

By Pat Anson, Editor

An industry funded report is calling for greater use of non-opioid medication for post-surgical pain to combat what it calls the “frightening reality” of the opioid epidemic.

The report by an expert panel convened at the Jefferson College of Population Health in Philadelphia claims that relieving a patient’s acute pain with opioids is expensive and “not always in their best interest” because it could lead to addiction.

“The added costs attributable to misuse and abuse of opioid prescriptions originating in the acute care setting are considerable. With steadily increasing numbers of surgical procedures being performed, even small increments in the percentage of chronic opioid users will create an unsustainable societal burden,” wrote lead author Janice Clark, RN, Jefferson College of Population Health.

The report also endorsed efforts to have Medicare eliminate a requirement that hospitals ask patients about the quality of their pain care in patient satisfaction surveys.

“Patient satisfaction has been associated with greater inpatient use, higher health care and prescription drug use and expenditures, and increased mortality. Clearly, giving patients what they want, or think they need, is not always in their best interest,” wrote Clark and her two co-authors.  

“There is so much wrong with this article it is hard to know where to start,” says Janice Reynolds, a patient advocate and retired nurse who specialized in pain management and oncology. She called the report “opiophobic” and unethical.

“It is unconscionable these people say the person in pain cannot say whether his pain was well managed or not,” said Reynolds. “Pain is what the person says it is, existing when he says it does.  It is subjective.  Only the person experiencing it knows if treatment was effective or not, as well as whether he was treated in a compassionate, empathic manor. “

The report’s recommendations -- which are being published in the journal of Population Health Management -- are very similar to guidelines released last month by the American Pain Society, which also promote the use of non-opioid medication for post-surgical pain.

“A wide variety of effective alternatives to opioids for pain management are available and patients need to be educated on what strategies are most appropriate for their procedure,” wrote Clark, who said in an email to Pain News Network the Jefferson College report did undergo peer review prior to publication.

The report calls for greater use of acetaminophen, non-steroidal anti-inflammatory drugs (NSAID’s) and preglabin (Lyrica) for post-surgical pain, as well as an injectable bupivacaine delivery system called Exparel that was developed by Pacira Pharmaceuticals, a New Jersey drug maker. 

The report was sponsored by Pacira and the company’s vice-president of medical health sciences, Richard Scranton, MD, was one of its co-authors.

At times the report reads like a promotion for Exparel, calling it an “innovative delivery system” that achieves “effective pain relief at substantially smaller doses.”

“In the acute pain space, where patients now ask for drugs by name, there is unprecedented risk of overprescribing, overuse, and misuse—particularly of opioid drugs. Exparel is an opioid alternative with equivalent pain control that reduces the need for postsurgical opioids and devices,” the report says.

“There should have been a disclosure up front that the company sponsoring the study makes Exparel,” said Reynolds.   

There is an acknowledgement on Page 2 of the 12-page report that Pacira Pharmaceuticals sponsored it, but the company is not identified as the maker of Exparel, which accounts for virtually all of the company's revenue.

Pacira Pharmaceuticals received a warning letter from the Food and Drug Administration in 2014 for its off-label promotion of Exparel, which was initially only approved for pain caused by bunion or hemorrhoid surgery. The U.S. Justice Department also subpoenaed the company for documents related to its marketing and sales of Exparel. 

“These additional materials suggest an extensive promotional campaign by Pacira to promote the use of Exparel in surgical procedures other than those for which the drug has been shown safe and effective,” the FDA letter states.

Pacira filed a lawsuit against the FDA claiming its first amendment rights were being violated. In an out-of-court settlement late last year, the FDA withdrew the warning letter and Exparel’s label was updated to state that it can be used for other types of postsurgical pain. The case was widely seen as a defeat for the FDA that could greatly expand the use of off-label marketing by drug companies.

A recent story by Stat questioned whether a $285 vial of Exparel provided any better pain relief than a $3 dose of bupivacaine after knee surgery.  The article also points out that other post-operative pain studies were conducted by researchers who received funding from Pacira.

Hummingbirds: A Poem About Pain

"Hummingbirds"

By Connie Dyste Tucker

I have one of my own,

a hummingbird, bright of feather,

light of wing. She fits into my day,

sipping my sugar, hardly hovering, always

sparkling.

Bird dogs, I have one of those, too.

Keen of sight, smart of nose.

He lays at my feet

dreaming of birds, not hummingbirds,

birds of substance – quail, grouse.

Birds he can present to us, his tiny, sad gifts.

And a spooky cat, a small black blanket

who sits in a chair, scared of the world.

For good reason.

So when I see him stroll out the kitchen door,

past the dogs,

boldly, unafraid, to a lovely spot in the garden,

I think, there goes a cat who can pull it off

when he needs to, you know, the confidence

thing.

I can take my pain and put it in my pocket,

walk out the door and say to the scary world,

I am light of feather, swift of wing.

I am not this sad heavy body,

I am dreaming of birds, I can fly away from this,

I can sip sugar. I can eat my words.

Editor’s note: Connie Dyste Tucker is a family friend who passed away last year after a long struggle with lung cancer and chronic pain.

Pain News Network invites other readers to share their stories (and poems) with us. 

Send them to:  editor@PainNewsNetwork.org. 

Opioid Battle Shifting from Chronic to Acute Pain

By Pat Anson, Editor

Efforts to limit prescribing of opioid pain medication are no longer confined to just chronic pain.

New York Sen. Kirsten Gillibrand (D) has introduced legislation that would require the Centers for Disease Control and Prevention (CDC) to issue guidelines for the safe prescribing of opioids for acute pain – generally pain that lasts for three months or less.

“When someone gets a tooth out and only needs medication for three days - why are they sent home from the doctor’s office with 30 Percocet?” asked Sen. Gillibrand.

The Preventing Overprescribing for Pain Act calls on the Secretary of Health and Human Services and the CDC to issue new guidelines for the use of opioids for acute pain within two years. New York Rep. Louise Slaughter (D) will introduce the bill in the House.

“We need to ensure these powerful medications are used safely while cutting down on the risk that extra pills could lead to possible abuse,” said Rep. Slaughter.

The CDC is currently focused on guidelines for primary care physicians to use when prescribing opioids for chronic pain -- which is pain that lasts for three months or more. 

Plans to implement the guidelines in January were delayed by the CDC after widespread criticism about its secrecy and lack of transparency during the drafting of the guidelines.

As many as 11 million Americans use opioids for chronic pain and many fear losing access to them if the guidelines are adopted. The CDC is currently reviewing the guidelines and no timetable has been set for their adoption.

“As the opioid epidemic continues to grow in New York and across the country, we can’t wait any longer to take action and curb this growing crisis,” said Gillibrand. “We have introduced bipartisan legislation that will help fix this problem by requiring the CDC to issue clear guidelines to help medical providers safely prescribe opioids for these common types of acute pain. I am urging my colleagues in Congress to pass this measure to help curb the growing opioid crisis.”

Gillibrand and Slaughter’s offices issued a joint news release citing a recent CDC report which found that in 2014 nearly 19,000 people died in the U.S. from overdose related to opioid pain relievers. Those statistics are somewhat muddied, however, because some overdose deaths may have been counted twice and some heroin deaths may have been misclassified as morphine deaths, according to CDC researchers.

With opioid prescriptions in decline for several years, many experts believe the still rising number of opioid deaths is attributable to a growing number of heroin and fentanyl overdoses, not from pain medication.

How to Advocate for Medical Marijuana Legalization

By Ellen Lenox Smith, Columnist

I wish everyone in the U.S. had safe and affordable access to medical marijuana. Although legal in 23 states and the District of Columbia, many of you still live in states where cannabis is illegal and may want to know what you can do to help expedite the process of legalization.

I thought it might be helpful to share our experience with you to help you turn your state into a more compassionate state.  My husband and I are the co-directors of medical marijuana advocacy for the U.S. Pain Foundation. We are very proud of the foundation for supporting the use of this medication and for taking a positive stand.

So here are our suggestions:

1) Google your state’s medical marijuana laws and become familiar with where your state stands.

2) If a bill has been submitted, find the names of the legislators that submitted it. Contact them and request a meeting, leave a phone message, write a letter or offer to testify. The goal is to begin establishing a relationship with this person, to let them know of your willingness to help get their legislation passed.  

3) Remember that you are in an illegal state, so you want to share the success you had while living or visiting a legal state. You do not want to take any chance getting arrested!

4) You will find that telling your story is the key. Try to find others who will also be able to share how this medication helped them too.  Share your medical condition, how it affects your daily life, and how using medical marijuana made a difference.

5) If you are able to attend a hearing, be sure to dress like you are going to work. Keep the language clean and show them that you are an everyday person trying to live life with major medical difficulties. You do not want to be perceived as a recreational drug user, so dress and act with a serious demeanor.

6) Along with sharing your story, you also need to discuss the qualifying conditions for treatment in the bill. Some states where marijuana is legal do not allow cannabis to be prescribed for chronic pain. If you don’t get the correct wording in there now for chronic pain, it may never qualify. Therefore, it is very important to include the following language in your bill:

A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following:

• Cachexia or wasting syndrome
• Severe, debilitating, chronic pain
• Severe nausea
• Seizures, including but not limited to those characteristic of epilepsy
• Severe and persistent muscle spasms, including but not limited to those characteristic of multiple sclerosis or Crohn's disease
• Agitation related to Alzheimer's Disease

If they want you to testify, prepare your speech before your arrive. Consider putting your main points on a card to talk from, instead of just reading from a paper out loud. Eye contact can really help.

Stay on point. Time is limited and you must respect this or they will shut you off to allow others time to speak. Share details about your medical condition, what effect it has on your daily living and how medical marijuana has made life more tolerable for you. Ask them to have a heart and help you and all the others in your state.

I always end with: “You never know what life might bring you next. I didn’t ask to have to cope with this condition. Please show your compassion.”

If there is no bill under consideration, then your work will be a bit different. You need find out if a bill had been submitted in the past and locate the sponsor. You should contact that person or persons and tell them you are ready to advocate and ask what they need from you to help get the bill reintroduced.

Whether you have a bill submitted or are working to get one started, you want to keep the topic alive in the media, so write letters to the editor, send a written story to news and radio stations, telling them you would like to share your story and why you want to see this legalized. You will be surprised how they can respond!

Another thing you can do is also contact us via the U.S. Pain Foundation to see if we have any ambassadors in your state that have expressed interest in advocating. We are happy to connect you if we have them listed. Email us at ellen@uspainfoundation.org or stu@uspainfoundation.org

Good luck and may medical marijuana soon be legal for all.

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.

Sneeze Alert: What It’s Like to Taper off Opioids

By Crystal Lindell, Columnist

As a result of feeling a bit better lately, I have been trying to go off all of my opioid pain medications, which at one point totaled as much as 60 mg a day — three, 8-hour time release 15 mg morphine pills and then as many as three, short-acting, 5 mg hydrocodone as needed.

I worked my way down from 60 mg a day to 15 mg a day over the course of a month, and then tried to drop down to zero. It did not go well. You can read more about that here.

A little over a week after trying to go cold turkey, for various reasons involving a fresh pain flare and horrific withdrawal symptoms, I ended up back on the drugs. And I have spent the last few months working with a team of doctors trying to figure all this out and attempting to slowly taper off those last 15 mg. 

This is what it’s been like:

Withdrawal is sneezing. Every three or four minutes. As soon as the opioids wear off at all — I’m sneezing.

And it’s anxiety. And waking up drenched in sweat. And it’s the kind of diarrhea that you have to learn to accept as a part of your life now. The kind that fills the toilet multiple times a day and leaves your legs weak. 

It’s calling your high school boyfriend at 2 p.m. on a Friday because you’re in Target having an anxiety attack for no reason and you need to talk to someone, anyone, or you might actually die right there between the fitting room and the yoga pants display. It’s immediately regretting that phone call and then having anxiety about why you made it in the first place.

It’s not sleeping. God is withdrawal not sleeping. You’re lucky if you get four hours in one night. And waking up at 3 a.m.   

It’s giving up, and then trying again tomorrow.

It’s realizing that cutting your pills in half and taking them in a different time configuration actually helps a lot. And it’s tracking every dose and every symptom in Google Keep.

It’s deciding that maybe dating isn’t the greatest idea when your fight or flight response is literally kicking in every time it takes a guy more than seven minutes to respond to a text message. It’s giving in and going out with a guy on a Tuesday night anyway because the escape is worth it.  

It’s doing a lot of things you aren’t proud of.

It’s your primary care doctor telling you that other people have no problems at all going off these drugs, then qualifying his statement with, “But, I mean, I believe you,” which somehow implies he doesn’t.

It’s reaching out to your old psychologist and pleading for help, and then getting referred to a psychiatrist who specializes in this sort of thing and finally finding one person on the whole entire Earth who actually has some idea of what you’re going through.

It’s a glass of wine, and a handful of Advil, and lots of sugar candy, as you try to find anything to help manage the symptoms.

It’s slow. Withdrawal is maddeningly slow. It’s going down 1.25 mg in a day and feeling like the world is ending and waking up more anxious than you’ve ever been. And wondering if you can actually do this.

And then it’s a post anxiety-crash four hours later, and being so tired that you can’t even move your arm to check your phone.

Withdrawal is multiple people calling you a drug addict to your face because your body is physically dependent on a medication you were given by a doctor. It’s multiple people saying you just need more willpower and more prayer and more desire to get off the drugs.

It’s wondering if maybe you are a drug addict.

It’s trying to eat Taco Bell because Taco Bell usually solves everything and then realizing that you can’t even stomach a cheesy gordita crunch because the withdrawal has destroyed your appetite. 

It’s working out to help the anxiety, and using the stupid Calm App for meditations that never work, and texting your best friend 72 times an hour so that you know you’re not alone. And then texting her again. And it’s breathing her oxygen for awhile because you don’t seem to have any of your own.

It’s intestinal cramping so severe that you’re literally doubled over in pain on the couch, crying out in pain, wondering if this is the end.

It’s deciding to go back to church because for some reason, for that hour each week, you feel maybe a little bit of peace.

Withdrawal is feeling weak.

It’s wondering if you’ll ever feel normal again. It’s wondering that over and over and over and trying to convince yourself that someday you will get a full night's sleep and you won’t wake up covered in sweat and you won’t have diarrhea first thing in the morning and you won’t have the crushing feeling of anxiety as you greet the day.

Withdrawal is trying to live a normal life while your body goes through hell every day. It’s trying to work and be a good friend and a decent human being when all you want to do is die. It’s trying to figure out how much information, exactly, you should give your boss about your opioid dependence.

It’s having a pain flare and thinking that maybe the drugs were doing more than you thought, and wondering if you’re even doing the right thing.

It’s saying that John Green quote about survival to yourself 59 times a day. The one that goes, “I'm not saying that everything is survivable. Just that everything except the last thing is.” And then it’s reminding yourself that this is probably not the last thing. 

And it’s reaching out to your Facebook friend who has the same chronic pain you have and him telling you that you have to do this — it’s important that you do this — because if you don’t the next best option is in-patient treatment and you don’t want that.

It’s trying to distract yourself with The Hobbit, and Spotlight and Downtown Abbey, and Facebook.

Withdrawal is still happening. It’s ongoing. It’s a long-term goal. A hope that one day you’ll be clean — whatever that means. 

It’s praying, and crying, and giving up, and trying again.

And it’s sneezing.

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.

A Pained Life: Change in Pain Care Policy Overdue

By Carol Levy, Columnist

In 2003, the National Pain Care Policy Act was first introduced in the U.S. Congress, calling for “adequate pain care research, education, and treatment as national public health priorities.”

At the time, information about chronic pain and the effect it has on lost productivity and economy was important enough that Rep. Mike Rogers (R-Michigan) wanted to try and do something about it.

While the House approved his bill, the Senate refused to take any action. Three more times it was introduced. Each time the House passed it and the Senate wouldn’t even consider it.

In the last few years there has been the gigantic hue and cry about the “opioid epidemic.” More often than not, the chronic pain community is named as culprit number one.

Just imagine if the Senate had listened in 2003 when Rogers first introduced his legislation.

Nearly 13 years have passed. How many new drugs? How many new treatments and procedures might have been developed by now? Would opioids still be one of the first weapons doctors arm their patients with? Would they still be telling patients, “You just need to learn to live with it.”

I often hear this from many in the pain community: “My doctor will not continue giving me the narcotic he has had me on for years. He no longer commiserates with me and says he will do all he can to help. Now he says ‘Sorry, I have decided to no longer write those prescriptions.’”

The patient looks at him, beseechingly. “What am I supposed to do? Do you have anything else to give me, to do for me? Please.”

He shakes his head, maybe ruefully, maybe not. “Sorry. Nothing else I can do for you.”

Many of us know the next step personally. We call other physicians’ offices. “Are you accepting new patients?” Too often the answer is no.

If they say yes and you add, “I am looking for a doctor to prescribe medication for my chronic pain,” the door is slammed shut in our ear. “We do not take patients who want narcotics.”

Now we are seen as a drug seeker. All because we want to stop or at the least reduce the pain.

If we were diabetic and said, “I am looking for a doctor to prescribe my insulin,” the reception would most probably be quite different. At worst they’d say, “The doctor will decide if that's right for you or if a different form of treatment is better.”

Patients should not have to search high and low for a doctor to treat them. And a patient saying upfront what they feel they need is not a sign they are fakers, drug seekers or malingerers.

I get it. When a patient says they want oxycodone, hydrocodone or Vicodin, I can understand it being heard as “I want opiates.” Instead of a discussion about working together to figure out what to do, it is easier to dismiss the patient.

When the Affordable Care Act (ACA) passed, it included amendments that were part of the National Pain Care Policy Act of 2003.

President Obama recently said, “If we go to doctors right now and say 'Don't overprescribe' without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we're not going to solve the problem.”

It is wonderful that he recognizes this. But it is way past time to see action on the ACA's call to arms against chronic pain.

As it now stands, many in Congress want to become the third person in the consulting room, trying to proscribe what doctors prescribe if it is in the form of an opioid.

Research and development of new treatments -- including non-opioid drugs -- is what we have needed and continue to need. Opioids should be the last “go to” measure, not the first or only one.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.” 

Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.

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.

Plasma Therapy Helps Rotator Cuff Injuries Heal

By Pat Anson, Editor

Kobe Bryant, Peyton Manning and Alex Rodriguez have used it to treat chronic injuries and extend their athletic careers. But does platelet-rich plasma therapy (PRP) work for amateur athletes and weekend warriors?

According to a small pilot study published in PLOS ONE, a single PRP injection helps reduce pain and heal injured tissue.in patients with chronically sore shoulders caused by rotator cuff tears. 

"We studied patients 35 to 60 years old with rotator cuff tendinopathy due to normal aging. For the first time, we were able to not only find reported improvements in pain and mobility, but also in the tissue - the MRI before and after showed structural change and a decrease in the size of tears," says lead author Marni Wesner, sports medicine physician at the University of Alberta’s Glen Sather Sports Medicine Clinic.

PRP therapy is an emerging therapeutic procedure for the treatment of both acute and chronic soft tissue injuries. The procedure involves withdrawing blood from the patient and then spinning it to produce a high concentration of platelet cells. The plasma is then injected back into the patient at the injury site, speeding up the natural healing process.

The pilot study involved only a small number of participants – 7 patients with rotator cuff tendinopathy received a PRP injection and 2 received a placebo injection. All participants then took part in a 3-month home-based daily exercise program.

"Based on MRI findings before and after the injections, we saw improvements in the tissue six months later in five of seven patients undergoing PRP and an appropriate rehabilitation program. The healing in the tissue appeared to correspond with the reported improvement of the pain and also with the clinical assessment of function," explains Doug Gross, interim chair of physical therapy at the Faculty of Rehabilitation Medicine.

One of the patients who benefitted from the treatment was Debbie Brown, a retired police officer.

"For the past two years, I have tried everything for my right shoulder. Physio would help for a bit but then the problem would still be there. I tried acupuncture, Kinesio tape, cortisol injections - you name it, I've tried it," says Brown. "Once I did the PRP, it really did fix everything!"

At age 58, Brown says her injured shoulder feels like new.

"I can shoulder-check now and brush my hair. I can work out and be active again," she says.

Researchers admit the small size of the study and other factors may have affected the results.

“Patients considered for this study had very high expectations of PRP treatment, with 70% willing to pay out-of-pocket for the therapy to avoid the possibility of receiving a placebo injection. This presented a serious challenge for recruitment and will likely limit the ability of future investigators to enroll sufficiently large and representative samples of patients for PRP trials. High patient expectations and the placebo effect on clinical outcomes also cannot be discounted,” said Wesner.

In fact, one of the patients who received placebo treatment reported improvements in both pain and physical function – which could have been a placebo response to the injection or because of the home exercise program they participated in.

Los Angeles Lakers star Kobe Bryant was one of the first professional athletes to receive PRP therapy, traveling to Düsseldorf, Germany for a more refined version known as the Regenokine treatment.  Peyton Manning, Alex Rodriquez, Vijay Singh and other professional athletes soon followed.

Only a few small clinical trials have been conducted on the effectiveness of PRP therapy. Patients with knee osteoarthritis showed significant improvements as long as two years after PRP injections, according to a study published in The Journal of the American Osteopathic Association.

Vitamin D Ineffective for Knee Osteoarthritis

By Pat Anson, Editor

Recent studies have suggested that Vitamin D supplements may help reduce pain from fibromyalgia, arthritis and other chronic conditions.

But the “sunshine vitamin” did not relieve pain or stop cartilage loss in patients with knee osteoarthritis, according to new research published in JAMA.

Osteoarthritis is a joint disorder that leads to thinning of cartilage and progressive joint damage. Knee osteoarthritis (OA) is very common and affects over 250 million people worldwide. Nearly 40 percent of Americans over the age of 45 have some degree of knee OA.

Over 400 people with knee OA and low serum levels of Vitamin D participated in the placebo controlled study in Australia and Tasmania. They were divided into two groups; with one receiving Vitamin D supplements and the other a placebo.

Over the course of the two-year study, knee pain, stiffness and physical function were measured with the WOMAC pain scale and MRI scans were used to monitor cartilage volume, defects and bone marrow lesions.  

While the supplements did increase Vitamin D blood levels, they did not reduce knee pain. MRI’s also showed no significant differences in cartilage between the two groups.

“Vitamin D supplementation, when compared with placebo, did not result in significant differences in change in MRI-measured tibial cartilage volume or change in WOMAC knee pain score over 2 years. These findings do not support the use of vitamin D supplementation for preventing tibial cartilage loss or improving WOMAC knee pain among patients with knee osteoarthritis,” said lead author Changhai Ding, MD, of the University of Tasmania.

Vitamin D helps control levels of calcium and phosphate in the body and is essential for the formation of strong bones and teeth. Vitamin D also modulates cell growth, improves neuromuscular and immune function, and reduces inflammation

Vitamin D deficiency – a condition known as hypovitaminosis D -- is caused by poor nutritional intake of Vitamin D, inadequate sunlight or conditions that limit Vitamin D absorption. The most severe type of hypovitaminosis D causes general body pain, especially in the shoulder, rib cage, lumbar and pelvic regions.

Researchers at National Taiwan University Hospital recently found a “positive crude association” between fibromyalgia and hypovitaminosis D.  According to the Vitamin D Council, low levels of Vitamin D could be the result of fibromyalgia, rather than the cause of the disease.

Sources of Vitamin D include oily fish and eggs, but it can be difficult to get enough through diet alone. Ultraviolet rays in sunlight are the principal source of Vitamin D for most people.

Do Non-Opioid Pain Meds Raise Risk of Suicide?

By Pat Anson, Editor

We received a lot of reader reaction to our story about Sherri Little, the 53-year old chronic pain sufferer who committed suicide with an overdose of medication in her Los Angeles hotel room last year (see “Sherri’s Story: A Final Plea for Help”).

“Numerous prescription medications in the decedent’s name were found throughout the hotel room including a bottle labeled Lyrica on the rim of the bathtub next to the decedent’s body,” reads the coroner’s report.

Lyrica has a warning label that states the anti-seizure drug “may cause suicidal thoughts or actions.” At least two other medications Sherri was taking – the sleep aid Ambien and the sedative Klonopin  -- also have labels warning they may worsen depression or suicidal thinking.

Several readers wondered – as we did – why doctors would prescribe the drugs to Sherri, who had been suicidal for at least two years.

SHERRI LITTLE

“The off label use of antidepressants and anti-seizure meds for pain control is criminal. People are dying! And it's not because they're addicts! It's because the healthcare professionals have become compliant and have agreed to go against all common decency and sense,” wrote Arianne Grand-Gassaway, a chronic pain patient.

Many doctors are turning to non-opioid drugs like Lyrica to manage pain because they’re considered safer and less addictive. Worldwide sales of Lyrica topped $6 billion for Pfizer in 2014, up 19 percent from the previous year.  

“When a suicide occurs it is hard to know with certainty whether medications like Lyrica contributed to the suicide or pain itself was the primary cause,” said Lynn Webster, MD, past President of the American Academy of Pain Medicine and Vice President of scientific affairs at PRA Health Sciences.  “I feel the risk of suicide is many times greater for inadequately treated moderate to severe pain than with patients on these medications.”

Webster says the cocktail of drugs Sherri Little was taking for her pain, anxiety and depression was not unusual.

“It is very common to prescribe an anticonvulsant like Lyrica with a sleep aid. Lyrica is viewed as a safer medication than most options. Most people with moderate to severe chronic pain have difficulty sleeping so drugs like Ambien and Lunesta are routine.  Klonopin is also very commonly prescribed for an anxiety disorder or muscle spasm. It is also used to facilitate sleep," said Webster.

The Food and Drug Administration added suicide to the warning labels for Lyrica and Klonopin  after a review of nearly 200 clinical studies found that patients taking antiepileptic drugs had almost twice the risk of suicidal thought or behavior than patients taking a placebo. 

The risk is small – about 1 in every 500 patients – but don't tell that to the families of the four patients in the clinical studies who killed themselves.

After reading Sherri Little’s story, one reader told us Lyrica made her suicidal.

“I went to my doctor in January after being on Lyrica for a month. It seemed to be helping my nerve pain so she upped my dose to 50 milligrams twice a day,” said Allison Lindsay Shorter. “A couple of days later I started having deep thoughts like I was out of control of my emotions. My anxiety was sky high. I argued for no reason with everyone. I had feelings of hurting myself and whoever got in my way.”

Shorter told her boyfriend she wanted to kill herself and hid his cellphone before swallowing a bottle of muscle relaxers. She was rushed to the hospital and survived.

“I felt out of control when I had all those thoughts and actions, I was scared of myself because I could not control anything. It felt like a demon or evil spirit,” said Shorter. “I knew then it was the damn medication.”

In addition to Lyrica, Shorter was taking 18 other medications to treat a long list of conditions, including fibromyalgia, complex regional pain syndrome, and neuropathy. At one time she was also taking Neurontin (gabapentin), another antiepileptic drug often prescribed for pain that comes with a  label warning of suicide, depression, panic attacks and dangerous impulses.

Why do doctors prescribe medication with such risky side effects?

“Most doctors are probably aware of the suicide risks but the general belief is that risk of suicide from the medication is very low and the risk of suicide from undertreated pain is much greater,” says Webster, who recently wrote a column on patient suicide (see “A Doctor’s Perspective on Patient Suicide”).

“The potential risks have to be continually weighed against the potential benefits.  Lack of treatment carries significant risk too. Suicide is at least three times more likely in the chronic pain population than the general population.  The risk appears to increase with the number of medical diagnoses. In my opinion the risk of suicide due to pain, treated or untreated, far exceeds the risk of suicide from these medications, prescribed alone or in combination.”

Webster fears the current backlash against opioids and efforts to further limit opioid prescribing will lead to more pain going untreated.

“This is a serious topic and I am afraid there are going to be many more suicides due to the anti-opioid movement.  Very sad,” Webster wrote in an email to Pain News Network.  

Ironically, small doses of an opioid may actually reduce the risk of suicide, according to a recent small study in Israel. Researchers at the University of Haifa gave 40 suicidal patients small doses of buprenorphine and found it reduced their suicidal thoughts after just one week.

Just as opioids reduce physical pain, researchers think it can ease mental pain.

“I think they’re onto something. However, buprenorphine acts on a number of different opioid receptors and it’s still unclear which one or ones are playing a role in the anti-suicidal effects,” psychiatrist Joan Striebel told New Scientist.  “I hope this work spurs more interest in what specific molecules could be involved in suicidal thought.”

Hospital Pain Care Needs Improvement

By Barby Ingle, Columnist 

Most hospital staffs are poorly trained in pain management, in my opinion. They are used to acute emergency situations and seeing many of the same ones over and over. So when a “zebra” (someone with a complex chronic condition) gets pushed in on a stretcher, they tend to have thoughts like these:

“Oh boy, I am going to have to work.”

“I don’t believe that this person is as bad as they say.”

“I have seen others in worse physical condition and this person looks ‘normal’ so they can’t be experiencing what they say is going on.”

I had an emergency room doctor tell me once that I didn’t have a blocked bladder. He got out a machine to measure how full my bladder was, but I think he never even turned it on. He said my bladder was empty.

I was in so much pain at the time that I told him he was reading it wrong and that my bladder was extremely full and hurt dramatically. I begged him use a catheter on me. Finally, probably after being sick of hearing me cry out in pain, he let the nurse use a catheter. Guess what? I was right. After my bladder was drained, the pain subsided and I was released to go home. The doctor apologized.

Another time I was taken to the hospital with multiple kidney stones. The ER rooms were full and patients on stretchers were lining the hallways. I was quietly crying from pain, curled up in a ball on my stretcher, watching as other patients were being paid attention to and given pain care. What were they doing different than me? They were loud and obnoxious.

I finally reached my breaking point. I allowed myself to yell out in pain and a few choice words also followed. In less than a minute, a nurse who had told me before that she couldn't give me anything for pain until they got me in a room was beside me with a dose of pain medication.

I know my body. Most people living with a chronic condition know their body and what is new, different, worse, or better. We just know. It’s time that providers trust us and realize that we are there for a reason. The vast majority of us are not trying to score opioids, but trying to get relief because we have reached our breaking point. 

One of the most important issues in an emergency room after lifesaving measures is the patient’s pain care. This is especially true in an acute situation, which is typically why we go to the emergency room in the first place. I don’t know many people who go to the ER or are hospitalized for chronic pain only.

The need for optimal pain care during hospitalization is high, but unfortunately proper and timely pain care is hit and miss at best.  

That’s why Pain News Network and the International Pain Foundation (IPain) are conducting a survey of pain patients about their treatment in hospitals.

The survey, which you can take by clicking here, will help us document how bad the problem is and what can be done to fix it.

Patients who try to be their own best advocate and take personal responsibility for their health should not be discarded because addicts or a small number of pain patients are abusing medications. Yes, abuse needs to be addressed. But pain should not be neglected. Controlling pain is important to the overall outcome of the emergency situation.

In past columns I have discussed the importance of asking for your pain medication at least 30 minutes before you may need them while in the hospital. That is because hospital nurses are trained to wait for you to ask for the medication before they order it -- even if the provider has it marked in your chart that pain medication is allowed. If you do not know to ask, your pain cycles and levels will become harder to control. I have been in this situation many times myself.

I know if I go to the hospital closest to my house, I will not get as good assistance with pain management as I would if I drove a little farther to another hospital. I have to consider other issues as well, such as how long I may have to stay at the hospital, will they have my regular medications, and will they have a staff that understands reflex sympathetic dystrophy and the secondary challenges that come with treating a ‘thick case file’ patient.

When I know I am being listened to as a valuable and knowledgeable patient and team member in my care, my pain will be better managed and I will rate the hospital higher in patient satisfaction surveys. When my underlying condition is not addressed, they’ll get a negative review.

Should a doctor be worried about how I am going to score them? Not if they treat me fairly, individually and as part of my treatment team. Does this mean they should just hand me whatever I ask for? No. It means that they need to use my personal assessment of pain as part of the planning for my care. Not doing so is neglecting the patient.

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.

Miss Understood: The Face of Lupus

By: Arlene Grau, Columnist

I like to think I eat healthy since being diagnosed with lupus. It wasn't too difficult because I grew up in a home where soda was never allowed and we hardly ever ate things high in sugar.

Since becoming a mother myself I decided organic foods were the best for my kids and greasy, processed items would not be something we would be eating. I notice the difference my diet has made in my overall well-being because anytime I give into temptation and have a cheeseburger, I end up extremely sick and with swollen joints.

Although I have food figured out, I recently discovered that lupus is full of surprises.

Living in Southern California, I know that I have to wear extra sun block to protect me from the sun because I break out in rashes, usually on my arms, because of my disease. This has happened every year, and on some occasions I’d get what's known as a butterfly rash across my cheeks, usually so mild it looked like blush instead.

Two weeks ago I woke up and my cheeks looked like I had been slapped so hard that it left welts and redness. My cheeks not only had a very severe butterfly rash, they were swollen.

I tried everything I had to cover up the rash but the redness showed right through my makeup. I bought over the counter hydrocortisone cream but it didn't decrease the redness, although it did help with the burning.

Washing my face with a brush was making it worse so I had to stop. It's been two weeks and no progress has been made.

I saw my rheumatologist a few days ago because I'm having a lupus flare. Aside from the issue I'm having with the face rash, I've got swollen knuckles, fingers and knees, and a significant amount of hair loss in the last few months. Anytime I shower or brush, I get a handful of hair that falls out or breaks off.

So now I'm taking folic acid, prenatal vitamins and ovation hair therapy pills to try to repair the damage. Luckily, my rheumatologist referred me to a dermatologist at USC and my doctor says they can prescribe something stronger for my face or even inject into the rash.

I've never been the type of person who cared what others thought about her looks until I got sick. Not because I'm sick, but because of all the scars I've acquired since my surgeries. My journey is only beginning. If my rash doesn't get better it will permanently scar my face.

What's the first thing you see when you look at someone? Their face. Since getting my rash I haven't wanted to leave my house. I even missed reading to my daughter’s class because I was too embarrassed to be with the other parents.

This morning I decided I wouldn't wait for my appointment with the dermatologist next week or for the medication to kick in (once I get some). I took matters into my own hands to find a way to temporarily cover up my rash. So, I went into a cosmetic store the minute it opened, found the cutest little worker and explained my situation to her.

I don't know much about makeup because I don't wear a lot, so I was amazed when she explained why there's a green cover up that goes on first, then she applied foundation and after that a powder. The end result had me crying like a baby. I couldn't stop thanking her for what she had done for me. I was Arlene again. I was looking at myself and I couldn't believe it. There was no redness or puffiness; it was the same flawless skin I was used to having before the rash.

It may seem silly, but something as simple as getting my makeup done has completely changed the way I feel about myself. I'm okay with leaving the house to run an errand because now I know how to cover up my rash properly. It's easy for me to cover up my body if I break out in rashes, but my face is always exposed even with a hat on. But now I feel beautiful again.

Arlene Grau lives in southern California with her family. Arlene suffers from rheumatoid arthritis, fibromyalgia, lupus, migraine, vasculitis, and Sjogren’s disease.

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.

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.

A Doctor’s Perspective on Patient Suicide

By Lynn Webster, MD, PNN Columnist

The death of the New York Times journalist, Sarah Kershaw, reminds me painfully of too many conversations I had with my patients during the course of my career as a pain doctor about whether or not they wanted to live.

During the 30 years of my practice, countless patients told me they had no hope for a life without severe disabling pain and would, therefore, prefer to die.  I believed them.

The CDC reports there are 44 deaths per day that involve opioids, but there are more than 105 deaths per day from suicide.  An undoubtedly significant (but uncertain) number of those suicides can be attributed to people with severe pain.

Suicides, by the way, come in at least two variations: active and passive. Active suicides intend to commit suicide and usually plan it. Passive suicides happen without premeditation by a person who finds it acceptable that her behavior might lead to death.

Of the opioid-related deaths, it is not clear how many either are active or passive suicides yet are not counted as suicides.

My patients often expressed to me that death seemed to be the only way out of the misery of pain. I often felt the most important role for me, even when I couldn’t relieve my patients’ pain, was to give them hope.

But reality often trumped my best intentions. After living for years with little improvement of their pain, some my patients found it hard to sustain their hope, regardless of my efforts.

Here is where the intersection of relieving pain and preventing harm from opioids exists.

I always warned patients that, if they took more painkillers than I prescribed, they might not awaken.  More times than I care to remember, after I said this, my patient would look me square in the eye and say with complete sincerity, “That’s okay, doc. It would be better to die than to live with my pain.”

Through the years, I had patients who died from suicide.  Some used a gun.  Others used the pain medications I prescribed.

It was never easy to prescribe an opioid to someone who had such intense pain that she wished to die.  But, often, there was no alternative unless I ignored the person’s need to mitigate the pain.

I worried whether the medicine that I prescribed to help my patient get through days and nights of horrific pain would be used as I directed, or whether it would be used to enable my patient to escape a world of suffering.

I could never be sure, and it was a constant source of stress and unhappiness for me. To an extent, it was beyond my control. As a physician, I had to give my patients something to enable them to survive with pain. Yet, as a human being, I had to deal with the fact that the pain medication might be used when the patient could no longer survive with that pain and had lost hope.

Whether opioids are a reasonable treatment for people with disabling non-malignant chronic pain will continue to be a subject for debate.  But there should be no debate about one thing.

People with chronic pain should not view suicide as their only option for relief.  We have to do more to prevent tragedies like the death of Sarah Kershaw from ever happening again.

Lynn R. Webster, MD, is past President of the American Academy of Pain Medicine, Vice President of scientific affairs at PRA Health Sciences, and the author of “The Painful Truth.”

This column is republished with permission from Dr. Webster’s blog.

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.