an angry man screamin

The CDC has issued new guidelines (JAMA, March 15, 2016) that strongly urge doctors to stop prescribing narcotics to patients with chronic pain. This public health organization believes its mandate will reduce deaths from opioid overdose. What the feds have not considered is the impact on people with long-standing severe pain, especially if they are disabled.

The Drug Enforcement Administration Changed the Rules:

In the last couple of years there has been a huge effort to make it harder for doctors to prescribe opioid pain relievers. In the fall of 2014 the DEA made it much harder for patients to obtain hydrocodone combination pain relievers (HCPs such as Lortab, Norco, Vicodin, etc). Previously, prescribers could call in or send in an electronic prescription to a pharmacy and could give a pain patient several refills. Now, patients can only get a 30-day supply and must visit the doctor’s office each time they need a new prescription.

Stories from Readers in Severe Pain:

The new DEA scheduling change has made it much more challenging for a patient who is disabled or in severe pain to access an opioid medication. Here are just a few stories from hundreds of readers who responded to our post on the DEA decision.

Stefany in Maryland shares:

“I have had 10 orthopedic surgeries–two on my back, plus a spinal fusion. I have also had four hip surgeries. These are only a few of the many surgeries I have had.

“I used to hate pain medication. I did all that I could to avoid taking opioids, relying on 800 mg of ibuprofen instead. Sometimes I try to avoid pain medication, but it is physically impossible. I hurt all over and become so miserable when I am off my meds. Since there is such a strict limit on them I usually run out. Trust me; I do not wish to be on them, but the alternative after 10 surgeries is basically impossible if I am to maintain two jobs and college classes.

“While I completely understand the DEA’s reasoning behind their new laws, all they are accomplishing is making people like us live in hell and for the drug seekers to turn more to heroin. You cannot control the people who are drug addicts. To punish people who do not abuse pain medicine and need them to live a more functional life than one of severe depression due to pain is really unjust.”

John in College Station, TX writes:

“I have been taking hydrocodone for over 25 years because of a severe accident. I have had a total knee replacement and neck fusion surgery. I have three bulging discs in my lower spine with nerve damage in my back.

“Last year the doctor said no more hydrocodone, per the new law, and changed it to Tylenol #4. It’s 80 percent less effective.

“Why did this new law punish me? I was barely surviving with the hydrocodone, and now this. I call it abuse to the elderly. I have a track record of 25 years of taking my hydrocodone and NEVER called in for extra or EVER abused it. Now I suffer in severe pain because others abuse it. The DEA, who got this law passed, did not think how it would effect the people who really need it to survive.

“I’m only 55 yrs old, and I’m scared to death what the rest of my life may become. I do not wish harm to anyone but if the people passing these laws ever experience the pain I have they would never have never passed such a law which amounts to ABUSE OF THE ELDERLY.”

Jake the Vet:

“I am a 28-year-old army veteran. I have a spinal cord tumor located in my nerves and am consistently in extreme pain–8 out of a possible 10 points on a 1 to 10 point scale.

“All I can get from my pain management doctor is a back brace, anti-inflammatories and acupuncture in my ears or gabapentin, which makes me feel awful. I have seen three neurosurgeons, none of whom will touch me. What am I suppose to do? Things need to change in this country. It’s an outrage!”

Carolyn in Nevada:

“I too have been taking hydrocodone for many years for chronic pain. Today I went to the pharmacy and was told I can no longer have it. My doctor prescribes it but the pharmacy says no. I’ll be spending my days in bed, I guess. May as well be dead.”

Charles in Ft. Worth:

“I was in a bad elevator collapse and have numerous spinal fractures as well as bulging, degenerated disks and bone spurs. I have lost two inches in height because of my back problems.

“I am living in pain I wouldn’t wish on my worst enemy. I need pain meds and I can no longer get any refills. My pain is making my life unlivable.

“The new laws have caused more damage than you can imagine. My mobility is very limited. I can no longer get out of bed or carry on my daily duties as I was able to before the laws changed last October. I feel my life is over. I can’t live with this pain. I don’t know what to do.”

The CDC’s New Guidelines:

In essence, the new federal opioid guidelines state that narcotics should not be prescribed for chronic pain patients. Instead, doctors should recommend acetaminophen (Tylenol) or NSAIDs like aspirin or ibuprofen. Other suggestions include cognitive behavioral therapy, exercise therapy or antidepressants. We suspect that there are many patients, like those above, for whom such suggestions will not be met with great enthusiasm.

For acute pain, such as after surgery or an accident, the CDC recommends that doctors prescribe opioids for no more than three days. Really? Some “acute” pain lasts substantially longer than three days!

The CDC acknowledges that cancer treatment may require opioid medication during the active phase of therapy. What the CDC has not taken into account is that cancer survivors may have to deal with chronic pain. The president of the American Cancer Society Cancer Action Network said it eloquently:

“Pain does not end when an individual completes treatment. Most often, cancer patients deal with lasting effects from their disease or treatment including pain for a significant period of time or indefinitely.”

The CDC guideline does not seem to take this into account.

Walking the Tightrope:

We recognize that there is tremendous abuse of narcotics in this country, but we are not sure the new guidelines will help reduce the problem. We have not seen convincing evidence that making it harder for chronic pain patients to access drugs like hydrocodone will make a huge difference in abuse or overdose deaths.

We also believe that it is virtually impossible to generalize about the most appropriate treatment for people with severe, chronic pain. Some people will do well with cognitive behavioral therapy; others can only function on opioid medications. These drugs allow them to work and function with dignity. They do not abuse the pain medicine, do not increase the dose and do not sell their medicine to drug abusers. They are about to become vulnerable to a huge federal mandate that will impact how physicians practice medicine.

It is our belief that the CDC should not tell physicians how to practice medicine, especially when it comes to something as complex as chronic pain. Each patient needs to be evaluated individually and treated with respect. The new guidelines will likely scare many doctors away from prescribing potent pain killers for longer than a few days or weeks. That could mean some patients will live in agony with no acceptable treatment through no fault of their own.

Share your own pain experience below and your thoughts about the DEA and CDC rules and guidelines. Please vote on this article at the top of the page. Here is a link to hundreds of reader comments about the DEA’s decision to make it harder for patients to get a prescription for hydrocodone-containing pain medicines.

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  1. Robert S.
    Maryland
    Reply

    I have had over a dozen spine surgeries. It began with degenerative disc disease and ended up with herniated discs and failed back surgery syndrome. I have been in severe pain for over 15 years and on opioid pain medications for that amount of time. I have had countless injections and even nerve ablation. The pain medication is the only way I can get out of bed and lead anything resembling a normal life.

    I have been on disability for this time and don’t know what I would do if not for my wife. Before being prescribed the pain medications I was contemplating suicide on a daily basis. I have already had to reduce my pain medication and if my pain doctor takes me off of the pain meds I don’t know what I will do. I can’t live with the pain I have without my pain meds.

    I have never abused or sold my medicine and I know that the other pain patients that go to my pain clinic have debilitating pain too. This is the most uncaring, heartless, and ill conceived attempt to fix a problem as I have ever seen or heard of. This so-called solution is going to do a lot more harm than good. There will be an increase in alcohol and illegal drug use while doing nothing to solve the opioid problem. The government has made the mistake of lumping heroin overdoses with pain medicine overdoses. Also, the real problem is the easy availability of cheap heroin.

    Reasonable guidelines can be presented to physicians and other pain management providers without ruining the lives of patients who suffer enough without the over-reaching arm of government agencies.

  2. Crystal J B
    FL
    Reply

    I have been in pain for 6 months with a severe prolapsed bladder. I need surgery, but all the surgical centers here are booked for a long time. I am trying to get help, have been to 3 gynecologists and am waiting for a pain management doctor. It is so bad I have to go to the hospital a couple of times a week to get anything for pain. This is beyond ridiculous.

  3. KAtharine
    DE
    Reply

    I have had numerous surgeries, especially on my neck, back and shoulder.My MD has prescribed hydrocodone for over 12 years and it enabled me to have much less pain. Now, she has taken it away and my quality of life has plummeted. It is so difficult to get through a day now…I was able to do so much before. I still do certain exercises.

    But without the meds I feel completely trapped. I cannot travel, go for long walks with my dog, or enjoy my granddaughter. Lying in bed is not my idea of quality of life. It does not seem fair to those of us who have never abused pain meds. I cannot smoke pot (I Don’t like it)! Often, I just wish I could go to sleep and not wake up.

  4. Tina
    Reply

    You know I do believe these people who are controlling our futures because of one reason or another will feel our pain when they die, after all they chose this field of employment to control others in some way. The reason I say this is because I have died three times from heart attacks and once from a staph infection.

    When I died I had to go threw a series of emotions reflecting my life’s experiences. The pain, the glory and each second lasted a lifetime of emotions… “Exaggerated to the fullest feeling a mind could ever emagine”! Mind boggling emotions that leave you feeling a raindrop on the ground. When I was going threw the feelings of how my friends might have felt when I pulled my friends pigtail (because I was a child at that time), not only did I feel her pain, I also felt her embarrassment and every emotion that “she” felt entirely.

    How can a few seconds pass where we feel the pain and joy of our entire life’s history? This can only happen in an alternating universe and I know without a doubt the people In charge of our outcome will feel this universe and it may never end for them because I came back when I died, I did live threw my infection.

    How can you teach these things to a 4 year old child, you can’t and I know because of this experience that it was real. This is the honest Gods truth, I fear for these people because they will have many pains from many people at their judgement. What did they do when the people were hurting?

  5. Nea
    California
    Reply

    The CDC needs to realize that limiting the necessary drugs for pain is what usually leads to heroin addiction. Since the CDC has applied these new rules I have seen a surge in heroin abuse in my area. Every single time I ask a heroin addict how they became addicted they tell me their doctor disco tinier their needed pain treatment.

    The CDC KNOWS that some people, after long term use of opiates, are no longer capable of producing the necessary natural pain hormones without treatment. Its no different than telling diabetics or heart patients that their meds will be stopped. This is a crisis…and the lack of available pain treatment is indeed killing people because when your in enough pain you will try ANYTHING to relieve that pain!

  6. daun
    springfield mo
    Reply

    I was an opoid user. Seems the Veterans Administration is booting us to the curbs with no real help. Gabapentin the dangerous drug is what they now are giving out by the handsful ,to any like me who suffer chronic pain. My deadly psoriatic arthritis and 7 auto immune diseases, fibromyalgia and on and on goes my list will not ever improve to points. I do not need pain medicines.

    I have been to so much therpay I could teach a class. I do a special diet due to prolapsed colon growing into my pelvic bone a second time and am living life jus t short of bags and tubes. . And I need this so called abused. Hydrocodone, if I expect to ever leave my couch n heating pad/bankets! Pure criminal is what it is to let DEA decide anything for the patients. Doctors should stand up and help us.

    I have written many of my state representatives. Of course falls on deaf ears! Suicide rates will go up tremendously , even if drug abuse in any small way goes down. I know I dont hand my medicines down to any street type users. I need each and every one. I used to be prescribed.

  7. Frances
    Reply

    Five years ago, I went to my doctor with back pain that I thought limust be kidney stones. It wasn’t. It is osteoarthritis in my lower back. He referred me to a pain specialist who put me on Nucynta and Tramadol. They took care of the pain but I didn’t like the side effects that stole energy and motivation from me. So when the specialist mentioned that injections might help, I was thrilled.

    I saw an anaesthesiologist who, after some trial injections, managed to reduce my meds by over a third. So when this doctor said his practice was moving out of the pain center to his own location, I happily went with him. And all was well for several months until I showed up for my 3 months appointment and another doctor told me my doctor was on a sabbatical. And, oh yeah, the partner didn’t do the type of injections the my doctor had been doing to me.

    I told that doctor that, had I known he was planning a sabbatical, I would never have left the pain center where I had originally been receiving the injections, and that I was quite angry at this unprofessional treatment! Which is when he told me the truth, that my doctor had been suspended for improper infection control practices and had infected nine people with staphylococcus bacteria!

    And just like that, I was back on my full meds. Three years later I did find another anaesthesiologist to administer injections but he never found the sweet spot and I couldn’t get any relief with him. And here we are in 2017 and despite the fact that I have never abused my meds and have only ever followed the prescription and despite the fact that my meds are nowhere near the strength of OxyContin or codone, I have just been informed that my dosage has been reduced to one third what I was receiving and my only alternative is Medical Marijuana which is not covered by insurance.

    I am sickened and shocked that a government that is not in a third world country nor is it a dictatorship, would make such a devastating law. There is also an obesity problem in North America. Are they going to reduce everybodys food? I can’t believe I’m being treated like this. How does this general law fit in with “First do no harm”???

  8. Sharon
    Indiana
    Reply

    I am so angry and depressed all in the same breath. The people that are making the rules have probably never been in pain. The people in this country make mistake after mistake, in my opinion. I have been on pain meds for 20 years. I’ve tried all the alternatives. I have had more shots in my spine, legs, arm, neck then I can count. The only ones that helped were in my elbow. I have been to PT 3 x, chiropractor, and nothing helped. I was told I would be on pain meds the rest of my life. I believe there will be more suicides, and the drug dealers will get rich. People will turn to herion or meth. I don’t know how long I will be able to take the pain. My meds are the only thing that gives me any quality of life at all, now that is being taken away. MEDS only for 3 days after surgery!! Who are these people making these choices for all of us? There has to be a better way. Doctors got us all into this mess, now the only ones getting punished are the patients. Should have educated people more. Maybe they want us all to die, the elderly. I agree the drugs are out of hand, but you never hear anyone talking about the heroin problem anymore. What is being done about that? You can buy booze easily, and it has killed thousands, but that is ok, I guess. Sorry so long, I will stop now. No one cares anyhow.

  9. Jackie
    Michigan
    Reply

    I agree with most of these comments: the CDC,DEA, and govt. have initiated a bigger mess than was already recoginized. QUALITY OF LIFE: without it, what’s the purpose? If you have children/family, and friends and go from even limited interaction to non exisistent interaction or even worse become a burden or more of a burden to them, how’s that fair to them? Govt./doctors have NOTHING IN PLACE TO HELP any of these patients to deal with the PHYSICAL OR EMOTIONAL ramifications of stopping opiate pain relief pretty much suddenly.

    Most people are not aware that years and years of use actually changes the chemcial makeup in your brain, now not only dealing with unimaginable pain, add mental isssues as well. What realistic change do the innnocent have? Addicts will be addicts and get what they want/need. Innocent people just trying to make the most of what life has left them to deal with are suffering horribly under these new laws. I strongly feel the addiction rate and overdose rate will ultimately increase, as some will choose to become criminals or addicts just to survive. Sadly, suicide will ultimately increase also. I almost feel it’s government/society’s way of “weeding out the weak” in a cruel attemept to not have to take care of the “weaker, non essential people” in their eyes. Totally unfair.

  10. Ann
    Pa
    Reply

    I go to a pain management center, and with the new laws I now must think of getting a pain pump. My husband cannot even get pain relief for end stage liver disease because he will be getting a marijauna card for his seizures, and because of the seizures he cannot take tramadol. What can you do??? But SUFFER!

  11. Christopher
    Peoria, IL
    Reply

    I fractured my C2 in three different places in a car wreck 21 years ago. I have been in constant pain ever since. Luckily I was in my early twenties when the wreck happened and just being young and healthy helped. As I have aged though the pain has gotten progressively worse. I didn’t have health insurance for the first 13 years after the wreck either so I just had to live with it. When I finally got health insurance and started getting things checked out, the doctors tried all kinds of different treatments for my neck and head pain. All the while the pain was getting worse. I have had injections in the C2 area, physical therapy, acupuncture, massages, a number of holistic approaches, i have been prescribed Vicodin, Percocet, and other pain meds.

    Nothing gave me any lasting relief, until 7 years ago I was put on Tramadol. This has been the only thing that has worked. For the first time in 20 plus years I have been pain free. I have also held a job for the first time in my life, another side benefit of not being in constant pain. The Drs just took me off Tramadol a couple weeks ago. Pain has been terrible again. They put me on Gabapentin but that made me so drowsy that I should not have been driving and quickly quit taking those. I am back to square one for pain again. I feel sorry for the people around me, being in pain and dealing with people all day are not a good combination.

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