WHY THE AMA RESOLUTION ISN’T ENOUGH: Potentially Negative Steps Taken By RESOLUTION 235 on the CDC Guidelines for Opioid Prescribing

14 Nov

By IPJ Staff Writer, Heather Grace

See my enclosed comments enclosed, in red. As well as bold/italic used for emphasis: AMA Resolution 235.

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CDC Opioid Prescribing Guidelines–A Threat To Pain Patients’ Lives

21 Sep

by Heather Grace IPJ Staff Writer

On September 16, the Centers for Disease Control and Prevention (CDC) did something dubious. What’s frightening… it’s likely to have a life-altering impact on all chronic & intractable pain patients. Was this a deliberate act? I’ll let you be the judge.

They decided to release/discuss the CDC Opioid Prescribing Guidelines that will go into effect in 2016. These guidelines were designed to further curb opioid abuse. But in fact, they seem to be about arbitrarily curbing treatment.

In order to even view the CDC’s draft of opioid prescribing guidelines, you had to attend the webinar. They were not downloadable. They recorded the webinar, but are not releasing it to be watched for those who missed it.

And to comment on the CDC’s hard-to-access proposed guidelines, you had just one day. No–that was not a typo! Just one day was allowed for comment! Comments had to be in by 5pm eastern on September 17th, which meant people like me and other west coast advocates did not get to comment. Unfortunately, I didn’t find out until it was too late that it would close at 2pm my time. How many others wanted to comment, but were unable to?

A final version of the CDC’s guidelines will go into effect 2016 onward. Based on what I’ve read/heard from an expert in the field, drastic changes are ahead. We should anticipate a very low arbitrary limit on pain medication for all patients nationwide, even the most seriously ill. What’s most troublesome–the CDC intends to set that limit even lower than the 100mg/day now in effect in many states. (See #5, below.)

The draft guidelines are outlined below thanks to the Pain News Network–thankfully. They will not be available in draft form on the CDC’s website, despite the fact that guidelines will be discussed from now through December.

CDC Draft Guidelines for Opioid Prescribing

  1. Non-pharmacological therapy and non-opioid pharmacological therapy are preferred for chronic pain. Providers should only consider adding opioid therapy if expected benefits for both pain and function are anticipated to outweigh risks.
  2. Before starting long term opioid therapy, providers should establish treatment goals with all patients, including realistic goals for pain and function. Providers should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.
  3. Before starting and periodically during opioid therapy, providers should discuss with patients risks and realistic benefits of opioid therapy and patient and provider responsibilities for managing therapy.
  4. When starting opioid therapy, providers should prescribe short-acting opioids instead of extended-release/long acting opioids.
  5. When opioids are started, providers should prescribe the lowest possible effective dosage. Providers should implement additional precautions when increasing dosage to 50 or greater milligrams per day in morphine equivalents and should avoid increasing dosages to 90 or greater milligrams per day in morphine equivalents.
  6. Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, providers should prescribe the lowest effective dose of short-acting opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three or fewer days will usually be sufficient for non-traumatic pain not related to major surgery.
  7. Providers should evaluate patients within 1 to 4 weeks of starting long-term opioid therapy or of dose escalation to assess benefits and harms of continued opioid therapy. Providers should evaluate patients receiving long-term opioid therapy every 3 months or more frequently for benefits and harms of continued opioid therapy. If benefits do not outweigh harms of continued opioid therapy, providers should work with patients to reduce opioid dosage and to discontinue opioids when possible.
  8. Before starting and periodically during continuation of opioid therapy, providers should evaluate risk factors for opioid-related harms. Providers should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid-related harms are present.
  9. Providers should review the patient’s history of controlled substance prescriptions using state Prescription Drug Monitoring Program data to determine whether the patient is receiving excessive opioid dosages or dangerous combinations that put him/her at high risk for overdose. Providers should review Prescription Monitoring Program data when starting opioid therapy and periodically during long-term opioid therapy (ranging from every prescription to every 3 months).
  10. Providers should use urine drug testing before starting opioids for chronic pain and consider urine drug testing at least annually for all patients on long-term opioid therapy to assess for prescribed medications as well as other controlled substances and illicit drugs.
  11. Providers should avoid prescribing of opioid pain medication and benzodiazepines concurrently whenever possible.
  12. Providers should offer or arrange evidence-based treatment (usually opioid agonist treatment in combination with behavioral therapies) for patients with opioid use disorder.

Patients: Prepare to Decrease Pain Med Dosages

Despite the fact that I have to be on pain medication for the rest of my life due to severe constant pain from a central pain syndrome / a spinal cord injury, I was advised by my doctor to prepare to decrease my dose, as it is a likely outcome. I’m really worried. I know people I’ve gotten to know like family will die if we’re forced to conform to the these guidelines.

As for me? As strong as I’ve been, I see myself back “on that ledge” between life and death, contemplating suicide, just like I did before adequate pain care in 2006… if it ever gets to that. If the CDC decides they want us dead, and if they indeed force me back to *that* point in 2016 with these guidelines — the twisted, ugly dark place most people come back from — the world would know exactly why I took my life. I won’t allow stats-massagers to list me as an opioid death.

The thing is, I don’t *want* that to happen. I don’t want pain care to get any worse for anybody! But I’ll be silent no more about the fact that I’m terried… truly terried. Neither should you, if you’re reading this and feel the same.

The CDC said the guidelines were developed after a series of meetings with a core expert group and independent peer reviewers that the agency did not identify by name. However, I believe I have found the names of the peer reviewers, thanks to a hidden PDF on their site:

PEER REVIEWERS

Jeanmarie Perrone, MD
Professor of Emergency Medicine, Hospital of the University of Pennsylvania Director, Division of Medical Toxicology, Department of Emergency Medicine University of Pennsylvania
Expertise: medication safety, emergency department prescribing, substance misuse, use of prescription drug monitoring programs, toxicology, provider education

Matthew J. Bair, MD, MS
Associate Professor of Medicine, Indiana University School of Medicine
Expertise: pain management, geriatrics, non-pharmacologic treatments, mental health, veterans’ health

David Tauben, MD
Chief, Pain Medicine
Clinical Associate Professor, Department of Anesthesia and Pain Medicine
Department of Medicine Division of General Internal Medicine
University of Washington
Expertise: medical education, primary care, pain management

You can view the rest of that PDF on my site, in case they remove it.

CDC officials have long been critical of opioid prescribing practices and have repeatedly cited a study that claims over 16,000 Americans are killed annual by overdoses linked to pain medications. But is that true?

Those numbers are grossly overstated, according to my research. I have reviewed many documents on many sites other that Pain-Topics.org, but they have great data on *WHY* the stats are inaccurate/inflated. From my review of this issue, it is clear statistics on a growing problem means more money to fight that problem each year, when the “pie” of government funding is carved up. Perhaps a larger share will go to the CDC next year, thanks to this unreasonable set of rules they plan to force upon people in pain? How terrible that dollar signs are more important than American citizens–even those of us in severe, unending pain.

From my research, I’ve found that pain medication is being sited as a cause of death merely because it exists in people’s systems, even if they were a passenger on a 747 that crashed. Also, to increase numbers of supposed “opioid-deaths,” statistics are inflated by including deaths caused by dangerously mixing of illicit/prescription substances with the intention of getting high. These are not patients who are being treated for serious pain-related illnesses. These are, sadly, people trying intentionally to harm themselves–to create a chemical reaction in their bodies that is unnatural and dangerous.

Not to mention, despite the hype, pain medication abuse is not anywhere near the top 10 causes of death in the U.S.! So why are we the scapegoats? It has to be money… what else could it be? We aren’t hurting anyone. We avoid illicit substances. We beg for help. Repeatedly. Isn’t it time this “war on drugs” stopped making *us* its casualties?

MY QUESTION IS: ARE WE GOING TO LET THE CDC STEAL OUR PAIN CARE AND KILL US ALL?

They claim they will be using evidenced-based material in forming these guidelines, but they don’t talk about all the people who kill themselves because the pain is too much to bear. Nor do they mention all of the people with intractable pain who die due to lack of appropriate care in the emergency room, despite cries for help and pleading with ER docs to call their pain management physician. It’s happened 3 times this year, to people I know!

I suspect a lot of this so-called data comes from PROP (Physicians for Responsible Opioid Prescribing), an extremely controversial organization that has lobbied Congress and criticized the FDA for not doing more to limit access to opioids. Why do I say this? There’s a link to PROP literature calling for “cautious, evidence-based opioid prescribing” on CDC’s website, on a page discussing safe prescribing tools” (See it here, at the bottom of the page.)

In case they remove the link on this page, I’ve included a screenshot of the page, here (click to see larger image):
CDC-Safe-Prescribing

The email used to comment on this atrocity created by the CDC was opioidcomments@cdc.gov. I got an error message when I tried to comment after 5pm on 9/17. But I suggest you flood the CDC with complaints, anyway! Call the Centers for Disease Control at
800-CDC-INFO / (800-232-4636) or TTY: (888) 232-6348, Monday-Friday
8am-8pm eastern. Email them using their contact form: https://wwwn.cdc.gov/dcs/ContactUs/Form. Write them at: Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329. View http://www.cdc.gov/contact/index.htm for more options.

Even Better: If someone has time, why not post a comment with the contact info for the peer reviewers, listed above? Let THEM know we’re mad as hell and not gonna take this… It’s time we united for the common good. It’s time ALL PAIN PATIENTS became PAIN PATIENTS/ADVOCATES.

Are you with me?


About The Author

Heather Grace is an Intractable Pain Sufferer, Writer & Advocate. She’s Co-Director of the 501c3 nonprofit Intractable Pain Patients United (http://www.ippu.info), has been a Speaker/Conference Planner at For Grace’s (http://www.forgrace.org) annual Women in Pain Conference and is a Pain Ambassador for the U.S. Pain Foundation (http://uspainfoundation.org).

© 2011-2015 Intractable Pain Journal & Heather Grace. All rights reserved.

CALL TO ACTION! Comment on #PainManagement Task Force Report

22 Mar

Attention ALL Members of the Pain Community: *YOUR* HELP is Urgently Needed!

Your chance to share feedback on the Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies & Recommendations is coming to a close.

By April 1st 2019, please read the Draft Report & share your feedback!

If you’re a patient, pharmacist, doctor, nurse, caregiver, loved one, etc — PLEASE SHARE YOUR COMMENTS ASAP, using the simple steps below…

The Pain Management Best Practices Inter-Agency Task Force developed the Draft Report, identifying gaps or inconsistencies in pain care, They also proposed updates to best practices/recommendations for pain management, including chronic & acute pain.

Why Should I Comment?

If you don’t tell the Dept of Health & Human Services (HHS) how *YOU* feel, important feedback from people like us will not be heard.

The Issue: Since 2016, there has been a disturbing trend. The CDC, DEA, State Medical Board’s & health insurance companies are all actively trying to keep medically-necessary pain relieving prescriptions out of the hands of seriously chronically ill patients.

WE MUST PUT A STOP TO THIS—PEOPLE ARE DYING IN RECORD NUMBERS! Some die writhing in pain via heart attack or stroke, due to the unbearable levels of pain they’re experiencing. Sadly, most people are dying via suicide, when the misery of untreated pain becomes too great.

WHAT TO DO:

Step 1. Read It: https://is.gd/2019HHSpdf

Step 2. Share *YOUR* Comments:

* Direct link: https://is.gd/2019HHSpdf

* Email: paintaskforce

* Mail:

U.S. Dept of Health & Human Svcs

Office of Asst Secretary for Health

200 Independence Ave SW, Rm 736E

Attn Alicia Richmond Scott—Task Force

Washington DC 20201

Comments are preferred via direct link vs email or post.

IMPORTANT NOTE: If direct link fails to fully open (https://www.regulations.gov/comment?D=HHS-OS-2018-0027-0001), reload your browser in *Desktop* Mode, especially if you’re on a mobile device & using Firefox.

YES! Feel free to copy/paste this info on your own site or via social media. #SharingIsCaring.

THANK YOU! ~Heather Grace

TheIPJ.com • IG @MsHeatherGrace • Twitter @IntractablePain

#ChronicPain #IntractablePain #spoonie #CPP #IPP #EhlersDanlos #EDS #CRPS #RSD #ChronicallyFabulous #BackPain #NeckPain #Migraine #Headache #Arachnoiditis #Endometriosis #Lupus #Arthritis #Rheum #IntercystialCystitis #CancerPain #Lyme #PeripheralNeuropathy #TrigeminalNeuralgia #SLE #MECFS #MS #CF #Autoimmune #ChronicIllness #ChronicallyHopeful #ChronicPainWarrior #ZebraStrong #CRPSwarrior

What To Do While Looking For A *GOOD* Pain Doctor

21 Mar

by Heather Grace IPJ Editor-In-Chief

In desperate need of a pain management physician to treat your Chronic or Intractable Pain? Finding one now — since the CDC Guidelines For Opioid Prescribing were released in 2016 — can be very difficult. So, what can you do to lessen your pain right away… while trying to locate a great doc?

See the enclosed information, based on Dr. Forest Tennant’s research/experience treating patients at his Intractable Pain Clinic. Though he’s now retired, there are lots of things that make dealing with your pain a little easier. And enough small improvements can help you get through the hell of untreated/undertreated pain.

If YOU are currently in pain & are without a doctor willing to truly help you by whatever means necessary: First and foremost, I am so sorry that you you’re where I once was.

Please PLEASE don’t give up. Not yet.

I know it’s not easy! Just know there are people out here who’ve been where you are *right now* — and lived to tell the tale. You’ll find us many of us via social media. Believe me, we are here!

Life seemed exceedingly difficult before I found good pain management. I very nearly let my constant/severe pain drive me to suicide. Honestly I don’t know how I was able to, but I held on by my fingernails. I held on long enough to find THE ONE: the doc who was both willing & able to truly help me.

In truth, I wasn’t expecting things to work out this way. My situation was extremely grim. Yet miraculously, I managed to survive undertreated Intractable Pain.

My Point: You never know when you’ll get your own miracle. Try and hold on — PLEASE. Hold onto your loved ones & above all, hold onto hope.

– – –

What To Do While Looking For A GOOD Pain Doctor

TABLE OF CONTENTS

* WHY DID I WRITE THIS HANDBOOK?

* WHAT TO DO?

* WHY YOU CAN’T ENDURE PAIN

* ENLIST A SPECIAL SOMEONE TO HELP

* APPROACH NO. 1: SELF-HELP WITH NON-PRESCRIPTION MEDICINES

A. THE RIGHT VITAMINS AND AMINO ACIDS
B. NON-PRESCRIPTION PAIN RELIEVERS
C. BENEFITS OF HEAT AND COLD
D. FIND A TOPICAL THAT WORKS
E. REDUCE YOUR RETAINED ELECTRICITY
F. GET SOME SLEEP
G. EXPERIMENT WITH SOME NATURAL HEALERS
H. EAT EXTRA PROTEIN
I. KEEP MOVING AND STRETCHING

* APPROACH NO. 2: PRESCRIPTION MEDICINE YOUR LOCAL DOCTOR WILL PRESCRIBE

A. ASK FOR THESE PRESCRIPTIONS BY NAME
B. TENS—A GREAT ADD-ON TREATMENT
C. TIPS ON HOW TO APPROACH A DOCTOR FOR PAIN MEDICATION

* FINAL ADVICE

A. WHAT IF THE APPROACHES IN THIS HANDBOOK DON’T SUFFICE?
B. HOW TO FIND A GOOD PAIN DOCTOR
WHAT IF YOUR PROBLEM IS SIMPLY NOT ENOUGH OPIOIDS?
C. TWO SIMPLE RULES FOR CHRONIC PAIN PATIENTS

WHY DID I WRITE THIS HANDBOOK?

There isn’t a day that goes by that I don’t get at least one phone call, fax, or e-mail from a desperate person with chronic, severe pain who can’t find a good pain doctor. Patients tell me that most doctors they encounter don’t treat pain, won’t prescribe opioids, or have the time to work a new patient into a busy medical practice. Many doctors restrict their pain relief medicine dosages and tell patients to “live with it” leaving the patient still suffering. Worse, a lot of doctors who hold out as “pain specialists” tell patients they only perform nerve blocks or related “interventions” and don’t do medical management which requires that a doctor prescribe opioids and accept the patient for long term care.* The very worst are “pseudo” pain doctors who tell patients they will have less pain if they withdraw from all drugs and admit they are really an addict whose pain is simply “in their head”. Don’t buy it. Read on. There’s plenty of help and some great — not just good — pain doctors.

WHAT TO DO?

This handbook outlines two approaches to keep you healthy and comfortable until you find a good pain doctor:

Approach #1. A self-help, do-it-yourself program using inexpensive non-prescription drugs and dietary supplements that are widely available in your local pharmacies and health food stores.

Approach #2. Enlist a local doctor of your choosing to prescribe some prescription drugs which almost any doctor will prescribe.

If you carefully and diligently follow these 2 approaches, you will stay alive and mentally function well-enough to buy you enough time to find a good pain doctor. If you diligently follow these approaches, you may even find them effective enough that you won’t require a pain doctor. There are more and more pain doctors coming on line who competently provide medical pain management. In the meantime, take good enough care of yourself to prevent your severe pain from destroying your mind, hormone system, tissues, or driving you to suicide.

WHY YOU CAN’T ENDURE PAIN?

Don’t just endure pain and lay crying in bed, ponder in despair, or think about suicide. Help is available and good pain doctors who care and know what to do are slowly emerging all over the country. Travel out-of-state to see one if you must.

But until you find one, protect yourself from the ravages of pain.

Yes, I said ravages. Pain doesn’t just make you miserable and ruin your quality of life. Daily it eats away at your brain, tissues, blood vessels, and hormones. Fundamentally, chronic pain accelerates aging and sends you to a grave long before your time. Most severe, untreated pain patients die of a heart attack, stroke, or infection. If you don’t die early in life from your pain, you will likely end up with dementia and loose your precious mental capacities. Indeed, some of my recommendations are to protect your brain and heart until you get the help you need.

*Footnote: Interventional pain specialists are usually anesthesiologists or rehab doctors who take special training to do
injections around the spinal cord. These injections can be very helpful, particularly if given within one year after the pain
begins.

ENLIST A SPECIAL SOMEONE TO HELP

Hopefully, you have a spouse, significant other, family member or friend who can help. You’ll need a “special someone” to help you shop at the pharmacy and health food store to follow these approaches. You may also want to shop on the internet or order from a catalog. Show your “special someone” this little handbook so they may better understand your needs.

APPROACH NO. 1: SELF-HELP WITH NON-PRESCRIPTION MEDICINES

STEP A: THE RIGHT VITAMINS AND AMINO ACIDS

Go to your local pharmacy or health food store and get the following to take on a daily basis:

1. A vitamin-mineral-herbal formula which contains magnesium, folic acid, and B12. This can be a tablet, capsule, powder, or drink. Take 2 times a day. Extra or supplemental B12, folic acid, and magnesium may help you.

2. Vitamin D3 – Often called Calcitrol. Take 2000 units a day which is usually 1 capsule.
Taurine or gamma amino butyric acid, 500 or 750mg – Take 2 at a time 4 times a day. (Total of 8)*

Take on an empty stomach with cold fluids.

*Footnote: Taurine and Gamma-amino-butyric Acid (GABA) are the amino acids that the body naturally uses to block the electrical impulses of pain. Chronic, severe pain depletes these biochemicals. They do not have drug interactions since they are natural compounds. You can take them with any prescription medication. Gamma-amino-butyric Acid can cause temporary flushing similar to niacin. You can try either one or both to see which best controls your pain.

STEP B: NON-PRESCRIPTION PAIN RELIEVERS

Go to a pharmacy that stocks a lot of non-prescription supplies. Purchase a bottle of these 2 pain relievers:

1. Ibuprofen (Advil® and Motrin® are common trade names) The dose of one non-prescription tablet is 200mg. The prescription dosages are 400 or 800mg in each tablet.*
2. Naproxen (Aleve® is the trade name product). Dosage is 220mg a tablet. The prescription dosage is 275 or 550mg in each tablet.

For 2 days each, try one and then the other. Take 1 to 2 every four hours. A two day trial is enough time to determine which works best on you.

*Footnote: The over-the-counter, non-prescription forms of ibuprofen and naproxen are about 1/2 to 1/4 the dosage of what a physician will prescribe. Consequently, you may have to exceed the dosage on the label to get pain relief. These agents are classified as anti-inflammatory pain relievers. Their common side-effects are nausea, vomiting, and internal bleeding caused by stomach irritation.

CRITICAL INSTRUCTIONS ON HOW TO TAKE THESE PAIN RELIEVERS

1. Take Ibuprofen and Naproxen with another drug which I call a “potentiator,” since it makes these pain relievers more “potent.”

2. Listed here are the potentiators you should try with ibuprofen or naproxen.

Initially try one of each with ibuprofen or naproxen to find out which is the most effective.

Acetaminophen – 1 tablet
Excedrin® – 1 tablet
Aspirin – 1 tablet
Immodium® – 1 tablet **
Benadryl® – 1 capsule of 25mg

Caution: If any of these cause you nausea, vomiting, bleeding, or black stools, you must stop them. Take an antacid, milk, or Pepto Bismol if you have nausea. Black stools are caused by internal bleeding, and you will need to consult a doctor if this occurs.

** Immodium® is the trade name for loperamide which is the only opioid drug that is non-prescription. It is sold over-the-counter for treatment of diarrhea although it has pain relieving effects when taken with ibuprofen or naproxen. Too much could possibly cause constipation.

STEP C: BENEFITS OF COLD AND HEAT

Obtain some hot and cold packs from a pharmacy. There are many brands to choose from. Most of the cold packs can be kept in your refrigerator for repeat use. Heat is most effective after a pain-relieving cream has been applied and massaged into the skin over your painful area. Heat drives the medication through the skin to give better relief. Heat relaxes painful tissue and increases blood supply. Apply some heat daily for at least 5 minutes to promote the healing effects that heat can bring. Cold works differently. A cold pack or ice may only need to be applied for a few seconds to be helpful. You can simply touch your pain sites until you feel some relief. Cold alters and diminishes trapped electricity, heat, and inflammation caused by damaged nerves and pain. You can alternate heat and cold. Always keep hot and cold packs ready to use on pain flare days.

STEP D: FIND A TOPICAL THAT WORKS

Purchase a variety of pain-relieving creams, lotions, ointments or sprays from a pharmacy, health food store, internet or catalog. Topicals are so-named, because you apply them to the “top” of the skin. You will find one or more that work on your pain if you test a few. Listed here are some of my favorites. You may find another one you like better, if you experiment with several.

Massage a topical into your pain sites and put heat or cold over them for best effects. Topicals are funny. One may not work for everybody, and it may not even work on all parts of your body.

Alcis®
Freeze It®
Biofreeze®
Magnesium (in Oil)
Aloe Vera
Copper cream
Cats Claw®
Boswella

Topical agents work best with massage, vibrator, infrared, or ultrasound. Often two or more at the same time work better than one alone.

STEP E: REDUCE YOUR RETAINED ELECTRICITY*

You must remove the trapped electricity (i.e. energy, heat) around your painful body sites. A damaged or dysfunctional nerve traps the electricity that your nerves constantly generate. Retained electricity may cause pain flares, burning, itching, redness, jerking and twitching, insomnia, headache, and loss of appetite. You must remove your excess electricity every day since nerves constantly make it.

Do at least 2 of the following each and every day to reduce the electricity that is trapped by your damaged nerves.

*Chronic & Intractable Pain are partly due to damaged nerves that constantly produce and retain or “trap” electricity. A build up of too much electricity causes a pain flare, inflammation, and additional damage to the body. The prevention and reduction of retained electricity must be a daily practice to adequately control pain. I call this concept the ”Theory of Retained Electricity.” Copper, brass, magnesium, and magnets act as a “lightning rod” and attract trapped electricity. The tissues of the body are negatively charged while metals like copper and magnesium are positive and attract or “pull out” retained or trapped electricity. The word “grounding” is related to the fact that electricity is neutralized or dissipated when it reaches the ground. This is why walking barefoot on grass or sand is helpful.

1. Walk barefoot on sand or grass for at least 5 minutes.
2. Take a hot bath with Epsom Salts which are magnesium sulfate. Alternatively, sit in a Jacuzzi or walk in a swimming pool for a minimum of 5 minutes;
3. Wear a copper or magnetic bracelet, anklet, or necklace. Maximal time is about 2 hours; (They can make pain worse if worn too long.)
4. Rub your painful sites with a copper object – time is 1 to 3 minutes. Use brass if you don’t have anything made of copper, since brass is mostly copper. (TIP: Foot-long pieces of copper pipe are generally available at your local hardware store.)
5. Magnets: Apply to your painful site, stand on a magnetic floor mat, lay on a magnetic mattress, or wear magnetic soles in your shoes. Minimal time is 30 minutes.
6. Massage one of the creams listed in Step Four above into your painful sites.
7. Apply a cold pack or ice to your painful site. Minimal time is 30 seconds.
8. Massage the acupressure sites nearest to your pain site. Time is 1 to 2 minutes. You can go to http://www.acupressure.com
for help.
9. Get a acupuncture or massage treatment from one of the clinics that are now in every community. You or your special someone can actually learn massage techniques and save money.

NOTE: Some patients with severe nerve damage &/or Intractable Pain may not respond positively to extended use of copper/brass/magnets. Use for short periods of time (a minute or less) and adjust time upward as appropriate. If you notice redness, sweating or heat eminating from the areas where these are utilized, or if you feel symptoms such as dizziness, immediately stop the treatment & discharge electricity by walking barefoot outdoors on dirt/grass.

STEP F: GET SOME SLEEP

Most severe pain patients can only sleep 2 to 4 hours before their pain will awaken them. You can promote sleep by using one of these three medications. You can obtain these 3 without abprescription at pharmacies or health food stores.

Tryptophan 1000mg
Melatonin 3 to 6mg
Diphenhydramine (Benadryl®) 25mg

You may combine these non-prescription sleep medications as needed.

STEP G: EXPERIMENT WITH SOME NATURAL HEALERS

Try some of the natural healers that patients and doctors have praised over a long period of time. No guarantees but here are my favorites. These come in tablets or capsules. Follow the instructions on the bottle.

Boswella
Aloe Vera
Alpha Lipoic Acid
Glucosamine – particularly mixed with Boswella

Also, go to a health food store and purchase pregnenolone, 50mg. Take 3 a day. Try this for 10 days. Pregnenolone is the natural body chemical that makes many of your hormones including testosterone, estrogen, and cortisone. It also acts as a natural pain reliever in the brain and spinal cord. It’s very safe which is why it’s sold without a prescription in health food stores.

STEP H: EAT EXTRA PROTEIN AND TAKE AMINO ACIDS

Protein contains the amino acids that make the body’s natural pain relievers: endorphin, gamma amino butyric acid (GABA), serotonin, and dopamine. Each day eat a food that contains a lot of protein. The following are about the only foods that are, by weight, over 50% protein: eggs, cheese, fish, poultry, pork, or beef. Many pain patients report that fish oil capsules help them. Also, I have patients who feel they benefit from the amino acids carnitine, arginine, phenylalanine, and glycine.

There are no controlled studies to definitely confirm a benefit to fish oil and some of the amino acids, but they can be cheaply obtained without a prescription from health food stores, catalogues, direct marketing companies and the internet.

They are worth trying, and adding to your self-help program.

STEP I: KEEP MOVING AND STRETCHING

Immobility is your enemy. You must get enough pain relief to get out of bed, stretch, and walk early each morning. If you spend too much time in bed or on the couch, tissue around your pain sites will atrophy and contract. This will likely cause you, in the end, to have more pain and immobility. To protect your pain site, you must stretch the area several times a day.

Try to maintain, proper posture. The natural alignment of the body is to stand up straight and walk without a limp or foot drag. Do this daily. Also, sit up straight and try not to lean too much to protect your painful areas.

APPROACH NO. 2 – PRESCRIPTION DRUGS YOUR LOCAL DOCTOR WILL PRESCRIBE

STEP A: ASK FOR THESE PRESCRIPTION DRUGS BY NAME

Ask a local physician, nurse practitioner, and/or physician assistant (PA) to prescribe some of the following prescription medications listed here. What the vast majority of MD’s won’t do is give you a potent opioid drug. However, today they will prescribe a wide variety of effective prescription drugs. Doctors want to help. Few, however, have had any pain training, so they will not prescribe the most potent pain relievers.

Ask specifically for one or more of the following by name:

1. Topical – applied to skin
a. Lidoderm® Patch
b. Flector® Patch
c. Voltaren® Gel

2. Nerve Block Agents
a.Cymbalta®
b.Lyrica®

3. Mild Pain Relievers
a. Fioricet® with or without codeine
b. Butalbital with or without codeine
c. Tramadol (Ultram® or Ultracet®)
d. Ibuprofen (Motrin®) or other anti-inflammatory drug

4. Stronger (Not Strongest)
a. Propoxyphene (Darvon®)
b. Hydrocodone (Vicodin®, Norco®, Lortab®)

STEP B: TENS—A GREAT ADD-ON TREATMENT

TENS stands for Transcutaneous Electrical Nerve Stimulation. It is a small electric box which is not implanted but is worn on your belt. It sends a low level electric current into your painful area, and it enhances the spinal cord to block pain aignals. TENS also activates endorphins. I personally believe the electric current additionally drives out or “unplugs” some retained electricity. A quality TENS unit requires a doctor’s prescription.

In the past many people, including you, may have tried TENS and found it to be worthless for pain relief. Here are the facts as I’ve learned them. TENS really helps once your self-help and medication program gives you about 60 to 70% pain relief.

If you add TENS treatment, you’ll get another 10 to 20% relief. By itself, TENS isn’t usually much help.

Don’t let anyone, including doctors, tell you that TENS, nerve blocks, psychotherapy, or physical therapy is a substitute for medication. They are not. Obtain the medications you need FIRST. Once you attain 60 to 75% pain relief, try non-medical measures including TENS. You can always stop pain medicine if you find a substitute.

STEP C: TIPS ON HOW TO APPROACH A DOCTOR FOR PAIN MEDICATION

It is critical that you approach a doctor correctly. If you just ask for pain medication, he/she may show you the door, and rightly so. Why? Every doctor in America has been propositioned by so many drug abusers and sellers of drugs that he/she will likely be suspicious of anyone who claims pain and asks for drugs. Do the following:

1. Get an at-home blood pressure-pulse rate device and make a record of your blood pressure and pulse rate. If the non-prescription measures described in self-help Approach No. 1 don’t control your pain, you will likely have elevated blood pressure and/or pulse rates during pain flares. Keep a record and show it to your doctor. Your doctor will be impressed and more willing to help if you’ve done some preliminary work to document your pain.

2. Take that special someone with you to vouch that you have legitimate pain.

3. Make a written list of all the measures you have tried. Note on your list if the measure was helpful, hurtful, or wasteful.

4. Cooperate and don’t argue with your doctor. Let the doctor know you will continue all the measures you’ve learned that help you as well as what the doctor prescribes.

WHAT IF THE APPROACHES IN THIS HANDBOOK DON’T SUFFICE?

Simple. You need a good pain doctor. One who specializes in medical management of severe, chronic pain. If you get only partial relief, review the approaches in this little handbook. Make sure you are diligently following them. Then keep looking for a good pain doctor.

HOW TO FIND A GOOD PAIN DOCTOR

Start asking around for a pain doctor that does “medical management” of severe pain. If you just ask for a “pain specialist”
you may get sent to a doctor who only per forms nerve blocks, epidural injections, or detoxes you (at great expense, of course!) rather than prescribe opioid drugs which you will require if the approaches in this little handbook don’t keep you comfortable. Who do you ask? Start with your County or State Medical Associations. Some websites have a referral service. Your best bet is to ask other pain patients. Ask them which doctors arbitrarily restrict medication or dosages, so you can avoid them.

Do one other thing. Enlist a family member, significant other, clergyman, friend, or lawyer to help you find a “medical management” pain doctor. Some very good medical management pain doctors are now cropping up in most every state.

You may have to travel out-of-state for awhile until one emerges near you, but your very life and quality of life may depend on your willingness to travel.

WHAT IF YOUR PROBLEM IS SIMPLY NOT ENOUGH OPIOIDS?

So often I receive calls from patients who know they can control their pain if their doctors would simply raise their dosage of opioids such as hydrocodone, morphine, methadone, fentanyl, or oxycodone. If this description fits you, you belong to a large group of suffering people. Thousands of patients are in agony and dying before their time due to bias against adequate opioid dosages. Obviously, this means its time to find a good pain doctor. But in the meantime start at Step A in Approach No. 1 in this little handbook. “Self Help” is the best medicine. Be aggressive in reducing your retained or trapped electricity. Keep a daily record of your blood pressure and pulse rate to help document that your pain is poorly controlled. Always remember that opioid drugs produce some complications, so avoid opioids or minimize your opioid dosage by following this little handbook.

TWO SIMPLE RULES FOR CHRONIC PAIN PATIENTS

The mere fact that you’ve read this little handbook tells me you are a chronic pain patient which means you’ve had daily pain for over 3 months.

Rule No. 1 is to try and treat yourself with the approaches in this little handbook. “Self Help” is the best medicine.

Rule No. 2 is to find medication that gives you 60 to 75 % pain relief BEFORE some practitioner talks you into some procedure, surgery, intervention or non-medical treatment. Written here are the “Self Help” fundamentals to chronic pain control. Master them.

As with any medical treatment, consult your physician before using any of the ideas contained in this handbook.

ABOUT THE AUTHOR

Dr. Tennant started his pain clinic in 1975. Originally it focused on treating the pain of cancer and post-polio. He has authored over 300 scientific articles and books, and currently serves as Editor Emeritus of Practical Pain Management, the nation’s most widely circulated pain journal for physicians. He has also held sessions as well as shared his research at Pain Week, an annual conference for medical professionals.

He has formerly served as a Medical Officer in the US Army and US Public Health Service. In the past he has been a consultant to the US Food and Drug Administration, National Institute on Drug Abuse, Drug Enforcement Administration, LA Dodgers, National Football League, and NASCAR. He has authored another handbook for pain patients called “The Inractable Pain Patient’s Handbook for Survival.”

What To Do While Looking For A GOOD Pain Doctor

21 Mar

by Heather Grace IPJ Editor-In-Chief

In desperate need of a pain management physician to treat your Chronic or Intractable Pain? Finding one now — since the CDC Guidelines For Opioid Prescribing were released in 2016 — can be very difficult. So, what can you do to lessen your pain right away… while trying to locate a great doc?

See the enclosed information, based on Dr. Forest Tennant’s research/experience treating patients at his Intractable Pain Clinic. Though he’s now retired, there are lots of things that make dealing with your pain a little easier. And enough small improvements can help you get through the hell of untreated/undertreated pain.

If YOU are currently in pain & are without a doctor willing to truly help you by whatever means necessary: First and foremost, I am so sorry that you you’re where I once was.

Please PLEASE don’t give up. Not yet.

I know it’s not easy! Just know there are people out here who’ve been where you are *right now* — and lived to tell the tale. You’ll find us many of us via social media. Believe me, we are here!

Life seemed exceedingly difficult before I found good pain management. I very nearly let my constant/severe pain drive me to suicide. Honestly I don’t know how I was able to, but I held on by my fingernails. I held on long enough to find THE ONE: the doc who was both willing & able to truly help me.

In truth, I wasn’t expecting things to work out this way. My situation was extremely grim. Yet miraculously, I managed to survive undertreated Intractable Pain.

My Point: You never know when you’ll get your own miracle. Try and hold on — PLEASE. Hold onto your loved ones & above all, hold onto hope.

What To Do While Looking For A Good Pain Doctor

20 Mar

What To Do Before Good Pain Doc.pdf Pdf via Dropbox

What To Do While Looking For A Good Pain Doctor

by Heather Grace IPJ Editor-In-Chief

In desperate need of a pain management physician to treat your Chronic or Intractable Pain? Finding one now — since the CDC Guidelines For Opioid Prescribing were released in 2016 — can be very difficult. So, what can you do to lessen your pain right away… while trying to locate a great doc?

See the enclosed PDF, based on Dr. Forest Tennant’s research/experience treating patients at his Intractable Pain Clinic. Though he’s now retired, there are lots of things that make dealing with your pain a little easier. And enough small improvements can help you get through the hell of untreated/undertreated pain.

If YOU are currently in pain & are without a doctor willing to truly help you by whatever means necessary: First and foremost, I am so sorry that you you’re where I once was.

Please PLEASE don’t give up. Not yet.

I know it’s not easy! Just know there are people out here who’ve been where you are *right now* — and lived to tell the tale. You’ll find us many of us via social media. Believe me, we are here!

Life seemed exceedingly difficult before I found good pain management. I very nearly let my constant/severe pain drive me to suicide. Honestly I don’t know how I was able to, but I held on by my fingernails. I held on long enough to find THE ONE: the doc who was both willing & able to truly help me.

In truth, I wasn’t expecting things to work out this way. My situation was extremely grim. Yet miraculously, I managed to survive undertreated Intractable Pain.

My Point: You never know when you’ll get your own miracle. Try and hold on — PLEASE. Hold onto your loved ones & above all, hold onto hope.

We Are All Kintsugi: We’ve Been Broken, Then Transformed

15 Oct

by IPJ Staff Writer Heather Grace

Kintsugi, or Kintsukuroi, literally translated means “gold joining.” It is the Japanese art of breaking & repairing things that are highly valued/special to the artist. Then, each piece is lovingly restored—put back together with gold, silver or platinum.

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What was once whole has been made anew in a unique/lovely way that can be celebrated, solely because  it was broken.  The places which were fractured are highlighted, becoming eloquently beautiful. Cracks are never obscured in Kintsugi. They intentionally become a focal point of this transformative art, because what may seem flawed is embraced.

Kintsugi acknowledges breakage/repair as a part of becoming the best version of oneself. Philosophically, this empoweringly artistic style treats scars as an essential aspect of all life.

In this way, we see that our own cracks—the things that may break us physically—become a symbol of our inner strength.

Much like Kintsugi, each of us with chronic illness & pain have been broken. Our serious life-altering struggles should not make us feel as though we’ve been rendered useless & can be discarded. Never!

Each of us has power to move through our most difficult low points, becoming something new, surprising, beautiful. We should not disguise our struggles. They’re a part of us & we should learn to love and respect every aspect of who we are. Each of us should see our scars in a new light: as symbols of our transformation.

No matter what we’ve faced, we are strong and resilient. Each of us can come out of our darkest days & in time shine, brighter than ever before.

After all, our scars are not proof we have been broken, but that we have lived, grown & healed. We are all Kintsugi.

Chronic & Intractable Pain Self-Care That Works

16 Oct

Pain Self-Care

Pain Self-Care That Works: Create Your Own Pain Management Toolbox

by Radene Marie Cook IPJ Staff Writer

Download PDF of 2015 Presentation: Pain Self-Care That Works