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CDC Becoming Involved in Opiate RX Guidelines. Bad News for Chronic Pain Patients.

Nov 01, 2015 - 16 comments
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Chronic Pain

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Chronic Fatigue Syndrome

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Pain Disorders

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News in Chronic Pain

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Opiate News

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opiate therapy

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CDC in Pain Management



Oh No! This is more evidence in eh unofficial War against American Citizens with Chronic Pain. Just when I thought it couldn't get worse - it looks like the nightmare continues.

I'm attempting to keep us (Chronic Pain Patients) up-to-date on legislation, "guidelines" and trends in Pain Management. When I ran across the article regarding CDCs attempt to dictate how Pain Management will be administered I could not believe my "eyes"!

Wikipedia, the free encyclopedia defines the CDC's functions as follows:  "Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability. The CDC focuses national attention on developing and applying disease control and prevention. It especially focuses its attention on infectious disease, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention and educational activities designed to improve the health of United States citizens."  I guess they interpreted that to cover the administration of opiates in Pain Management. How many government agencies need to involved? Pure nonsense. It's my opinion that they over-stepped their boundaries. They couldn't even mange the Ebola outbreak effectively. Their "guidelines" were dead wrong - actually helped spread the infectious disease! They have bigger fish to fry than to become involved in opiate therapy.  

What made them PMPs - or experts in Pain? Am I angry - a bit - but more so I am frustrated and distressed in what I view as the continuing attack against the disabled, the injured veteran, our seniors, the sick, weak and helpless and we, America's Chronic Pain patients.

"The CDC is about to publish "Guidelines for Opioid Prescribing." The problem with "Guidelines" is they often are perceived as law. This is the very question many ppl are asking such as Pat Anson, Editor of The Pain Network News. Here are some exerts from Pat Anson's article: "When is a medical guideline voluntary and when does it become a “standard of practice” that doctors are expected to follow?"

"That is one of the key questions in the ongoing debate over controversial guidelines for opioid prescribing unveiled last month by the Centers for Disease Control and Prevention (CDC)."

"The draft guidelines recommend “non-pharmacological therapy” and other types of pain relievers as preferred treatments for chronic non-cancer pain. Smaller doses and quantities of opioids are also recommended when the drugs are used to treat acute or chronic pain."  ..... A letter said, "The American Cancer Society “cannot endorse the proposed guidelines in any way” because they “have the potential to significantly limit cancer patient access to needed pain medicines.”

And there's more. Here's a link to Pat's article in the Pain Network News: http://www.painnewsnetwork.org/stories/2015/10/8/are-the-cdc-opioid-guidelines-really-voluntary

You can also find this article in The American Academy For Pain Management. Here's their link: http://www.aapainmanage.org/policy-in-the-news/are-the-cdc-opioid-guidelines-really-voluntary/

Here's what we're talking about:

The following is the draft by CDC for Opiod Prescribing:

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.


This is just the tip of the iceberg. "Guidelines" from governmental agencies often are seen as the law. If you disagree with the continuing onslaught of laws intended to limit and  eventually omit the use of opiate therapy in long term chronic pain - each of you need to make your voices heard.

We must write our state and federal representatives - and write them again - and contact them through Social Media or in any form you can - and continue to make your voice heard.  

There will be more on this subject - but this journal is long enough for today. Please excuse it's length. I did leave additional information out to shorten this journal. I appreciate your eyes on this issue and would appreciate your support.

Thanks So Much - and Bless all of you that struggle with chronic pain every day. My heart goes out to you.

Just me ~
~Tuck

Americn Pain Foundation - Dissolved

Oct 22, 2015 - 4 comments
Tags:

Pain

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Chronic Pain

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foundations

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changes

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medical

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Pain Societies



I officially joined MedHelp in June of 2008. I was on a Medical leave for about two years and returned early 2015. I've just had to time to begin searching for some of the wonderful Chronic Pain Societies and Associations that I often referenced. It saddened me to find that the first one I searched has ceased operating. They were so helpful. They worked diligently to make needed changes for those of us that live with Chronic Pain and the challenges it brings to our lives.  

I found the letter they left on their page inspiring - and sad - and a call to arms for all of us that reside in this hostile pain management environment. I've copied it in-part and it reads:

BEGIN
"With deep regret and heavy hearts, we sadly inform you that due to irreparable economic circumstances, APF must cease to exist, effective immediately. ...... APF hopes to be able to transfer content from various information, education, and support programs to other organizations so that you may continue to benefit from the value these programs have provided to thousands of individuals and families across the country.

Your personal experiences in living with pain and seeking compassion, empathy and medical care – often against the odds -- have driven our efforts over these many years. This includes enactment of key provisions of the National Pain Care Policy Act in the Health Reform Bill that led to a landmark report issued in 2011 by the Institutes of Medicine. This report documents the shocking numbers of US citizens that live with pain and calls for immediate changes to address gaps in care. Despite this, the current climate towards improving the plight of people with pain in the US continues to be precarious and hostile.

As you unfortunately know, the need for public outcry around the needs of Americans struggling with pain conditions is greater today than ever before in light of the multi-front assault occurring daily on our right to dignified care. Misguided state and federal policies are impeding access to appropriate and reasonable medical care for people struggling with pain, and deterring even the most compassionate medical providers from treating anyone with pain conditions.

It is therefore critical that each of you raise your voices singularly and together to demand the care you deserve. It is only by continuing to demand attention to the ever-worsening barriers and unacceptable suffering that change will occur.

Elected officials, policy makers, and the media need to keep hearing from each and every one of you so they are not allowed to walk away from the consequences of this over-looked public health and medical problem. ....."  
END

I'll continue to search the other Pain Societies and Associations that we relied on through 2013. I'll post links as I locate them - and make certain they are still operational.




Washington and Oregon Residents Fighting for Pain Management

Sep 21, 2011 - 0 comments

Attention: Washington and Oregon State Residents

Article From the American Pain Foundation (2011)

http://action.painfoundation.org/site/MessageViewer?em_id=13682.0&printer_friendly=1

The American Pain Foundation (APF) commends the Seattle Times for its article, “New Pain-Management Rules Leave Patients Hurting.” The article fairly portrays the struggles faced by people with pain in Washington state as they try to access appropriate and effective pain care. This uphill battle is one we are facing together as a community. There is growing concern that people with pain in Washington face discrimination at every turn in their search for timely and appropriate pain care.  If this article resonates with you, we invite you to submit your comments to the Seattle Times.

Please share this email with your family members, friends, colleagues and health care providers and ask them to comment as well. Don’t forget to post this on your Facebook wall or send a tweet to your followers on Twitter.

Feel free to send copies of your letters to APF at ***@****.

Thank you for your help — together, we can make a difference by speaking out for the rights of people with pain!

American Pain Foundation

To Connect and Support our Efforts:
•Please check out PainSAFE™ (Pain Safety & Access For Everyone) website.
•Keep up with us on Facebook.  
•Follow APF on Twitter at www.twitter.com/americanpain for the latest pain news and information and at www.twitter.com/painadvocacy for information on advocacy, policy and public awareness activities.
•Get involved by using our online Advocacy Toolkit.
•Visit the APF Action Network to learn what advocates are doing to build the movement for better pain management and get involved!
•Visit the Exit Wounds site to learn more about our Military and Veterans living with pain.
•Join PainAid, our online support community.


Shingles Post Help

Sep 01, 2011 - 0 comments

Shingles Pain Management (Post Herpetic Neuralgia)
by PeterD1958, Aug 30, 2011 09:00PM
Tags: Pain management, shingles pain, post herpetic neuralgia
[delete]
Hello,

I’m writing this post to be of service to others who are suffering from painful post herpetic neuralgia due to shingles. I’d like to share my experience, strength and hope with you, so that hopefully you’ll have a better time dealing with the extreme difficulties this pain can present. I’ve been living with this pain for over a year now. Please feel free to contact me if you’d ever like to communicate with a sympathetic person who knows what your going through.  You can reach me via email at: pdebenedittis  comcast  net   (I’ve written my email address this way on purpose so that spam bots don’t haunt me. You know you need to use the @ and . symbols to make it a real email address, right? )

In a nutshell, I had a very extreme case. I had 2 dermatones around the right side in the area of my navel get completely covered with sores. The pain I went through was so sever, I felt like I was beaten with baseball bats several times a day for the first few months. After about 5 months it was only once a day or so that the pain was really sever, though it constantly hurt. Now, 13 months later, the deep pain is gone, except for only a twinge every now and again. I do have constant pain on my skin that ranges from annoying to crying out loud painful. I say all this so that you’ll know I’m speaking from experience, not just making things up. And despite how bad things were, there are lots of reasons to be hopeful. Here are things I did that worked to help manage the pain.

1) Mediation.  This is by far the most important thing I did to get my life back to where I didn’t hate being alive. The results were not instant, but I started noticing good effects after only a couple of weeks. I started off using a guided mediation from the Abraham – Hicks book “Into The Vortex.” It came along with a CD that had several 15-minute tracks of positive affirmations. All I had to do was just relax and breathe along with the tape, while trying not to think to much about anything. This was something I could manage as I was still pretty loopy from drugs a lot of the time. They had a track specifically on physical health and well-being. It was great!

I now mediate frequently using longer disciplines where I sit up straight (which was difficult early on).  Not only did my pain significantly diminish, I had a much more positive outlook on life. I found myself getting more and more happy for no reason—even though I still hurt a lot.  So punt whatever beliefs you have about meditation and dive in. It’s the best thing I can recommend to ease your suffering.

Also consider prayer. There’s a ton of studies showing it works to improve healing, even when done remotely. Get over your skepticism as there’s good science showing it’s a powerful aid to healing. Please contact me with your real name and I’d be happy to pray for you at least several times a week. My girlfriend and I host a Blessing circle at our home every week, so you’ll get the benefit of a group of people praying for you once a week as well.

2) Drugs. Remember I’m no doctor. Be sure your medical provider is on-board before you listen to anything I say here. But for me, making friends with drugs was important. Neurontin (gabapentin) has worked best for me. The other major drug they use for nerve pain made me suicidal. I’m not kidding, the warning label even said this was a side effect for teens. I’m 54. Be careful if you take it. Start with low doses and make sure you have someone around to monitor your moods before you find yourself in too much despair.

Lidocane cream is pretty good, and can be used with internal drugs. The patches are best, especially since they cover the affected area and keep it from triggering a pain flash when it’s touched. One drawback though, is that you may feel good enough to move around while you wear them, which can cause a rebound effect of hurting for a few days afterward. My job is public speaking. So I needed these to get by and earn income. But be prepared with down time of a day or two (sometimes three) in between consecutive days of using patches.

Aspirin. It was really helpful to me to supplement the Neurontin with over the counter pain pills. They all worked, but the ones with big chemical names can be hard on your liver. If you can take it, aspirin is a blessing. Even at extremely high doses, I didn’t suffer any ill effects, and felt like I could get through my day without much trouble. Hint, get plain old aspirin. Not buffered or coated. Just chew them up and take a big drink of water. It will be easier on your stomach. Get over the taste. You’ll find the nastiness isn’t so bad after about a week. It’s much better than all the upset the coatings and junk will put in your stomach.

3) Non drugs. Traumeel cream. Arnica cream. Very, very good stuff. Buy them at your health food store. You’ll be glad you did. Especially if you wear lido patches. You have to go 12 hours in between applications. And you can’t use the lido cream at that time. These homeopathic alternatives made a real difference.

I found that Capsicum cream and other things like geranium oil were a real pain. They didn’t give me much relief from the shingles pain and hurt a bunch everywhere else they touched my skin.

4) Devices.  Early on, using a TENS unit helped a lot. It gives mild electrical shocks to the affected area. I had deep pain below the surface of my skin, and the TENS eased this quite a bit. Once the deep pain subsided, the TENS didn’t do very much. Be sure you play with the amplitude and duration adjustments. Some settings are better than others. Not only will some settings not work, but they can actually make it hurt more, especially the surface skin pain.

I also used a device called an Alpha Stim. It’s expensive, unlike the Tens which you can buy for $50 bucks if you shop around. The Alpha Stim uses micro pulse shocks to your ear lobes to break up the patterning of your brain’s ability to feel pain. It worked really well when my pain was most intense, during the first 3 months or so of this ordeal. After that, not so much.

5) Compression. This really has been a good thing. I bought a rubber weight loss belt and put it around my stomach (the infected area) before bed. It let me sleep much better as I no longer had the sheets rubbing against me. I don’t use it anymore, as the discomfort it causes is now more than the pain it prevents. But for the first 8 months, it was a real blessing. You’ll have to wait until all the scabs are gone before you use this.

I also sleep on the side that hurts. This causes a few minutes of pain when I go to bed. But as long as I don’t role over the rest of the night, it’s a better alternative that the cascade of pain that the sheets moving on me causes. By doing this I can still sleep with my girlfriend as she spoons me. The physical comfort is very healing when I get depressed.

I also went and bought the softest shirts I could find. Only buy cotton, the static electricity from polyester clothes will set you off and you won’t even know why. Those shirts can be really soft, but the non-natural fibers will make you end up feeling worse. I bought my shirts a little tight around the waist. This gives me the trade off of having a little annoying pain constantly, versus huge flashes of pain when the cloth rubs against me. When I’m home, I just don’t wear a shirt.

There you have it. I hope there has been something helpful for you in this post.

Blessings,

Peter D.