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National Pain Strategy Released

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Posted 3/28/2016 3:17 AM (GMT 0)
That's not the issue? What has already happened is that doctors are worried and paranoid because of these new guidelines and are cutting people's meds in half or deciding not to prescribe anymore, leaving their patients stuck in pain and withdrawal. People lose their jobs and can't take care of their families ect. To punish pain patients because of addicts is beyond unbelievable! The reason there were more comments for the CDC regulations is that people for it are passionate about the issue because they were addicted or know someone who overdosed ect. Pain patients are mostly just trying to go about and improve thier lives and are not activists. And they shouldn't have to be.

Post Edited (Dorothy123) : 3/27/2016 9:25:17 PM (GMT-6)

Posted 3/28/2016 3:30 AM (GMT 0)
Chartreux, the National Pain Strategy and the CDC Guidelines are aimed at Primary Care Physicians that treat chronic pain. as well as acute pain. If Pain Management drs will start going by some of these guidelines remains to be seen.

As far as the insurance goes, I have seen posts several times here about insurance not paying for a particular pain med because the FDA recommends it for cancer related pain and not non cancer related pain. Some insurance companies are already restriciting the number of immediate release meds they will pay for in a 30 day period as well as not paying for pain meds if they exceed
120 mg Morphine/Morphine Equivalent Daily Dose. By the way the CDC has decreased that to 90 mg. To add to this the FDA is getting ready to put warniing on Opiates about the dangers of prescribing opiates with certain anti depresssants. If you have a prescription for an opiate and one of these anti depressants, it is doubtful that some insurance companies will pay for both. Trying to fight the insurance companies after the FDA has put these warning out does no good. It seems like the powers that be know that they can't get all of the drs to prescribe like the want them to, so they are doing what they can to be sure that the patients might not be able to afford to pay for some of the meds prescribed. It is not the CDC's job to govern the safety of drugs, it is the FDA's. But, the CDC has influence over the FDA.

Dorothy123, chronic pain patients not being passionate about their pain managment has cost them greatly. They don't have to be activist to keep up with the laws and guidelines and things that govern the meds they take that helps them manage their pain and the changes that are being proposed that could affect those meds. It does no good to complain after changes are made.


FDA Drug Safety Communication: FDA warns about several safety issues with opioid pain medicines; requires label changes-(Click on List of Serotonergic Medicines)-
www.fda.gov/Drugs/DrugSafety/ucm489676.htm

Post Edited (Mercy&Grace) : 3/27/2016 9:36:02 PM (GMT-6)

Posted 3/28/2016 4:55 AM (GMT 0)
Very well put M&G. What bothers me is the volume of chronic pain patients that are not familiar with what has been going on in their backyards for years. This did not happen over night, this has been in the works for a long time to get to this point. How many times have we seen people come to the forum upset because their dr reduced their dose & they have no idea about the DEA or the FDA being involved. Its mind boggling.
Posted 3/28/2016 8:46 PM (GMT 0)
Mercy & Gracy it is happening at the PM doctor levels, as recently my pm office talked "It's been awhile since you've had injections" Wow, really I wanted to scream "No" at him because the injections for my lower back do nothing except fatten his wallet and takes away from me...It's also noted in my file they don't help me and I have ptsd from injection therapy from a situation years ago by a very bad PM Doctor...Also I can't have anyone touch my neck and the pain in my neck has been gradually increasing over this past year However the last time I had a neck injection it literally froze my neck for over three months and there are older posts on here from that horrible experience...If the new CDC guidelines are going to mean injection therapy all over again before we get our pain meds issued out that is unexceptible. I will allow for doing very light PT and ultra sound only on my neck, it helps some...but to say we have to use injection therapy when many on here have fail that...what and whom do they want to pay for that... I understand that these rules are after drug seekers, but we ligit patients get caught up in it as well..it is at the pm level and I do agree pcp's should not prescribe pain meds past a certain point without recommending pain management. but, it is trickling down to the pm doctor's...
again the CDC is over stepping and like you said it 's the FDA that is supposed to be doing this if it's going to happen, the CDC needs to worry about those nasty Mosquito virsuses...it's wrong!
Posted 3/28/2016 8:54 PM (GMT 0)
I guess that's why I have been saying over stepping is because it's the wrong branch or department of the government doing this and ...such...and why now...where is this going politically???
Posted 3/28/2016 10:22 PM (GMT 0)
Chartreux, pain drs insisting on doing injections is a individual choice of the drs. It is possible that more pain drs may start insisting on injections, but that remains to be seen. For some patients that don't have insurance or that their insurance won't pay for the injections, if the drs insist on doing the injections they people just won't be able to get their pain meds.
Posted 3/29/2016 3:56 PM (GMT 0)
I agree with Straydog as if I was older, then maybe I wouldn't be as concerned about this, but I'm not.
While suicide is very tragic, it has happened in my family and while getting their hands on pain meds is just one aspect of it, the second and bigger focus should be the mental health issues and the lack of a good mental health care in the USA...it's not always about the meds they get their hands on, we lose focus there and choose to blame the drug/medication...Maybe before a pcp prescribes pain medication a depression screening should be done...who's to say, it's tragic, but again the legit patient pays for it in the end...
Plus the CDC is over stretching...should be the FDA...
Posted 4/8/2016 3:11 AM (GMT 0)
There is a petition you can sign to support funding for chronic pain research, treatment, prevention. They are trying to get 100K signatures by the end of the month.

Here is a link: https://petitions.whitehouse.gov/petition/utilize-part-1-billion-granted-toward-opioid-epidemic-help-chronic-pain-pandemic-america
Posted 4/8/2016 3:21 AM (GMT 0)
Candy_Apple, the thing is if the politicians haven't seen fit to find the money for this by now, they aren't going to. People forget that the ACA says that research into pain management and better pain management is part of it. But, because no money has been allocated, nothing has happend. Unfortunately they aren't going to take money away from the addicts and give it to chronic pain patients. People also need to remember that better pain management and better access to pain management in now way involves opiates, from the politicians point of view.
Posted 4/8/2016 2:31 PM (GMT 0)
I keep up with the current environment of pain and pain legislation by subscribing to the National Pain Report by e-mail. I recommend anyone with chronic pain to subscribe to the National Pain Report. It is free and the content contained in their e-mail distributions is informative and knowledgable. The National Pain Report often posts real-person accounts written by individuals who live with chronic pain and their personal stories.

Every 4 months, my prescriptions for opiates are reviewed by my insurance provider for authorization. Every 4 months I wonder and worry if the insurance review board will authorize what my MD has prescribed. That I am receiving Palliative Care makes my worry a bit less . . . but still, I worry that at some day, at some point, my insurance company will say "no." That my insurance company will say, "take a Bayer aspirin."

However, I also have a friend who was recently diagnosed with secondary adrenal insufficiency (failure of the adrenal glands to produce adequate cortisol, a life-essential hormone, due to pituitary gland suppression). Her secondary adrenal insufficiency was caused by too many steroid injections for lumbar disc dysfunction and long-term use of Norco. So, there is a need for physicians to better understand the risk that they are placing patients in with too frequent use of steroid injections. For many MDs, steroid injections are an easy revenue stream.

And who, among patients, has even heard of secondary adrenal insufficiency. My guess is very, very, very few. Adrenal insufficiency is serious. I know. I have primary adrenal insufficiency (Addison's disease).

I appreciate this forum. It is a good resource and a good source of current information on pain management. It is kind in its offering of support and human connection.
- Karen -
Posted 4/8/2016 5:17 PM (GMT 0)
" Her secondary adrenal insufficiency was caused by too many steroid injections for lumbar disc dysfunction and long-term use of Norco. "

This is a good example of reasons that are/will be used to not prescribe pain meds.
Posted 4/9/2016 4:31 AM (GMT 0)
It is so hard to pick a med that can help you, but also end up hurting you.
For example-I have adrenal issues due to prescribed steroids daily over 10yrs(up to 100mg). Many times the steroid dosage was increased due to pain levels and not wanting to increase pain med dosages.

Increase steroid dose=adrenal issues and lower pain med dosages
Decrease steroid dose=higher pain med dosage and increasing med tolerance

I completely understand the difficulties Drs face when prescribing pain meds, especially when the government is involved. My concern is that, in lieu of prescribing narcotics, a physician will use an alternative method, but not fully grasp that these methods carry their own risks. Since my medical combo platter started at a very young age, I'm fully aware of side-effects, and have real conversations with my med crew. Seashell, it sounds like your friend had a well-meaning Dr performing those injections, but he failed to grasp that while steroids are not narcotics, they come with their own batch of side effects.

I have no idea what the answer is, how to find the answer, or how to implement the answer. Unfortunately, the CDC seems to be looking for an answer as well. And who are the people caught in the middle-we are.
Posted 4/9/2016 1:16 PM (GMT 0)
Roccky:
I pass no judgment on anyone taking corticosteroids or narcotics, as I myself take both corticosteroids and narcotics.

Corticosteroids, in particular, are a double-edged sword - offering substantial benefit in reducing inflammation and pain and dampening an overactive immune response but with risk of significant secondary side effects of tissue thinning, pituitary-adrenal suppression, and elevated blood glucose.

I have Addison's disease (primary adrenal gland failure) and am dependent on taking corticosteroids - for life.

My concerns are less with the prescribing of narcotics than with the prescribing of corticosteroids.

Seriously, how many people in the general public are even aware of their adrenal glands? And the life-essential role of cortisol, produced by the adrenal glands.

Cortisosteroids are prescribed for everything from asthma to a pre-med with IV chemotherapy for cancer (to reduce nausea) to Medrol packs for lower back pain to epidural injections for cervical and lumbar disc dysfunction.

As narcotics become more restrictive, my concern is that pain management MDs will increase the use of epidural injections as an available option for pain control - putting people at increased risk for secondary adrenal insufficiency without full patient awareness.

Adrenal insufficiency is no picnic. It is a devastating illness/condition. Adding to the problem is the difficulty in accurately diagnosis adrenal insufficiency. I guarantee you, adrenal insufficiency is not on the radar of MDs when someone presents with nausea, muscle/joint pain, fatigue. My added concern is that people who develop adrenal insufficiency will go for months/years without accurate diagnosis.

I wonder if the CDC and DEA, in creating a more difficult climate for narcotics, will not be creating another problem by shifting MDs towards corticosteroid injections and putting people at increased risk for adrenal insufficiency.

I just do not see how any governmental agency - CDC, DEA, or FDA - can tell someone that they do not hurt. In essence, that is what the national pain strategy is doing. By setting strict limits to the prescribing of narcotics, the agencies, in essence, are telling individuals with pain that their particular pain experience can only "hurt" to a certain level, no more. What is a 120 mg morphine equivalent ceiling today will become a 90 mg morphine equivalent tomorrow will become a 75 mg morphine equivalent . . .

My heart truly aches for those of us (me included) with chronic pain. That I receive Palliative Care and fall under the auspice of Palliative Care gives me some comfort in thinking that my pain will continue to be somewhat controlled, but I am not certain. And isn't it unfortunate that someone (like me) has to "qualify" for Palliative Care to receive a modicum of pain relief.

I do not know. The health care system in our country sincerely seems broken.
- Karen -
Posted 4/9/2016 4:09 PM (GMT 0)
Such a difficult situation. Drug addiction is considered a disease...the CDC gets involved. Trying to 'control' a situation that is already so far out of control. Reigning in doctors and dentists that have given into the idea that no one should ever experience pain or discomfort. Prescribing Vicodin for a tooth extraction and such. Apples and oranges.

I am a recovered alcoholic that has kept myself on a very tight watch when it comes to the use of pain medication. I have very frank discussions with my primary care doctor and my dentist. I use every possible non chemical modality that I can to reduce the amount of prescription chemicals. I try not to fear the future.

I am becoming rather well versed in the consequences of steroids, as my daughter has Cushing's Disease.

Pain is subjective. We here, encourage every form of dealing with pain. Relaxation, meditation, swimming, bio feedback, etc. Why do we have to? Because the doctors haven't been, that's why. It's about time someone told them they should.

Too many times I have gathered with others such as myself and seen the misery suffered by those who were allowed to run down a very dangerous path by doctors too quick to grab the prescription pad.

Is this a perfect solution? Of course not. Hopefully, things will settle down soon and there will not be too great a disruption for those of us that need the science because all of the other methods no longer have the desired benefit of pain relief.

I, myself, am meeting with a new pain management doctor on Monday. In preparation, I have been writing down all of my conditions. I am up to 3 pages so far, handwritten. I am fighting depression as well. Unmedicated, as the three that I have tried so far have all given me vertigo.

If you are having difficulty with getting your pain properly treated, I am sorry for you. It is a shame that things have gotten so out of hand. Here, where I live, someone is treated with Narcan at least once a month. There is a drug dealer living across the street from me. I don't need a calendar to tell me when it's the beginning of the month as business picks up there like clockwork. Hypodermic needles are showing up in the areas that our children play. Everybody screams that 'Somebody' should do 'Something'.

I can't help but see both sides of the coin. Will this truly change things? I doubt it. But, Somebody is trying to do Something.
Posted 4/9/2016 8:34 PM (GMT 0)
And once you stay on them for an extended period of time, the more care needs to be taken when decreasing the dosage. Pain meds can be used for a period of time, and decreasing the dose it not difficult. I've been on steroids for a decade, and due to the nature of the med, will most likely be on them for life. You can't just stop if you have a decrease in pain.

Narcotics do not have the long lasting effect on your body like steroids.

Steroids, the drug you love to hate.
Posted 4/9/2016 11:31 PM (GMT 0)
I am reading this and I am scared that I won't get a med to help me. It is not a controlled substance but a muscle relaxant. I want to take half of the smallest amount because I am allergic to drugs. I can not use MM because it would increase my appetite and Elavil also increases my appetite. Valium did not seem to help me much. I am hoping to get methocarbomol because the other stuff was too sedating. Spoke with my pharmacist about it. Will only use it when necessary.

They dug into my foot for skin cancer problem and can't swim. Feel horrible. Am tired of all the pain.

peace to all
Posted 4/10/2016 9:49 AM (GMT 0)
Rocckyd,I have to disagree with you on the long lasting effects of narcotics versus steroids. There are several narcotics that carry long-term effects physically and mentally,some are catastrophic than others. Liver disease is rampant in addicts as well as long-term opiate users,kidney disease and heart problems are almost equivalent and those are just the ones that carry the risk of being fatal. Early onset dementia,short-term memory loss and cognitive impairment run rampant in longtime opiate use,severe hearing impairment is found in more than half of those treated daily with opiates for over 10years and more than likely that association between the loss and opiate therapy is never made but rather deemed as groing old. How many PM patients here have hearing impairment? The medical community is lax in documenting the relationship between the issues and the meds and most often for the protection of the Drs.. can't really document they have been giving you something for 10 years that caused liver failure or dementia.
Posted 4/10/2016 7:42 PM (GMT 0)
IMO there's no one right answer. Injections are a good choice for some, but it's up to the judgement of a pain doctor. We patients have very good hindsight diagnosis abilities, but we got our education after getting our conditions.

I got over a year's relief from my fiirst and second steroid injections. My injections helped me avoid surgery and anything stronger than tramadol for the next half dozen years.

Eventually my conditions got worse, I had some accidents which created new conditions and needed to add Norco, and the injections stopped working. This was mainly because after breaking my neck, simple touch sensations get screwed up in the neck area and are perceived by my brain as pain.

I don't get anythng near good pain relief, and my doctor doesn't expect me to. There isn't really anything that works more than getting me to a functional level for this kind of nerve pain. I've spent years trying them.

There's no point in insisting that opiates are better than steroid injections. Even in the same patient, one treatment may work better at one time or for one condition than another. It should be up to doctors, not agencies, what treatments are appropriate. You can add physical therapy, surgery and other treatments to the argument.
Posted 4/11/2016 7:02 PM (GMT 0)
I hear y'all on all this, but the fact is it's coming down to injection therapies...in fact I'll be getting injection soon for carpal tunnel, it's that before even surgery can be prescribed. It's a crazy time and scarier things will come down if the CDC gets it's way on this...It's a doubled edge sword...
I just don't understand the CDC involvement instead of the FDA...
There are other things the CDC needs to concentrate time on.
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