Let’s Go Crazy: Lessons Learned From Prince

By Emily Ullrich, Columnist

As many call for Prince’s death to be a “wake up call” to America about the dangers of prescription drugs, I propose a different wake up call.

If the allegations are true, and Prince did die of an overdose, I propose that we use the messages that Prince preached and lived: messages of understanding and compassion. America needs to “wake up” to the oppression and depression that keep many chronic pain patients quiet about their conditions, and the reprehensible stigma with which this country punishes pain patients.

By now, many of us have read Lorraine Berry’s insightful piece, “Prince did not die from pain pills -- he died from chronic pain.” Perhaps the most poignant statement Berry made was, “Chronic pain kills. It killed Prince. It’s time to talk about it.”

We love to find flaws in celebrities, particularly those of a scandalous nature. Instead of finding compassion for a beloved icon, we are quick to turn our backs and make the pain of loss easier by falling prey to the judgmental “celebrity druggie” stereotype.

I propose that we pay tribute to Prince in a way I think he would have appreciated, by using this tragedy to start a conversation about the differences between addiction and dependence, about the commonality of chronic pain, and the deeply rooted prejudice associated with the disease of chronic pain.

But, I also propose we take it one step further, and affect change. We need not complain to each other endlessly about “us” (those who suffer chronic pain) and “them” (the healthy), and the great rift between. We have been doing that for years, and although it’s nice to know that someone else “gets it,” it is not other chronic pain sufferers who we need to understand our plight.

As much as we may not like to admit it, there are some similarities between addicts and chronic pain patients -- neither of us get the treatment or respect we need and deserve. We tend to be equally as judgmental of addicts, deeming them lower on the social hierarchy than us, in the same way as healthy people think of us to them.

I am not suggesting we continue to blur the lines between addiction and dependence, but I am suggesting we consider fighting this battle together.

There was a time when white people who sympathized with black civil rights activists were considered “almost as bad” as the “uppity blacks,” who demanded their well-deserved, long overdue rights to equality. Eventually, most people began to understand that treating people differently, as though they were not entitled to the same liberties, was intrinsically wrong. Many didn’t like it, but they had to abide by it. Understanding would only came later.

The same can be said about the lesbian, gay, bisexual and transgender community, and other groups that differ from what society considers “normal.” On many levels, these groups still struggle with inequities, just as we do, but they are making strides. And we must, too.

As it stands, the current political and social climate surrounding pain medication and chronic pain itself, not to mention addiction, have become civil rights issues. We no longer need to worry about gaining understanding, as much as we do defending our basic human rights. Although understanding is a part of the answer and a desirable outcome, sometimes people must be pressed to follow rules against discrimination. 

I was an outsider long before I was a chronic pain patient. I am a long–time artist, activist, outspoken woman, and all-around “weirdo” in many circles. But, I’ve never been ashamed of that. In fact, I’ve always taken pride in my one-of-a-kindness, having been voted “Most Unique” in my class of ‘93 at a conservative, rural high school.

To me, Prince always seemed a kindred spirit—emotional, passionate, creative, misunderstood. Now that I know he suffered chronic pain, and that he may have had double hip replacement, I find myself even more drawn to his spirit of individuality and strength. I find myself respecting him and relating to him on an entirely different level now.

His elusive, gentle, humane, kind, pained soul was not merely the cliché tortured soul of an artist, but also the tortured soul of a human being who must present a strong face, while holding back the physical and emotional pain, loneliness, and often hopelessness that all chronic pain patients can relate to.

In the name of Prince, I propose a revolution. The play on words is not accidental. Prince revolutionized music, fashion, art, gender and sexual perceptions, and more. He was for many of us the embodiment of our coming of age and understanding. Let us memorialize him in a way he would appreciate—by standing up for who we are, and by not being afraid or embarrassed of what people will think or say.

And like his band, The Revolution, let us stand with him, and make the world see that we will not be shamed, shunned, or disenfranchised, and that we will stand up for our rights and be prepared to explain and defend our cause -- life.

“Dearly beloved: We are gathered here today to get through this thing called life. Electric word, life. It means forever and that's a mighty long time.”

In Prince’s honor, let’s go crazy and do something unheard of. Understand each other and learn from this.

Emily Ullrich suffers from Complex Regional Pain Syndrome (CRPS), Sphincter of Oddi Dysfunction, Carpal Tunnel Syndrome, endometriosis,  Interstitial Cystitis, migraines, fibromyalgia, osteoarthritis, anxiety, insomnia, bursitis, depression, multiple chemical sensitivity, and chronic pancreatitis

Emily is a writer, artist, filmmaker, and has even been an occasional stand-up comedian. She now focuses on patient advocacy for the International 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.

A Pained Life: Teaching the Reality of Pain

By Carol Levy, Columnist

Excedrin, which makes an over-the-counter pill for migraine sufferers, has a wonderful TV ad.

A sufferer wanted to show her mother what she sees and experiences when she has a migraine. Excedrin developed a simulator that does exactly that (click here to see it).

The mother puts on the device and sees the visual disturbances her daughter sees when she has a migraine attack. As she removes the device the mother turns to her daughter, hugs her and says, “I'm so sorry. I didn’t know.”

How wonderful, I thought. If only...

If only there was a way to simulate the pain of constant, intractable chronic pain.

If only there was a way to get our message across, and in a visceral way.

Too often we are told, even by medical professionals:

“It can't be that bad.”

"I had a sprained ankle so I get your pain.”

“It's all in your head. You just don't want to (go out, work, be a part of the family, the community, the world, etc.)”

It is common for a pain sufferer to write in the comment section of articles on chronic pain the following:  

“I wish doctors would have chronic pain, even if only for a day or two so they would get it.”

When I had the worst of my trigeminal neuralgia, I could not tolerate any touch to my forehead on the affected side. This meant I could not wash that part of my face or my hair. As a result I would get a big buildup of soap and dirt in the area which, because of a facial paralysis and my eye not being able to close well, caused eye infections.

The only way to clean the area was to put me under general anesthesia. The nurses and doctors were wonderful about it, the doctor having shampoo in his locker in case I forgot mine.

When someone asks me about the pain and they say outright or make expressions indicating they don't believe me, I trot out my general anesthesia anecdote. Then they get it. After all, why would a doctor or a patient take the risk of anesthesia without a real need to do it?

I recall a TV show, maybe it was Doogie Howser, MD, where medical students went through a simulation of what it is like to be a patient. They were given cloudy glasses to feel the disorientation of being unable to see clearly. They also put pebbles in their shoes to feel the discomfort of severe pain when you are trying to get around.

I had hoped maybe they did actually do this at a medical school somewhere, but no matter what words I put into Google Search, I could not find anything. The closest are programs where actors are hired to portray various illnesses to help teach students better diagnostic skills, insight and empathy.  But no actors had the role of being in chronic pain.

How can we teach the students?

I didn’t realize when I started writing this I would feel so frustrated by the question.  I guess I expected I would find a pithy answer.

Unfortunately, part of the answer is that students come from the general population, which often cannot accept the level of pain we feel. So they bring that skepticism and disbelief with them.

It would be unethical to put them in actual pain.

But maybe if we could show them the impairment, if we could find a simulator to allow them to feel the frustration of being unable to tie a shoe, go out in the slight breeze without the triggering of exquisite pain, or even walk, we too might too hear a “I'm so sorry. I didn’t know.”

And wouldn’t that be wonderful.

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.

It’s Not a Character Flaw to Need Pain Meds

By Jillian Drexler, Guest Columnist

I'm writing because I want to share the story of the “opiate and heroin epidemic” from the point of view of a chronic pain patient.

I was diagnosed with fibromyalgia last year. I also suffer from bulging and herniated discs in my neck and back (due to 3 car accidents that were not my fault), migraines, sciatica, and PTLS (Post Tubal Ligation Syndrome), just to name a few. More than likely the fibromyalgia was caused by the 3 car accidents, but I'm not certain.

I never imagined my life being what it is today. I don't know from one day to the next how I'm going to feel. I don't know if I'm going to feel just okay or like I've been ran over by a truck multiple times. It makes it hard to plan my day(s) out.

If the pain itself isn't draining enough, the uncertainty sure is. The pain drains you in every way imaginable -- physically, mentally, emotionally, socially and beyond. And then there are the times when you don't sleep. You can't sleep because of the pain and not sleeping triggers more pain.

I lost my insurance after returning to work after my son was born. I couldn't afford it through work, yet I no longer qualified for Medicaid. I feel that if I had insurance all those years, the severity of my pain could have been prevented or drastically reduced.

I am not prescribed any pain medications for my conditions. I know what medication helps my pain and helps me have some quality of life, but unfortunately I'm denied this medication.

I'm on an anti-depressant whose off-label use is to treat fibromyalgia, a seizure medication whose off-label use is to treat nerve pain, and a muscle relaxer. The muscle relaxer and seizure medication provide the most relief, but they don't completely help me. Over the counter pain medications don't scratch the surface of the pain I endure on a pretty much daily basis.

When I first called my doctor last fall to schedule an appointment, I was immediately told she does not prescribe narcotics and was asked if I was okay with that. I was fine with it because I didn't know what was wrong with me.

JILLIAN DREXLER

While seeing her, she mentioned referring me to a neurologist and pain management on two separate occasions. This hasn't happened yet because my insurance is still up in the air, even though I went through a period of unemployment and am currently working part time.  

What am I supposed to do? Never in my life did I think at 32 years old, I'd be in a fight to have some quality of life. Why is this happening? It shouldn't have to be this way.

At an ER visit earlier this year, the emergency room doctor insinuated I was a drug seeker. I'd just had gallbladder surgery a week prior and because I was still in pain and seeking relief, I was pretty much deemed a drug seeker.

A lot of these doctors are pegging the wrong people as drug seekers. Chronic pain patients didn't ask for their illnesses. We don't enjoy missing the pain-free life some of us had, having to limit the number of hours we can work or even quit our jobs, and missing events with family and friends.

Most of all, we don't enjoy being judged for needing pain medication in hopes of having a pain-free day so we don’t spend all our time in bed. This isn't life. It’s simply existing.  Some of these doctors forget about the Hippocratic Oath they were once required to swear by. They forget they work for us.

With the recent adoption of the CDC opioid prescribing guidelines, many chronic pain patients are left to suffer. Either they're like me and aren't getting any pain medication, their prescriptions are being cut, or they're being taken off of their pain medications cold turkey. This was supposedly been done to combat the opioid and heroin epidemic. I agree there is an issue with abuse and something needs to be done, but why does it have to be at the expense of chronic pain patients?

While the opioid and heroin epidemic are the focus, there's a suicide epidemic in the pain community that's being ignored. Some chronic pain patients are in so much pain, they feel the only way to stop their suffering is to end their life. No one should be made to feel that way. What ever happened to our right to life, liberty and the pursuit of happiness? The government is taking away the very rights it has an obligation to protect. 

I realize not every chronic pain patient benefits from or can take opioids. A lot of us benefit from marijuana. But that's not legal in every state. There has to be a better way! And, why wasn't a better way found before preventing us from getting the medications that help us to function? Why do the lives of opioid and heroin addicts supersede those of chronic pain patients?

The CDC guidelines say pain patients should find other ways to control their pain. The biggest suggestion I've come across is Tylenol. If Tylenol is all it took to relieve chronic pain, I don't think so many chronic pain patients would be ending their lives to stop the suffering. Tylenol just isn't meant to help with chronic pain.

What other options are there? Massage and acupuncture usually aren't covered by insurance. And, with a lot of chronic pain patients being forced to quit their jobs or work reduced schedules, most of us can't afford to pay for alternative treatments out of pocket.

So, we can't have our prescription pain medications, marijuana is still illegal in many states, a lot of us can't bear physical therapy, and over the counter pain medications just don't cut it. What are we left to do? It seems that suffering animals receive more compassion and concern than human beings.

A few years ago, I would barely take an aspirin for pain, let alone a prescription pain medication. I was more physically active, took vitamins and supplements, and was overall a happier, productive and somewhat healthier person. I didn't look down on or judge those that needed prescriptions to live.

Fast forward to today and I still take supplements and vitamins, yet I'm unable to be as physically active as I was and take several prescription medications. I've lost so much -- my career, quality time with family, my independence,  and being able to do a lot of the things I'd come to know and love. I feel as though I'm not even the same person I used to be. I'm a shell of my former self.  

In the midst of all of this suffering, I've gained something as well.  A few months ago, I was introduced to #PatientsNotAddicts on Facebook and on Twitter. #PatientsNotAddicts is an advocacy group whose mission is to show the world chronic pain patients are not addicts. I am the state representative in Ohio for #PatientsNotAddicts.

I've learned so much from the group and its members. I take what I learn and have experienced and share it with other chronic pain patients. There are a couple of people who I've formed friendships with. It's great to have friends you can talk with and who understand what you're going through. 

In closing, I just want to say it is not a character flaw to need prescription pain medications. However, it is a character flaw to be okay with treating all chronic pain patients as though we're addicts.  Not only should it be illegal, but it's just plain wrong. It shouldn't be this way! How are those responsible for allowing this to happen able to sleep at night?!

Jillian Drexler is from Cincinnati, Ohio.

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.

How to Cultivate Hope and Not Dwell on Suffering

Pat Akerberg, Columnist

For the millions of people arm-wrestled into submission while they endure lives compromised by chronic pain, the kinds of suffering that go with it require no explanation.

Suffering comes in all forms of physical challenges (unrelenting pain, incurable illness, complications and limitations), psychological struggles (depression, anxiety, self-esteem, image and identity) and spiritual dilemmas (faith, meaning, purpose and acceptance).

Hope, an invisible yet essential holistic supplement, strengthens our resolve to face these challenging twists and turns by making the unbearable, bearable, and somewhat negotiable. 

Hope gives rise to a sense of meaning, purpose and possibility in our lives. Without it, our outlook becomes bleak and our emotional landscape flat. 

So how does hope link up with pain and suffering? 

I believe there are identifiable stages that occur between the degrees of suffering and hope we experience, creating a rise and fall relationship between them. 

When suffering is low, it makes sense that our hopefulness would be at a high level.  Like it was when I was lucky enough to be a part of what I call the “worried well” population.

Call that the “fortunate” stage when a person has not yet been tested by any of the tougher blows life can deliver. Unconstrained at this stage, hope can be defined as the belief that something better is always possible.

Inversely, the middle or “setback” stage knocks hope off its very axis, as our health is threatened.  Here we define hope as getting better, and fervently invest all of our energies in chasing that outcome.

However, if the condition becomes chronic, a person can feel quite powerless, with little control over being able to decrease their kinds or levels of suffering.  Their ability to feel hope about improving their situation plummets.

We usually think in terms of beginning, middle and end with stages.  However, what if there’s no end in sight, no “moving past” or “moving through” our medical plight?  Chronic illness shoves us into the “enduring” stage.

While it may seem that hope eludes us in this stage, at a time when it is needed the most, that doesn’t mean it no longer exists or is unavailable. But the journey to uncover that hope is tricky. Some tell inspirational stories about being transformed by rediscovering hope in a new way. 

Others seem to find a more self-empowering approach that influences how they will allow the latter stage to impact them. It’s not the happy, faux version of hope, but the livable version rooted in the hard work of finding a personalized realism.   

Feeling stuck in the “setback” stage for years, it hit me that not only was I irreparably damaged by the surgery promised to “cure” me, I was also medically conditioned by multiple doctors that my situation was hopeless – harmed beyond help or relief.

I have come to define this equally destructive medical implication as “learned hopelessness.”  No, not the popularized “learned helplessness.” People who learn to take action on the things within their control and bypass those they can’t aren’t helpless. 

But a medical system that has little intellectual curiosity, compassion, or time to devote to tough cases can create further assault by unwittingly kicking the hard can of truth right over the line into hopelessness. That was true for me, until I realized that both suffering and hope needed to be untangled and redefined to fit my new reality if I was ever to endure the “enduring” stage. 

With a damaged trigeminal nerve, I was still defining hope in improbable degrees of “getting better.”  Even just the notion of holding a compromised, shaky steady state felt like defeat vs. a small victory. 

Overcoming Emotional Traps

Once I caught on to these medical, mental, and psychological traps, I had to modify hope into feasible terms by translating it into the smallest incremental possibilities, and then some progressively larger ones. 

I’m talking simple things like being able to take a short walk, Skype with my granddaughter, have a short visit with a friend, follow a yoga CD, go to a retail store, and such. Sometimes my best hope equates to making it through the next hour. 

As I was able to redirect my focus on those smaller things in the enduring stage, I found that my repertoire for cultivating a smidgeon of hope expanded. I was onto something within my control that could influence my levels of suffering and hope.  Even better, that something wasn’t dependent on what doctors did or didn’t say or do.   

These small, successive flickers rekindled my battered relationship with hope. I felt as if hope could be resuscitated in spite of so many crashes. 

My pain hasn’t decreased physically as much as it has shifted into my side view mirror at times, as opposed to blocking my windshield (which grieving over losses can do).

What works better for me is to remind myself that no matter how difficult a time I might be having, I’ve survived worse ones.

We also create twisted parallels when we perceive and talk about suffering and hope by comparing how we were (before chronic pain or illness) to now (with them).  Such comparisons are faulty because they’re not apples to apples in time or circumstance.

Seven years in the “setback” stage taught me that if I focused on my level of suffering as it increased– which I call “suffering over my suffering” – it became a costly, self defeating exercise.

It’s tricky the way hope nudges us into a decision point to help us endure.

Instead of dwelling on the suffering of what we can no longer be, have, or do; it teaches us to lean into ways that side step the medical, mental, or emotionally dooming loops that sabotage the very thing we’d like more of – small reasons to still have hope.

Pat Akerberg suffers from trigeminal neuralgia, a rare facial pain disorder. Pat is a member of the TNA Facial Pain Association and serves as a moderator for their online support forum. She is also a supporter of the Trigeminal Neuralgia Research Foundation.

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.

Legalizing Marijuana? Don’t Forget its Medical Use

By Ellen Lenox Smith, Columnist

At least half a dozen states may be joining Colorado and Washington in the full legalization of marijuana. As a medical marijuana patient in Rhode Island, that has never been my battle. I have tried to stay focused on improving medical marijuana laws in Rhode Island and 23 other states, such as expanding the conditions for which it can be prescribed to include chronic pain and other medical issues.

It is mind boggling to me that some states have not yet approved marijuana’s medical use, but seem to be jumping right into legalization, most likely because they see it as a way to generate tax revenue.

We must hold onto the medical programs and be sure they are not mixed into the rules for full legalization. That would be like allowing medication from the pharmacy available to anyone to enjoy for pleasure. This is our medicine.

I have no problem with others having the pleasure of using cannabis socially, but let’s make sure we maintain the integrity of the medical programs.

This is our vision for every state in this country in the near future:

1) Medical marijuana is approved in all states and it includes reciprocity from state to state so we are safe to medicate legally when we travel.

2) Patients qualify when their doctors confirm they have a need and cannabis is no longer limited to specific conditions. There are many less common ones that can be treated effectively with this medication. 

3) Patients have a choice of growing, which is both therapeutic and helpful for those who find strains they are compatible with.

4) Each state offers compassion centers or dispensaries that are strategically placed so all have access within a reasonable distance.

5) Prices at these centers are affordable and on a sliding scale. Many who are afflicted with health issues already have massive medical bills. We do not want to have the mindset of making a large profit off the sale of their medication.

6) When all states are legal, we then conquer the battle of being reimbursed for our medicine from our insurance companies.

7) Allow centers to grow the plants they need to accommodate patients with all of the various strains. 

      8) Allow centers to sell various forms of medical marijuana, including dry product, oils, tinctures, topicals, edibles, etc.

      9) Allow a delivery system for those seriously ill and a gifting program to those financially unable to pay.

     10) All centers grow organically, keeping us safe from pesticides and other chemicals.

     11) People using medical marijuana will have the legal right not be drug tested, discriminated or fired from employment.

As the demand for full legalization continues to spread across the country, please help your state maintain the integrity of its medical program. Medical marijuana is intended to help us with quality of life, not to make a huge profit from. Let those that are using it for recreation be the ones to pay taxes and bring in the revenue for your state.

Let’s keep this medicine affordable for those in need.  For those that do not need it for medical reasons, be glad you are able to use cannabis socially and not have to face issues like us!

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis.  Ellen and her husband Stuart 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 or to contact the Smith's, 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.

What Arachnoiditis Did to Me

By Shane Schwartz, Guest Columnist

I injured my back lifting tiles and went through every possible treatment, including physical therapy, steroid injections and a host of other things before finally deciding to have surgery. I couldn't take the pain any longer.

After speaking with the neurosurgeon, I elected to proceed and had a 360 degree 2 level fusion at L4-S1 with plating and decompression. It was quite an extensive surgery lasting over 9 hours. I did okay for the first 6 months and was placed in physical therapy as part of my rehabilitation -- supposedly to get back to 80% of my normal health.

Well it fell apart shortly after that and I underwent another round of epidural injections in hopes of some sort of relief, but to no avail.

After being kicked to the curb by my neurosurgeon and being told of all kinds of different diagnoses which made absolutely no sense, I went to the Oklahoma University Medical Center because I was told I had a brain tumor by the crooked neurosurgeon’s partners in crime.

Upon arriving at the hospital, I said I needed a brain scan because of what the doctors who did my spine surgery had told me. The doctors at OU pretty much laughed after a physical exam of me. They scheduled me for spinal imaging and that is the first time I ever heard of Arachnoiditis. My father is a nurse anesthetist and he was very concerned when he heard that word being used.

Suddenly everything started fitting into place as to what was happening to my body. Look at the before and after pictures of me. My heart goes out to everyone dealing with this.

I sent my MRIs scans to a very qualified physician who specializes in this disorder and went to visit with him after reviewing my scans. He confirmed it was Adhesive Arachnoiditis.

Folks, this disorder is so much more than a spine issue. It robs me of everyday life as I once knew it.

I'm 41 years old, but feel as if I'm 90. No disrespect to the elders, please don't misunderstand me, but it causes unrelenting pain throughout my entire body.

BEFORE AND AFTER PHOTOS OF SHANE SCHWARTZ

I just want to be able to enjoy life with my children again. I have a 17 and 8 year old who have basically had their father stolen from them.

This disorder needs to be on the front burner of every doctor doing any kind of spine surgery, as I was NEVER warned of anything even remotely close to this as a side effect.  I question almost daily if tomorrow is even worth it. This is no way to live.

The spine surgeons keep getting richer at the public expense and when something of this nature occurs, you are like a tin can and kicked to the next doctor, who may or may not take you. From my experience no doctor wants to deal with Arachnoiditis once they hear the word. WHY?!?!? I am a human being!!!! Not a tin can that can just be kicked around and down the road because these doctors don’t want to deal with it or own it!!!

It's so very frustrating, depressing, and my anxiety is through the roof. It's just HORRIBLE!!!

God bless anyone and everyone who has this disorder and has to deal with it on a daily basis. I am open to conversing with others in my shoes. I love and wish us all the best and thanks for reading.

Shane Schwartz lives in Oklahoma.

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.

The Hidden Dangers of Self-Medicating with OTC Drugs

By James Campbell, MD, Guest Columnist

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

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

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

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

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

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

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

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

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

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

Drug Interactions

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

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

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

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

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

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

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

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

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

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

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

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

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

Why Aren’t Pain Patients Protesting?

By Mary Maston, Guest Columnist

I’ve become somewhat disenchanted with my role as a pain patient advocate. When I started out in 2011, I was armed with a strong opinion, an admittedly big mouth, and I suppose I had grand illusions of working with others to effect positive change.

I wanted to help right the wrongs being inflicted on people who depend on pain medication -- not because they want to -- but because of some catastrophic life event that forced them to choose between taking medication to be able to function in their lives or not being able to function at all.

I’ve been there myself. I’m still there and always will be because my kidney diseases are never going away.

Throughout this journey, I’ve had the opportunity to converse with and learn from some highly educated and well versed people in the pain community. Watching them do what they do to help others is nothing short of awe inspiring, and it has helped to keep me going. For that, I can never thank them enough.

The one thing that’s been drilled into my head all these years and has been mentioned in just about every article I’ve ever read about chronic pain is the number 100,000,000.

ONE HUNDRED MILLION. That’s supposedly how many chronic pain patients there are in the United States. If you believe that statistic, we make up nearly a third of the population of the entire country.

So my question is this: WHERE THE HELL ARE YOU??

I read most of the articles that are published on pain and/or pain meds, and all of the comments on both the articles and on Facebook, if that’s where the article is posted. For the most part, I see the same names commenting over and over. Kudos to those who stay persistent, but where are the rest of you?

ONE HUNDRED MILLION and the author is really lucky if he/she gets a couple hundred comments. Usually 30-40 is the going rate. Sometimes it’s even less than that. You can’t blame those who don’t have an internet connection either. Just about everyone has a phone or tablet these days and even elderly people are online in record numbers.

Maybe it wouldn’t have made much of a difference, but maybe it would have if the CDC opioid guidelines had gotten more of a response than they did. We’ll never know now. Where were you when the CDC was taking public comments? I can’t remember the final number, but I know for sure that they received less than 5,000 comments, and many of those comments were people who were in favor of the guidelines – people working against you and the advocates that are trying to go to bat for you.

I personally shared the CDC comment link repeatedly in my Facebook group and practically begged people to write a comment and share their experiences. From talking with other administrators of other groups in the past, I’m sure they all did too. Only a small handful from my group wrote a comment, and by small handful, I mean less than 20.

To say I was disappointed with the final number of comments from patients is an understatement, but what’s done is done and now we all have to live with the outcome.

ONE HUNDRED MILLION - WHERE ARE YOU?

There’s another petition to the White House that’s been active since May 3, asking all of the government entities, including the President, to take pain patients and what we are going through into account by revising the CDC guidelines. It’s been online for 14 days now and only has about 600 signatures. It needs 100,000 to reach the White House.

ONE HUNDRED MILLION - WHERE ARE YOU?

The bottom line is this: We as advocates are doing the best we can and are trying to help you, but we can’t do it by ourselves. Make no mistake, we are rapidly losing this battle and in the end, you are the ones that are going to lose big. Venting in closed Facebook groups is great if it makes you feel better, but complaining in a closed group about not getting your meds to people who can do nothing about it does absolutely NOTHING to contribute to solving the problem. Neither does posting comments on Facebook. You have to go beyond that.

When we use that number, 100 MILLION, and then something big comes along like the CDC guidelines or petitions to the White House and you all don’t step up, it makes us look like we’re just pulling that number out of our rear ends -- like we’re lying.

What are we fighting for if we can’t produce the numbers to back it up? Just my opinion, but if you feel you’ve been wronged because you can’t get the meds you need, I shouldn’t have to beg you to help me fight for you.

I may be mistaken, but I get the impression more and more that other advocates are starting to feel this way as well. How can you help people that aren’t willing to do anything to help themselves? The answer is simple. You can’t.

We know you’re out there and we know what you’re going through; you write to us and tell us. Why won’t you take it further? We only have so many tools we can use, and it’s only going to get worse if you aren’t willing to lend your voices and your signatures to the things we are trying to use to fight for you.

ONE HUNDRED MILLION – that’s a huge number. Imagine what we could do if we all stood united and took a stance. That number of voices is hard to ignore. SO WHERE ARE YOU?  

Mary Maston suffers from a rare congenital kidney disease called Medullary Sponge Kidney (MSK), along with Renal Tubular Acidosis (RTA) and chronic cystitis. Mary is an advocate for MSK and other chronic pain patients, and helps administer a Facebook support group for MSK patients.

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.

Don’t Complain About the Grilled Cheese

By Barby Ingle, Columnist

2016 is turning into the year of the patient advocate. It’s been great to see pain sufferers who’ve been quietly supporting our advocacy work for years finally start speaking up for themselves. I think the CDC opioid guidelines and having so many doctors change their practices have caused this surge.

We need to be heard, but I am also seeing people still trying to convince the CDC that we are suffering and that we are not drug seekers. It reminds me of the quote by Dale Carnegie: “Those convinced against their will are of the same opinion still.”

Being in advocacy meetings and testifying at the federal and state level on a multitude of pain challenges and policies, I have learned that there is a better way to approach this. I have gone to legislative meetings where minds were made up before we even testified. They gave us our 2 to 5 minutes to speak and then went ahead with the decision they were set to go with before the meeting started.

Having done over 300 media interviews, I can also say even in a live interview this is what you can expect. The reporters and producers have a set script and set agenda before you arrive. They have the questions and graphics set in advance. If you think you will be able to tell your side and convince someone to change their mind in a public setting, think again.  

Here is a parallel example. If you walk into a sandwich shop owned by a grilled cheese sandwich maker and the shop is called Sammy’s Best Grilled Cheese, don’t expect to find a beef brisket dinner on the menu.

Yelling at the owner (who advertised properly what you will get there) or complaining on social media will only bring Sammy’s free advertising. They are not going to change their menu. They know that will not make everyone happy, but it is their shop.

You want a beef brisket dinner? Find a different restaurant or make your own. And if you make your own, don’t expect the grilled cheese fans to come.

In the case of TV, after doing a few shows myself, I know the producers are not looking to see if people liked the show or not, they are looking to see if people react. Yelling or writing mean letters, emails, and social media posts is only giving them ratings and marketing for free. It promotes their agenda and message even more. It’s exactly what they want.

They already know that there are more chronic pain patients than addicts, that patients have limited access to proper and timely care, and that the sponsors of the program are paying them. And they will cut you off the more you fight. 

How can we be heard? When it comes to legislation, we need to work to get into committee meetings before the big public hearings. Legislators need guidance before the hearings happen. Share social media posts, call the legislators’ offices and send letters before the hearing. Show up at press conferences for the bills that we support.

It is very difficult to change a legislator’s mind at a public hearing. We have to get them before the hearings. Once we get on the inside, then we can get placed on advisory committees and work strategically towards making changes. This is something that will take time to do, but it is the most effective way to make meaningful, lasting change.

When it comes to media, we need to place our own stories and not react to every story or segment that has already aired. They can’t go back, it is done and it is out there. Commenting on them is okay, but it is not going to get our voices heard for meaningful change. Who are you trying to convince at that point? If the show or story doesn’t promote what you want, why keep pushing it through social media?

The person or media group that put it out is happy to see the reaction to their piece. Most readers do not even go through and read what you write, and others will see 207 comments and skip through them. Why not give them no comments and no attention if it goes against what you believe? Instead write your own blog, media article, or TV station about airing a segment on chronic pain and the area of interest you want covered, the way you want it covered.  

If you want a beef brisket, go to where you can get one, don’t spend time going to Sammy’s, where you know it is not sold. Going after the chef and demanding he offer a different choice is not going to happen. It has only given us Soup Nazis like the CDC: “No soup for you!”

We need to create our own recipes. Give them well-thought answers with research to back it up. We know that the studies the CDC used were poorly done, so maybe start with presenting better research. There isn’t any? Then we need to create our own research studies, surveys and needs assessments.

The same concept can be applied to finding the right healthcare provider. If you read their website and they don’t offer the treatment you would like to try, find one who does. You will have a better chance of being heard, bettering the pain community, and making a difference that can be lasting and effective. 

The solution is going to take time. It will mean electing people to public office who understand what we are going through, who are pain patients themselves or a caregiver who gets it. It is going to take patients voting and speaking out at the right place and time. Speaking up after a decision is made is not helping. It is making us look like seekers and addicts.

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.

Pain Companion: Losing Your Smarts to Pain

By Sarah Anne Shockley, Columnist

In my last column, When Pain Hijacks Your Brain, we looked at a couple of ways that living with chronic pain affects cognitive ability; specifically, blank spaces and brain freeze.

This month we’ll look at memory loss and overall loss of brain power, and share some tips I’ve learned about mitigating their impact.

What to Do About Memory Loss            

Can’t remember what you did yesterday or even two minutes ago? Short-term memory loss is common for people in pain. I believe it is because the body and brain are simply overloaded having to deal with compromised health, and the overall stress and exhaustion that pain creates in the system.                   

Sure, forgetting things happens to everyone. But for those of us living with chronic pain, it seems to happen more often and it takes longer for our brains to come back online.                 

Write yourself notes and stick them everywhere. Write the note immediately or you will forget not only what was supposed to go on the note, but that you were writing a note at all. (No kidding)                               

I keep the smallest size of Post-it Notes in my car and stick notes on the dashboard so I don’t forget where I’m supposed to be later or what I need to do when I get home. I leave these little pads all over the house with pens nearby.                   

I have Post-its all over my computer, my desk and my kitchen, and I just throw them out when I’m finished with them. I have gotten into the habit of writing EVERYTHING down the minute it comes into my head and sticking it immediately where I will find it later.                   

What about the problem of walking over to the Post-it pad and forgetting what you’re supposed to write there on the way? (You’re only laughing because something similar has happened to you, I’m sure!)

Go back to the physical spot where you were when the thought came to you and put yourself in the exact same position and wait a moment. Somehow, the body and brain sort of coordinate in resetting yourself back in time, and then your brain often sends you the same message again.                   

Oh, and don’t forget to have the Post-its and pen already in hand.        

What to Do About Loss of Brain Power                   

My brain in pain can barely make sense of how to balance my bank accounts. Truly. It scares me to look at a row of numbers. Not because numbers are scary to me or I’m terrible at math – I aced all my graduate finance and economics courses – it scares me because, when in pain, I can’t make heads or tails of them. It’s like looking at Egyptian hieroglyphs.                   

It is incredibly disconcerting to lose your smarts to pain. Focusing on anything becomes nearly impossible. I remember having a vocational aptitude test done after I was injured and not being able to read a high school level paragraph or answer the questions appropriately.

I sat there and reread the same three-sentence paragraph about four times and simply couldn’t make any sense of what they were asking me to do with it. If you’ve had an experience like this, you know how frightening it can be to realize you just don’t have access to your normal cognitive functioning. It’s like someone turned the lights off upstairs.

Your brain in pain is simply not firing on all cylinders or most of its energy is going to dealing with the pain you’re in and healing your body. There just isn’t much brainpower available to you for normal cognitive processes.                   

This was true for me during the most acute part of my pain and it went on for quite some time. Thankfully, I have been able to recover much more access to my cognitive processes since then. So, please know that if you are going through the worst of this kind of side effect right now, it can get better as you move out of the most acute pain. You can get your brain back.             

For the purpose of regaining a modicum of brainpower, and for using some of my unused mental energy, I started doing extremely easy Sudoku puzzles, a popular Japanese number game.                   

At first, doing Sudoku worked like a sleeping pill because I quickly wore my brain out just trying to make sense of the very easiest puzzles and basically knocked myself out. I kept at it as a nightly sleep aid and eventually I was able to complete the easy puzzles. I usually had to erase what I’d already filled in and start over about 3 or 4 times in order to finish one small puzzle.                

I found that, in addition to acting like a benign sleeping pill, Sudoku helped bring my brain back online over time. I was able to progress from Easy to Medium to Hard. (I have not graduated to the Evil level yet.)

This tells me that even if the brain is hijacked by pain, it is possible to bring it back by starting small. Simple crossword puzzles can work too, but initially I found that even these were too demanding and frustrating. I could come up with a number from 1 to 10 more easily than a specific word.      

There are other ways to bring the brain back online as well: Scrabble, Monopoly, cribbage, backgammon or any other game requiring some counting, but are not overwhelmingly complex.

Jigsaw puzzles, origami, scrapbooks, photo collections; anything that requires organizing visually can also be useful. If you have enough mental energy for it, small amounts of foreign language study can also do the trick. Many public library systems have easy and free courses you can use online.

These ideas seem really simple, I know, but that’s exactly where to start. Really easy and really simple.

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.

CNN Gets It Wrong About Pain Patients

By Sarah Daniels, Guest Columnist

You may have seen last night’s CNN town hall meeting on “Prescription Addiction: Made in the USA.”

I couldn’t believe it when Dr. Drew Pinsky said that real compliant pain patients are “a very tiny minority” of prescription opioid users.

I’m so sick of being grouped in with addicts! Because of all the new CDC regulations, I had to go weeks without my medication after being on high doses of opiates for a long time.

No one would give me my medication. Every pharmacy I went to said they were out. One pharmacy had the medication and was getting ready to fill it when the head pharmacist came over and told me unfortunately they wouldn't be able to give me the script. When I asked why she said they didn’t have it. I explained I was told they did and it was being filled. She said it wasn’t enough.

I asked if my doctor could write a different script for a temporary amount, would they be able to fill it and she just handed it back to me saying, "Like I said, I’m sorry, I can’t help you."

Then I went to a hospital pharmacy that did have the medication and they actually told me they needed to save it for patients who had short-term pain like surgeries for broken ankles. When I asked how someone's broken ankle pain was more important than my chronic pain from my genetic illness they asked me to quiet down and leave. If I didn't they would have to call security.

I was being polite and respectful, because I know as a pain patient you have to be the best advocate you can be, especially with all the stigma attached to opiates. I was also being quiet because I am never loud when discussing my pain meds, as you never know who is listening.

I never fight or argue or really raise my voice with anyone. I am a happy person despite my illness. I am grateful and thankful for each day I wake up and am able to spend with the people I love.

I did not appreciate someone making me out to be a completely different person than I am. It was like they actually felt threatened by me. Give me a break. I was in a wheelchair.

Now I’m not able to find the medication. My doctor wrote me a script for the medication because we have both decided it is the only thing and best thing for me to be on. It gets me out of bed and still, I can’t get it.

Now I am forced to go to a new pain clinic with new meds, where they're making me stop medical marijuana, which is the only thing keeping me from a feeding tube. They are making me come in for a visit once a week and each week I have to get drug tested and get labs drawn which costs $16. The visit itself costs $35.

SARAH DANIELS

They also want me to see a pain psychologist twice a week (who I already saw with my previous pain specialist and was cleared by). God only knows what that costs.

I’m on disability. It barely covers my insurance and yet I have to do all of these things to be compliant. I have to come up with the money for all of these appointments and procedures, find someone who will be able to drive me, as I am disabled and cannot do so on my own, and also be  well enough to even leave my house to make these appointments, just so that I am considered compliant. So that I can take a medication that I’m not sure will even work.

I am just disgusted by what is going on. As pain patients we are left in the dust. Nobody stands up for us. We try to stand up for ourselves, we are pretty strong, but we need bigger louder forces on our side.

Sarah Daniels lives in the Detroit, Michigan area. She suffers from Ehlers Danlos syndrome and gastroparesis. Sarah is a proud supporter of the Ehlers Danlos National Foundation and the Gastroparesis Patient Association for Cures and Treatments (G-Pact).

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.

Wear, Tear & Care: Media Hysteria and the Opioid Crisis

By J.W. Kain, Columnist

I recently received this email from a family member:

Hi Jen,

I was listening to a thing on pain medication and why prescription meds are so dangerous. They turn the receptors off in the brain and the person forgets to breathe.  That part is a totally separate thing from the pain. Dr. Sanjay Gupta was on talking about it. I think that is a very valid argument about overuse of pain meds.

For example, Prince had very valid issues to use the meds and also lived a very clean life style. If he overused, it goes to follow that someone who doesn't lead a clean lifestyle is in more danger. It's not the meds as much as the brain receptors. The breathing part is scary. So I'm not such an advocate anymore.....unless you can tell me this isn't true and why he would say that.

I love you and don't want anything to happen to you. Xoxoxox

I got mad after reading that, even though I knew she was coming from a place of love and fear. It didn't take long for me to calm down because I saw the bigger issue.

First off? Yes, those claims are true. They are also massively simplified. Heavy pain medications slow down or impair bodily functions. You’ve seen those opioid-induced constipation commercials. That is why only a select few of the chronic pain club gets high-voltage pills for daily life as opposed to post-surgical pain.

Here’s a great quote from WBUR’s interview with Dr. Howard Fields that explains the difference between addiction and dependence, the latter being what most chronic pain patients experience:

“Addiction really gets to the issue of compulsive overuse of a drug so that it becomes the dominant thing in your life. If you are going to your physician once a month and getting your prescription refilled and you are able to lead a normal life by taking a pill maybe three or four times a day, you’re not addicted.

But if you’re spending all your time in the search of a drug, or trying to get the money to buy that drug, or stealing from your friends, or going around in other people’s medicine cabinets looking for opioids, then you’re addicted.”

My view of this increasingly volatile situation is that opioids — which the majority of pain patients use responsibly — cannot be banned without another medical intervention in place. Yet some pain management clinics are declining to prescribe opioids.

So what’s fueling this explosion of insanity?

Welcome to the opioid crisis media extravaganza. There is currently a media blitz surrounding the national opioid crisis:

  • A doctor in Buffalo was indicted and closed his practice, leaving thousands of his patients without access to pain medication.
  • A California doctor was convicted of murder for writing too many prescriptions (and to be fair, that case was pretty shady).
  • The late pop icon Prince died after allegedly overdosing on opioids (though few talk about his chronic and debilitating pain, a condition that is “criminally under-treated”).

Many, many people have overdosed and/or died. That is undeniable and is certainly a problem. But the national reaction has not been the appropriate response. The CDC guidelines that discourage doctors from prescribing opioids gloss over pain patients like we don’t exist and only add to our desperation. A former FDA commissioner even slanders us.

So many patients are doing everything right — exercise, strength training, meditation, deep breathing, over-the-counter pills, medical marijuana, aqua therapy, physical therapy, chiropractic work, Reiki, crystals, and anything they see that makes a vague promise to help.

Pain can drive sufferers to extreme lengths, be it suicide or illegal drugs like heroin. Patients are far more likely to turn to street drugs if there is no access to proper pain medication. Or, you know, when pharmaceutical companies outright lie about the addictive natures of their pills.

It's coming out in the news more steadily now, but the rumblings have been around for several years. The opioid crisis may have started partly because OxyContin, “a chemical cousin of heroin,” had addictive qualities and yet was prescribed with abandon.

Purdue Pharma reps went to doctors and told them their pill wasn’t addictive and lasted for twelve straight hours!

In reality, OxyContin presents a serious end-of-dose failure. This is when a drug says it will quiet pain for twelve hours, but in reality only works for eight. This causes patients to take additional pills or stronger ones, which can lead to overdose and addiction.

A four-hour gap? What did Purdue expect to happen?

The knee-jerk reaction to the crisis is to limit the prescriptions of opioids. What does this do to pain patients? It leaves many of us without access to pain management methods that the majority of us have not abused.

Doctors tell sobbing patients that long-term opioids are usually not the answer. But they are the answer for many patients who literally have no other options beside being bed-bound or dead. Those patients are now in grave danger of being driven to extremes. Like that one awful guy who ruins things for everyone else, there have been patients who’ve abused their health care regimens. Sometimes they can’t even help it, like so many of those OxyContin patients who were lied to.

Many of us have to sign pain contracts before we can even dream of receiving opioid prescriptions. These state that our pills are doled out in certain quantities over a set period of time and that they cannot be replaced, supplanted, or in any way refilled for one month. If we lose them, if they get stolen or if the world explodes, we cannot get more.

We have to get new prescriptions in writing every month. The hard copies have to be delivered to the pharmacy. Our driver's licenses must be presented to the pharmacist so they can track our pill usage. Then, and only then, do we receive our prescriptions.

Tell me: Why on earth would we jeopardize that? Most of us are responsible. We don't overuse what we have. We know we can't, or we’re cut off.

A lot of people say, “You’ll end up hooked." The medication will change our brains to make us need, need, need, and we will do anything to fill that need.

And yet, both I and other patients in my support groups, online chats, and frequent fliers at the doctor’s office time our prescriptions and take them exactly when due. We pair that with every other over-the-counter intervention we can think of, like wearables, pain patches, creams, and braces. We can’t rely on opioids because they might disappear at any moment.

The current approach to battling the opioid crisis lumps pain patients with true addicts, and it skews the statistics. I’m not naïve enough to say that some addicts didn’t start as pain patients. I know some did. But in my entire decade-plus in the medical system, I personally know of only one person who started on pain medication and ended up in rehab. I know a few more online, but I can count them on one hand.

My fundamental message here is that unless the proper education is provided, even your biggest supporters — your family, your friends, your colleagues — might react to the media hysteria without doing research that contextualizes the data. They might read a tweet or a headline and react out of fear. Stories will keep being conflated.

They might even send an email like the one sent to me. They only mean the best, but it adds to the collective national fear that is leaving thousands upon thousands of pain patients without the treatment we need.

Prohibition didn’t work in the 1920s. This version of Prohibition isn’t going to work either. The sooner we as a society come to that conclusion, the better.

J. W. Kain is an attorney in the Greater Boston area who also works as a writer and editor in her spare time.  She has chronic back and neck pain after two car accidents.

You can read more about J.W. on her blog, Wear, Tear, & Care.  

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.

Seeing Both Sides of the Opioid Debate

By Crystal Lindell, Columnist

I have suddenly found myself on both sides of the opioid issue.

I’m a chronic pain patient who is among the lucky few to have gotten better, or at least mostly better. And now, I’m so “lucky” that I get to take myself off opioids. It’s been hell.

I had this idea in my head that it would be like in the movies — 72 hours of feeling like death and then I would go on with my life. But it turns out even after your physical body adjusts to life without the drugs, your brain aches for them and begs you to take them.

I have it on good authority — a psychiatrist at a university hospital who specializes in this sort of thing — that I was never classically addicted to the morphine and hydrocodone that I took on a daily basis for my intercostal neuralgia. I never took more than the prescribed dose. I never took them to get that “high” that can come from the drugs. I never bought any off the streets.

I took them for pain. As prescribed. And I passed every stupid urine test they ever gave me. If they gave out grades for taking opioids correctly, I’m not saying I would definitely have an A+, I’m just saying I probably would. 

But when you’re on morphine 24 hours a day/ seven days a week for three years straight, your brain doesn’t much care why or how you took them, it just wants to know why the heck you stopped.

And so even after the initial diarrhea and the sweating and the body aches subsided, my brain was left in shambles. And I was hit with horrific, lingering crippling anxiety and insomnia.

It turns out there’s this thing called post-acute withdrawal syndrome, or PAWS. And first it should be noted that they really didn’t take things typically associated with puppies and use them to name ugly, terrible withdrawal-related issues. But whatever.

Anyway, as you go off certain drugs, like opioids, “Post-acute withdrawal occurs because your brain chemistry is gradually returning to normal. As your brain improves the levels of your brain chemicals fluctuate as they approach the new equilibrium causing post-acute withdrawal symptoms,” according to an article on Addictions and Recovery.org.

“Most people experience some post-acute withdrawal symptoms. Whereas in the acute stage of withdrawal every person is different, in post-acute withdrawal most people have the same symptoms.”

And the symptoms can last for two years.

Here’s is a list of symptoms from that article:

  • Mood swings
  • Anxiety
  • Irritability
  • Tiredness
  • Variable energy
  • Low enthusiasm
  • Variable concentration
  • Disturbed sleep

I have all of them, if you were wondering.

The anxiety and insomnia are a special kind of hell, because they don’t even let you escape with sleep for a few hours a day. You’re just awake, all the time, wondering if the world is actually going to end right then.

And you know in your mind that the anxiety isn’t logical. You know that just because the guy you’re seeing has read your text message but he hasn’t immediately responded to it doesn’t mean he’s met someone else and gotten married to her in the last seven minutes.

But anxiety doesn’t give an eff about logic. So your heart rate ramps up and you feel sick to your stomach and you convince that if he would just TEXT YOU BACK it would all be fine. And then he does, but it’s still not fine. Because it’s never fine.

Possibly most depressingly of all, I’m struggling to write. The anxiety convinces me that I have nothing important to say and nobody would want to read it anyway, and that anything I type has probably already been said better by someone else. It paralyzes me, and takes away the one thing in life I have always been able to count on. And getting this very column out has been an exercise in sheer will.

So yeah, it’s been awful. And most of the doctors I’ve been working with truly believe that since the drugs are technically out of my system and I wasn’t an “addict,” that I should be super awesome and totally good to go. Except I’m the completely opposite of that, and I’m really struggling with all this.

The worst part might be that dealing with withdrawal has so many ties to morality in our culture, so every time I have an anxiety attack and I reach for half a hydrocodone to calm me down, I feel like I failed at life. I feel like I went from A+ to F-.

The thing is, even with all this hell, I still don’t regret going on morphine three years ago. Back then I was in so much pain that I was genuinely planning ways to kill myself and the opioids were the only thing that helped me. They not only saved my life, they helped me keep my job and stay somewhat social.

But now, as I try to get my brain back to normal, I’m struggling. Like I mentioned, I’m working with a psychiatrist and psychologist and I have also recently made the decision to go on anxiety medication and try sleeping pills.

I still wake up in a state of panic more days than not though. I feel like something horrible is going to happen at any moment, and feel lucky if I get five hours of sleep in one night. So it’s not like I’ve found a magic cure.

The bottom line is it’s time we all admit how incredibly complicated opioids really are.

On one side, people in pain deserve access to them. Quality of life is important and nobody should have to suffer because of mass hysteria about hydrocodone. 

But we can’t ignore the fact that no matter how responsibly we take these drugs, our brains get addicted to them over time. And stopping them isn’t as easy as a 72-hour withdrawal weekend.

Doctors need to know these things, and then they need to relay them to their patients. And only when we have an honest conversation about the benefits AND the risks associated with these drugs can we begin to move forward in a productive way.

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.

Making Everyday Life Less Painful

By Barby Ingle, Columnist

Every day is a challenge to remain independent when living with chronic pain. Normal activities such as walking, taking the stairs, squatting, sitting for long periods, and getting in and out of vehicles can be quite challenging and painful.

To get more out of life, I had to learn how to minimize disruptions in my daily routine and how to be a time and energy saver. That meant making some changes around the house.

Every pain patient and their family should assess their surroundings, perhaps with the help of professionals, and prioritize the modifications needed. This can help the patient maintain their independence and function.

Some of the lifestyle modifications you may wish to consider include: 

 Clothing

  •  Flat shoes instead of heels for patients with lower extremity issues
  •  Slip-on shoes
  •  Velcro or zipper closures for shirts or sweaters
  •  Velcro or zippers for shoes instead of shoelaces

 Bathroom

  •  Elevated toilet seat
  •  Grab bars in the bathtub, shower, and next to the toilet
  •  Long-handled comb or brush so the patient does not have to raise his or her arm high
  • Tub or shower bench 

Bedroom

  • Blanket support frame so that blankets or sheets do not rest directly on the feet of a patient
  • Nightlights in the bedroom and other rooms where the patient may walk if they awaken during the night

 Automobile

  •  Car doors that are easy to open and close
  •  Handicapped parking stickers
  • Modified controls to facilitate driving
  •  Seat positions that are easy to manipulate

Kitchen

  • Easy grab handles for cabinets
  • Large knobs on appliances requiring manipulation (stove, dishwasher, washing machine)
  • Lightweight appliances (vacuum cleaner)
  • Lightweight dishes and pots
  •  Lightweight flatware with long handles
  • Long handled cleaning appliances (brooms, dustpans, sponges)
  • Long-handled "grabbers" for removing items on high shelves or picking up items from the floor
  • Sliding shelves or turntables on kitchen shelves so the patient does not have to reach into cabinets to access items in the back 

Miscellaneous

  • A note from your doctor recommending special accommodations, such as an aisle seat in airplanes
  • Electric wheelchair to avoid upper body strain or injury
  • Medical support professionals or accountants to budget medications, special appliances, home-nursing care, and other medical-related supplies and expenses
  •  Nursing or home health care
  • Use of wheelchairs in airports, train stations, or malls
  • Voice activated lights, appliances, or computer
  • Wheelchair-access modifications at home

Undoubtedly, there has been progress made in recent years by healthcare professionals and patients towards understanding and properly managing pain. Unfortunately, pain still poses a problem for patients who are under-diagnosed, over-diagnosed or misdiagnosed.

Controlling the pain you are in is essential to quality of life. Knowing the characteristics of pain and why it is happening give you an advantage in dealing and controlling aspects of pain. Taking control of your life and being responsible for yourself will assist you in lowering your pain.

I see these life changes as a way to improve my daily living -- not as defeats. Using tools in life help those with disabilities from pain have a better life. If a tool can help us accomplish more and increase independence, we should not be ashamed of using it.

Barby Ingle suffers from Reflex Sympathetic Dystrophy (RSD) and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain FoundationShe 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.

Stop Attacking Chronic Pain Patients

By Jaymie Reed, Guest Columnist

Last week I had one of the most horrifying experiences ever. I was called and told to be in my new pain doctor’s office within 4 hours for a pill count.

You see, my own body is attacking itself, eating away the covering from the peripheral nerves in my arms and legs. I have Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and it is very painful. I need opioid pain medication to treat that pain.

It was humiliating to sit in the doctor’s office waiting for my pills to be counted and my urine screened for the second time since I became a patient there. I felt my blood pressure rising and asked the nurse what it was. I was told it was 193/108.

Shakily, I asked, “What did I do wrong? Why did I have to come in here?”

The answer: “The DEA is breathing down our necks, so we have to do this!”

To myself I was thinking, “Why do I have to trade my dignity for healthcare so I don’t have to live in pain? Why are they making me feel worse and adding to my stress?” 

What ensued that day has prompted me to try and turn up the volume for chronic pain patients and what they have to deal with every month. Having to choose between pain, dignity or quality of life, such as being able to cook a meal, go to your child’s school event, or even making it to work, is a choice that none of us ever dreamed we’d have to make.

JAYMIE REED

JAYMIE REED

The DEA, CDC, Congress and the lobbyists’ war against opioids has intimidated most all medical professionals to the point that many are choosing to avoid treating their patient’s pain because of the scrutiny they face. Just the additional record keeping the DEA requires for opioid prescribing makes it unprofitable, so some doctors simply jump ship and refer patients to the pill counting and urine screening protocol of a pain management specialist. The next stop after that is often an addiction recovery center.

Your own doctor should be the one person you can count on, but when we ask why and get the stock DEA answer, you feel lost. There has to be a better way because the war on opioids only adds an insurmountable amount of stress and worsens our pain levels, not to mention the added financial cost.

As the days go by, watching the war against opioids get nearly as much media coverage as Donald Trump, it’s become increasingly clear someone has an agenda. One possibility might be the lobbyists’ interests, which are often focused on increased funding for addiction treatment.

Will sending chronic pain patients to addiction centers be a solution or will it be responsible for a rise in the death toll? Any doctor will tell you a person in REAL pain won’t be helped by 30 days of counseling.  But, we are told the government requires it, all because of the witch hunt a few congressmen and lobbyists have created.

According to the CDC, the top 10 leading causes of death in the United States are

  1. Heart disease: 614,348
  2. Cancer: 591,699
  3. Chronic lower respiratory diseases: 147,101
  4. Accidents: 136,053
  5. Stroke: 133,103
  6. Alzheimer's disease: 93,541
  7. Diabetes: 76,488
  8. Influenza and pneumonia: 55,227
  9. Nephritis (kidney disease): 48,146
  10. Suicide: 42,773.

So the 18,893 overdose deaths in 2014 related to opioid pain medication don’t even make the top ten leading causes of death. Neither does the 10,574 overdose deaths related to heroin and other illegal drugs. Those numbers are concerning, but the real picture isn’t being painted.

Why do the mainstream media keep saying that opioids are a leading cause of death? Why are chronic pain patients made to feel like having an opioid prescription is equal to owning an assault rifle? No one in the media asks to hear from actual pain patients. And no one wants to know that thousands of chronically ill people like me are being treated like criminals by their own doctors.

The life of a chronic pain patient today is dreadfully frightening. Try visiting a pain management clinic and see if you could live your life that way. Searching the streets for drugs or finding a burial plot has never been a thought for me, but for some of us in pain they become an option when the only alternative is being treated like a prisoner in a recovery center. 

When the pain sets in with little or no medication, then the streets (if you can get there) or that burial plot start looking pretty good.  The news media needs to hear our voices and help end the attack on pain patients. 

Is anyone listening?

Jaymie Reed lives in Texas.

Pain News Network invites other readers to share their stories with us. 

Send them to:  editor@PainNewsNetwork.org.

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