One night, a woman I’ll call Tonya got a compliment from a guy when she was out with her boyfriend. Tonya’s boyfriend cursed her because another man had complimented her. He said: “You give it to everybody, I want it too.” In anticipation of his physical abuse, she reasoned, “I could go off to Wonder World.” She then injected heroin, to be “in her own world,” she later told me. Tonya ...

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I've noticed a frightening trend in the latest research on patients taking prescribed opioids: whatever the negative outcomes, researchers attribute them to the opioid medications instead of the underlying pain. The many detrimental outcomes these studies find are exactly what you'd expect from a person suffering long-term chronic pain. They don't recognize or calculate into their studies that opioids were prescribed to ease intractable pain. It's like stating ...

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Last month I saw Joan, a woman who has had low back pain for years. She’d been through the ringer like every other person in severe pain: countless procedures and medications. She continued to have daily pain that stopped her from staying focused at work, playing with her kids or being the spouse or friend she wanted to be.  After our long consultation and review of her records my prescription ...

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Last week I took the naloxone challenge. I walked up to a pharmacy window, waited in line, and requested naloxone from the pharmacist. She showed a supportive but knowing look, and I became acutely aware of the four people in line behind me. After giving her my name and date of birth, she was able to pull my insurance info from prior visits, and I left with a dose of ...

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I was standing behind my trolley in our local supermarket when, in my wallet, I came across that drawing of a human heart. In the miniature pen-and-ink composition, the heart is suspended between two birds’ wings. At the bottom is a dateline: Opioid Vigil, October 19, 2012. Memory is a slippery thing, but I recall the 20-something artist as tall and rangy. At that opioid vigil, he sat behind the exhibit table, ...

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I often hear the mantra, “You must stay ahead of your pain, or else.” The president of the American Academy of Pain Medicine, states a common mistake people make, is waiting too long to take pain medication. By the time you’re in pain, you’re starting from behind the eight ball. "It takes a lot more medicine to control pain after it’s started as opposed to starting it ahead of time," he ...

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I recently read an article -- "California Doctors Alarmed As State Links Their Opioid Prescriptions to Deaths" -- that infuriates and frightens me I'm furious that doctors are being persecuted for opioid prescriptions written years ago, and frightened that my doctor here in California may be pressured to stop prescribing them for my painful genetic disorder (Ehlers-Danlos). Twenty-six states have already implemented arbitrary restrictions on our ...

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I haven’t counted how many times this happens every month, but I find it annoying. I send a prescription for a drug (sometimes not even expensive) to the pharmacy and soon after, I get a fax asking me (or my medical assistant) to go online and print a prior authorization form to complete and fax to the insurer, or answer numerous qualifying questions on the screen, or (worst of all) 
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We have embarked upon a unique strategy to assess and manage pain. "Opioids Rarely Help Bodily Pain" is not a catchy phrase but a mnemonic related to educational learning which serves as the cornerstone of a new acute-pain management paradigm. As is known, the evaluation of pain is extremely difficult due to its subjective nature. However, this new evaluation not only accounts for the patients’ self-assessment but, for the first ...

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“I feel like a caged animal” — My patient offered me this lens through which to view his life seeped in chronic pain. For him, pain dictated his entire sense of being — it was something that simply could not be distilled down to a single value on a 10-point scale. The cage represented the restriction of life and the boundaries within which he was allowed to experience, let alone ...

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