Limitations of pain medicine do not reflect physicians' inadequacies, doctor writes

**Justin** · 09-08-2009, 08:04 AM

Limitations of pain medicine do not reflect physicians' inadequacies, doctor writes

In a commentary in the New York Times (9/8, D5), Colin Fernandes, MD, director of a pain clinic in Northern California, writes that in pain medicine, "the challenge...is to find a balance between pain relief and side effects; to ensure that opioid painkillers like Percocet [acetaminophen-oxycodone] and Vicodin [acetaminophen/hydrocodone] are being used to treat pain, not mood or sleep." But, according to treatment guidelines recently released by the American Pain Society and the American Academy of Pain Medicine, clinical trials on opioids tend to exclude "patients at higher risk for substance abuse or with significant coexisting medical or psychiatric problems." These trials indicate that "on average, patients given opioids experience an improvement of only two to three points on a pain scale of 0 to 10," while "side effects and risks abound." Fernandes notes that pain medicine, "like every other" specialty, "has its limitations," which "are not a reflection of" his own "inadequacies." Rather, they are "the current state of the science," he concludes.

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**Katie** · 09-08-2009, 10:53 AM

I beg to differ on how much the opiates reduce pain. In fact, I will challenge him to prove it.

I went from a 9 out of 10 to a two to a four, depending on the day. But it took a year and a half to find someone who understood and cared about me to get that pain relief.

Did I build some resistance? Of course, but not a great deal, and I leveled off quite awhile ago. I understand probably more than most, because of my sensitivities, just how much these drugs can adversely affect us. But for true pain sufferers, they do much more good than harm. The alternatives are not pretty.

But I don't have an addictive personality (does chocolate count?

) and for those that do, the doctors are walking a fine line at times. I get it, and I'm sure there are good actors out there when it comes to conning the doctors into prescriptions. But don't throw the baby out with the bathwater.

Sweeping statements like this give uneducated doctors the ammunition they need to deny the true pain patients their relief.

It reminds me of the so called spine expert who the insurance has used to discredit my application for out of country surgery. He wrote a book, which made outrageous claims. The first was that neither ice nor heat work for back pain except as a placebo. That neither penetrate more than a millimeter or so, and to use cold in summer and heat in winter, as that is what is most comfortable for patients.

Another was that most people who avoid sex are using pain for an excuse to hide a bad relationship. That if everything was good in their marriage, the 'spiney's' response (my term) should be "Let's try. Even if it hurts, it will sure be worth it."

Reeallllly......

Sorry, I guess I got off track for a bit, but I am very sensitive to statements that often end up making pain relief more difficult to get for legitimate patients.

It also reminds me of the physicians' excuse for not giving terminal cancer patients enough pain medication to ease their suffering. It is in case they get addicted. I think that is a problem that will resolve itself in a short period of time. The biggest side effect of pain medication with many doctors is paranoia. Present company excluded, Justin

Off my soapbox now

**KBear** · 09-08-2009, 11:01 PM

I agree Katie. I believe it is paranoia that causes so many doctors to under prescribe. I have no problem with my doctor drug testing me, I'm glad they do, so they can weed out the abusers from the rest of us. Not to mention, if I just wanted drugs, I could save a hell of a lot of money by buying them on the street, versus what I pay for all the doctors appointments, procedures, tests, MRI's, and surgeries. I have done absolutely anything and everything that has been asked of me by my doctor and I hope that this helps them realize that I really am in pain.

**Cindylou** · 09-09-2009, 07:23 AM

Amen Katie. Well said. I couldn't agree more. Clearly the doctor who wrote this article has not been on the other side of pain himself, or he would get the relief narcotics can offer the true sufferers. Articles like this really piss me off. One step forward, two steps back. Let's lose some of the paranoia please and get back to the job of treating folks with insufferable pain! Forgive my frankness, but some of us would rather opt for suicide than the quality of life without narcotic intervention! And that is the truth, period.

**KBear** · 09-09-2009, 09:12 AM

Originally Posted by Cindylou

Amen Katie. Well said. I couldn't agree more. Clearly the doctor who wrote this article has not been on the other side of pain himself, or he would get the relief narcotics can offer the true sufferers. Articles like this really piss me off. One step forward, two steps back. Let's lose some of the paranoia please and get back to the job of treating folks with insufferable pain! Forgive my frankness, but some of us would rather opt for suicide than the quality of life without narcotic intervention! And that is the truth, period.

I completely agree, sadly.

**Patti** · 09-09-2009, 09:56 AM

Bravo ladies!

I don't feel alone. The pain meds "thing" has been haunting me for months. The guilt surrounding all of it...and the Michael Jackson tragedy sparked a new wave of paranoia among some doctors. To hear someone else say out loud that if not for medication.......some days I wish I would'nt wake up..but God plays tricks on me and doesn't allow me to sleep

Then I think of my friends and family and just have to trust that I will be alright, and be able to live with whatever outcome is there for me.

I try to keep moving....stay engaged, try to exercise..anything to keep my mind off of things while still being proactive in looking for new solutions. I hope you guys have a peaceful day....

**Katie** · 09-09-2009, 10:25 AM

Hang in there Patti. I used to feel so humiliated with people knowing I am on them, and with the state I was in at the beginning, I had to do some explaining

Now I show very little 'loopiness', just am not as enthusiastic with life.

And now I have almost no shame, and actually joke quite a bit about being on them. Our small community knows that I have a lot of pain, but were staring at me a lot when I decided to 'top up' and party for the first time in six years this spring. I danced the evening away, and people we knew kept looking at me.

I just said that I was feeling no pain in more ways than one, and thank heavens for the little blue pill (no, not that one

). and hoped they didn't think I was faking it all this time. It's pretty bad when you have to have an excuse for enjoying life

And suicide was the 'alternative' that I was referring to in my first post, but I think you all get that.

I was afraid that my rant was a little over the top, but guess not?

I understand that many doctors have to be very careful because they are being policed by the 'pill powers' that be, and those 'police' may be what do us in eventually. If we do not have the ability to control our pain, we will lose many more people, and they will probably be labeled as 'unstable' by those who will be covering their a$$es.

Thanks for starting this discussion Justin

**Justin** · 09-09-2009, 12:06 PM

Originally Posted by Katie

Thanks for starting this discussion Justin

No problem, Katie.

This editorial caught my eye the other day, while I was doing my daily morning reading. This is a great discussion and I'm happy to provide a platform where Spine Patients can freely share their opinions.

Carry on... :thumpup:

**KBear** · 09-09-2009, 12:16 PM

I can guarantee you, if it wasn't for pain medicine, I would have already have taken my life. It is so depressing even with pain meds, antidepressants and support.... I can't fathom fighting without that.

**Katie** · 09-09-2009, 12:35 PM

So would it make any difference if we contacted this pain expert and let him know just how wrong he is? I suppose we would just be lumped into some preconceived victim group he has built in his head.