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De-prescribing opioids. A new concept for physicians?

As of now, in the USA, doctors are forced by the CDC to reduce the amount of opioids prescribed to them or they simply eliminate them all together. This has created a huge vacuum in the sense that genuine and in dire need of pain relievers, People in Pain (PIP) resort to alcohol, street drugs  and finally suicide.
This new concept created by Andrew Kolodny, psychiatrist and David Juurlink, pharmacologist and internal medicine have brought a multitude of patients to their knees.

You see, these doctors who are promoting the idea that chronic pain is in your head, that the brain, through meditation will miraculously eradicate it. (While useful in a multimodel program, it is not that effective in moderate and severe pain as a stand alone treatment). In essence,  they are advising  patients that chronic pain can be conquered via learning to think differently. After being monitored within  their program,  the patients go home hoping that this pain is gone forever. And for a time, some have a short reprieve from pain until the balance is lost to a flare and the pain starts with a vengeance once again.  

Facts:

1. Chronic pain can be intractable and excruciating. It is possible to suffer torturous levels of pain for years on end with no end in sight.

2. Arachnoiditis is incurable. this man-made disorder is a spinal cord injury that brings high levels of pain to the unfortunate patients.

In Canada, we are finding that some doctors have espoused this ideology of drastically limiting  opioids. Dr Andrea Furlan  is very proud of her new discovery -de-prescribing opioids. She reports in the interview with “White Coat Black Art”  on CBC radio show that her patients are feeling much better and praise her for eliminating opioids. Both have extolled the success encountered with the results.

REALITY

It is doctors like the ones mentioned here that will create enormous injuries to chronic pain patients. I am referring to pain that is permanent, that progresses and that medical body has not found any solutions to the problem. Why? Because sometimes medicine has nothing to offer in terms of treatment or cure. Nothing.

In the case of arachnoiditis, which is triggered by such common treatments such as epidurals, myelographies, blocks and spinal taps,  inflammation of the spinal cord nerves themselves result. Scar tissue envelops the spinal nerves tethering the nerves to themselves and the membrane of the protective covering sac. This starves the nerves of nutrients, short circuit body wide processes leading to intractable permanent pain, weakness, paralysis, incontinence and more. To date, there is no treatment or cure for this progressive disease.


Arachnoiditis patients all suffer and are impacted differently although most report progression in pain and dysfunction over time. Many arachnoiditis sufferers require walking aids such as canes, electric wheelchairs, walkers, crutches, for the rest of their lives. It is a far cry from these experts’ understanding of acute pain following trauma or surgery. This pain is in the pain sensing systems of the spinal cord nerves themselves..

There is very little understanding about the complexities of chronic pain. That's because their education in Pain is very limited; worse, they don't know what they don't know. The experience of living with permanent intractable chronic pain is foreign to them and they often arrogantly feel that their limited training provides them an understanding of pain superior to that of those suffering its daily reality.

Chronic pain patients, PIP are  important stakeholders in the equation. When will we be able to rely on physicians who genuinely comprehend the nature of chronic pain? When will our reports of lived experience be believed?  Dr Furlan, Kolodny, Juurlink are basically telling sufferers that we are imagining the pain. While modalities like mindfulness, massage, acupuncture have their places in multimodal treatment plans, intractable chronic pain patients continue to report unsustainable levels of intractable pain. That intensity of pain often only responds to a comprehensive plan that includes opiates, cannabinoids, anti epileptics and more. Patients aren't seeking (or getting) a “high” from opiates; most are seeking to maintain the ability to continue to function in our daily lives. Unrelieved, chronic intractable pain leads to becoming housebound/bedridden, depression and anxiety and more and more often, hopelessness and suicide.

It is this arrogance by physicians that that leads to years of misdiagnosis and disinterest to pursue a proper diagnosis.  


In my early days living with chronic pain (70’s era) it literally brought me to my knees. I attempted suicide, the pain was unbearable, I was out on disability and could not go back to my career, nursing.


Physicians who espoused themselves as  « saviours » have absolutely no idea about what they are about to create for chronic pain patients all over; a life of torture. In Montana, where the opioids are restricted and soon to be eliminated, patients are committing suicide. Chronic pain is debilitating, destructive and intractable.

Dr Furlan does not offer alternative treatments that will help with the pain. She  treats her patients as addicts. Not as People in Pain (PIP) but addicted to a prescribed substance . Yet study after study show heroin, not prescription opiates, are the initiating drug for most addicted. Intractable pain patients on stable opiate treatment are no longer the drivers of the opiate crisis.


For some, opiates can be reduced or discontinued, though only by being able to access other treatments such as lidocaine infusions, ketamine, mmj and others.  There are few treatments available but lidocaine infusion (not injection) allowed me to restore function enough to no longer require a wheelchair. For those who can access,  this treatment, after 6 years, have allowed me to enjoy trips, family reunions and other family activities that were good for the soul. Other patients receive ketamine with the lidocaine infusion. These infusions can help patients reduced and/or stop  opioids. I certainly did. The next day after the infusion, I stopped morphine, that was over 6 years ago. I did not have any withdrawals.  I never looked back. I went to the clinic in a wheelchair and walked out on my own two feet. A positive note: Ohip pays for 6 treatments on a yearly basis.

And so, instead of glorifying an ideology that will affect patients negatively and  their  future, I suggest that treatments such as lidocaine and ketamine infusions be marketed and offered to patients. I suggest compassion, research and understanding of the complexities  of pathologies inducing chronic pain, creating hyperalgesia, allodynia, CRPS, PTSD , I strongly suggest that physicians put their little egos aside and listen to their patients. Not only words but read between the lines. If this cannot be achieved, hire a pain whisperer (patient advocate) who can clue you in quickly and translate what the patient is trying to tell you.

I am absolutely flabbergasted that Dr Furlan, whom I have served jointly  within a board of directors for the now defunct Canadian Pain Coalition organization, that she would chose to force patients, to put pressure on them in order to meet HER own expectations with chronic pain . Shame on all physicians who take the express toll and ignore the dangers.Please tell these physicians how you feel and what kind of quality of life you have with opioids. 

Twitter handles:  @adfulran, @andrewkolodny,@davidjuurlink

© LCh20   2018