It took me decades of studying, training, hard work, and sleepless nights to become a doctor. In approximately five years, I became a successful writer, editor, columnist, and a whole array of other titles assigned to that type of work. In under 3 seconds, I became a chronic pain patient for the rest of my life. Around this time last year, I was taking my two dogs outdoors when they spotted ...

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Stigma towards health conditions interferes with access to compassionate care. Both social stigmas from friends and family and medical stigma from professionals are issues. Perhaps the worst recent example of medical stigma is how people with HIV/AIDS were treated in the 1980s. They were isolated physically and spiritually. While in medical school a professor related that on the HIV floor the food trays were left outside the door like ...

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Our community had one of “those” providers — a midlevel who was the local pain person. If you had pain, go to her. She would write you for anything you could want and more. It’s unclear if she was unscrupulous or just inept. But last year, the DEA finally figured out what she was doing and yanked her license. There was nothing in the news. Nothing on the internet. We ...

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What if I told you that your adolescent child could contract a disease that can never be cured, but only maintained? That it would be a lifelong struggle that could change their personality, compromise their potential and values, destroy their relationships and have a long-term detrimental effect on their overall and mental health? That this disease can even be fatal, when ineffectively maintained? What if I told you that the ...

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Recently, I was at a health care facility in a semi-urban region, less than 100 miles from a major metro. It had a whiff of industry from good times that have long drifted by. I tried to locate a Starbucks. Google Maps spotted one and took me towards the local university campus. As I drove there, I noticed several pain management clinics advertising themselves in unusual ways for "relief." Once inside the ...

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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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In a recent article for Pain Medicine News, "4 Steps Every Provider Must Take Before Prescribing an Opioid," two lawyers detail the voluminous documentation doctors must collect and maintain to protect themselves against all these new anti-opioid rules. When even so many doctors don't understand chronic pain, it's no surprise that lawyers don't either. They are trying to fit the practice of pain management into a legal framework to defend themselves ...

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. I recently attended a state medical society’s annual meeting where the agenda consisted of an awards program, several speakers and a keynote address.  The highlight of the evening, however, was listening to patients share their stories with the local medical community.  We’ve all heard ...

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Pharmacists play an essential role in today’s ever-expanding health care system today. They check for drug interactions, watch for signs of opioid overprescribing and try to determine whether a drug for one condition prescribed by one doctor will negatively impact the patient because of another diagnosis the patient has. In hospital units, their roles have become yet more complex — often serving on various quality committees, managing daily dosages of ...

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Marijuana has been used for reported medical purposes for thousands of years when the plant had THC content of 0.5 to 3%. The most common reported medical use is for pain. Several states and the District of Columbia have some form of legalized marijuana, with many states having legalized for recreational use. There has been discussion about how cannabis will help curb the opioid epidemic. It’s been reported that medical cannabis ...

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Pain usually cannot be “treated” like a standard ear infection. Treating patients in pain requires setting realistic expectations, using a variety of approaches, and patience. One patient I treated months ago highlights these points. At 6 a.m., I was ready for the change of shift at the hospital. The night doctor who took care of my patients was frustrated. He snapped, “You really should have had a better plan for her. ...

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