Tag Archives: pain management

Reiki Don’t Lose That Number

Oh boy, just when I thought things could not get any stranger…

I went to the pain management clinic yesterday, with the intent of discussing tapering off meds, because frankly I am tired of having to schedule my life around my prescriptions (especially since I had to decline a trip to Memphis last Christmas, due to the clinic not understanding how to handle things).

I want to try, because I’m pretty sure my back isn’t getting better – I mean, disks don’t regenerate, unless you’re Dr. Who – and unless and until the DEA stops being so stupid and people are able once again to get meds from chain pharmacies while they are on vacation, I don’t want to be chained to my medication.

This would not be a problem if Walgreen’s, Rite Aid, CVS, and so on would just refill out-of-state prescriptions.  But instead of figuring out a way to do this, and putting practices into place that can prevent fake scripts and so on, they are just cracking down and treating everyone like drug addicts.

As I have written previously, even the DEA misinterprets their own data, which indicate that this “most heroin addicts started on pain medication” idea isn’t true (or is at least suspect, considering it is based on interviewing addicts).

What I mean by this is, when one does admissions interviews for rehab, the question is asked, “How did you become addicted?”

Most people will not state that they became addicted because their family members and friends already do heroin and they felt pressured to try it (surprisingly common in PA, to have entire families addicted).

Most people will not state that they thought heroin would be a decent escape from boredom, or something to do at a party.

No, what most people state is that they had pain, became addicted to pain medication, got cut off by the doctor, and then switched to heroin.

Because they are ashamed, or they don’t want to appear “weak”, or any number of reasons mostly related to saving face.

Yes, even in a rehab setting, there is still this fear of being stigmatized – and, as many of you know, this isn’t an irrational fear.  I have written about the contempt with which many counselors hold their clients/patients.

So, ok…that is my take on why the data are so skewed, and why everyone is freaking out over “pill mills”, opiate addiction, and pain management.

But I digress, sort of.

I went to the pain clinic yesterday, and the first thing I noticed was that there were very few cars in the parking lot.  And very few patients in the waiting room.

And new staff.

As I was signing the monthly “yes-you-can-drug-test-me” form, I noticed at the top that the physician’s assistant in charge was a name familiar to me – he ran an urgent care clinic years ago, and I was a patient of his.

Now, don’t get me wrong, I like this guy.  He’s personable, he’s smart, and likeable.

But he’s a walking advertisement for the Skeptical Enquirer, under the heading of “quack cures and woo-woo science”.  He is someone I would never have thought I would see dispensing pain medication in a clinic.

This guy wears many hats – he’s a Reiki master, a hypnotherapist, and a proponent of “energy healing at a distance”.

I said to him, “Hey, I know you!  You wrote the letter to the unemployment people when I got fired, telling them that I really did have a bad back and that the methadone clinic doctor had brought me in that day.”

Aside #1: The excuse for firing me was that I hadn’t called in to say I was being treated for a disk problem that occured WHEN I WAS AT WORK.  They got me on a technicality, stating that sending the clinic doctor back to pass the word that I wasn’t coming in the next day “wasn’t proper procedure”, and that they had had NO idea where I was.)

I had a hearing with the unemployment people, and my former supervisor lied stated that she had tried to call me numerous times but I wasn’t answering.  I had phone records to disprove this but the guy in charge of the hearing wouldn’t look at them.

I asked him what he had been doing, and what he was doing working in a pain management clinic?

Aside #2: I kinda knew what he was doing, as he’s all over the internet giving lectures on podcasts and at UFO/Paranormal conferences and such, but I wanted to hear about what brought him to this clinic.

He stated he had been living in New Mexico for 3 years.

Of course, probably Taos or some other new age community.

He didn’t say what brought him back here, but he did say that if anyone had told him years ago he would end up working in a pain management clinic, he wouldn’t have believed it.

I agree.  I was rather gobsmacked myself at seeing him there.

I told him I was thinking of tapering off, due to the whole vacation thing.

His suggestion?  “Just don’t take any more.  Detox and get it over with.”

What??

I mean, the guy used to work as a consultant to the rehab company I worked for (which actually gets him a lot of points with me, as he did stick up for me at my hearing).

But he ought to know that one does not just stop taking 60 mg of morphine, cold-turkey.  Yet that was his advice to me, and he added that tapering off is a “form of torture”.

What??

Hey, I don’t even go off antidepressants without tapering.  I don’t need my blood pressure skyrocketing like that, and whether it’s “withdrawal” or “discontinuation syndrome” (withdrawal off “nice” drugs like antidepressants), it’s damn unpleasant.

But he was nice enough to let me decide how to do it, so I went with tapering.

Um…his idea of tapering is cutting the dose in half, right away, and adding a stronger shorter duration opiate like oxycodone “for break-through pain”.

That’s not my idea of tapering but I figured I would give it a shot.

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Blood, Meds, and Tears

Today’s post is a mixture of my continuing medical saga, and a rant about drug laws.

Follow-up on doctor stuff:  I saw my primary care doctor on Friday 9/26.  He listened to my symptoms, wrote a lot of stuff down, joked a bit (one reason why I like him), poked and prodded and did all those doctory things, and sent me on my way with a paper to take to the local lab.   So, on Tuesday 9/30 (yesterday) I went to the lab and they filled up a lot of tubes with my blood and had me pee in a cup.  I don’t have a problem with tests – gotta have them to see what’s going on.

Later that day I got an email with my test results!  Wow is that quick or what?  Turns out nearly everything is normal except for 2 tests that came back indicating inflammation.  That could mean anything so no big deal; after all, I have had a fever for a very long time and lots of achiness and so on, so inflammation was kind of a no-brainer.

There are still 2 tests out, an ANA and a double-strand DNA, which look for autoimmune disorders specifically.  So hopefully someone can see what’s causing the inflammation.

Edit (10/4): Got the labs back for the antibody tests…and they were all negative. Still, at the bottom of the report, it said

“The possibility of autoimmune disease remains.”

Your guess is as good as mine why this was included.  I guess more testing is needed, though no one has called me to schedule any.

I have an appointment in November with a rheumatologist who, from what I could find out on the internet, is one very smart woman who studied at Stanford and Johns Hopkins (#1 place for rheumatology and autoimmune disorders), and wrote an impressive research paper on inflammation and cell function in autoimmune disorders.  I didn’t understand most of it.  Anyway, here’s hoping Dr. Okoye can get to the bottom of everything.

Original post: So I am not worried today.  I am a bit concerned the other tests won’t show anything, as last time I was diagnosed with lupus they had to draw blood every week for months just to catch it when it appeared (that was 20+ years ago, though).  It’s somewhat common for people to test negative, and it is also common for people to be told to forget about it when they do.

Since autoimmune symptoms are so weird and varied, there is always the risk of sounding like a hypochondriac – though at least my doctor could actually SEE the dry eyes and dry mouth (and fussed at me about not carrying around water at all times), validating the Sjogren’s diagnosis (which is an autoimmune disorder).

Of course he didn’t see the Raynaud’s (fingertips changing color in response to cold) as it wasn’t happening that day, but he felt my hands and said he could feel inflammation (how, I don’t know but his intern could too) and told me “the good news” was that I don’t have rheumatoid arthritis.

Edit (10/4): See?  I could sort of see that coming!

Worrying doesn’t affect anything in the material world, so it doesn’t help for me to do it. I still feel crappy but at least I know it’s not as crappy as it could be.   Oh and gross!  He also scheduled me for a colonoscopy ewwwwww.   I will get that at the end of this month but I won’t be happy about it!  (Don’t worry, I am NOT going to blog about it!)

Tell you what, though, I am going to have it done without anesthesia, as I am afraid it won’t play nice with the pain meds I already take on a daily basis (if anyone would like to share if anesthesia is really warranted for this procedure, feel free)….which brings me to my main topic for today…

…pain medication and the controversies surrounding opiates and pain management.  Medscape reports that a doctor (yes, just one) has come out with a statement on opiates for patients suffering from non-cancer pain (“New AAN Position Statement on Opioids for Noncancer Pain”, Medscape, 9/29/2014). Oddly, this is taken to be a policy statement from the entire American Academy of Neurology, even though there are no other authors or even other doctors who signed it in agreement.

This doctor, Gary Franklin, in my opinion, hasn’t seemed to have thought this out well enough, as he cites some statistics but comes up with some pretty weird (to me) interpretations of them.  He starts out by saying (about the use of opiates for pain):

“The evidence of harm is high, and the effectiveness is low,” Franklin told MedPage Today, calling attention to a graphic in the statement that shows the imbalance. “That is the whole story.”

Is it really the whole story?  As a former alcohol and drug counselor, I think it’s a bit more complex than that.  Let’s take Pennsylvania as an example.  According to The Philadelphia Inquirer (Drug Overdose Deaths Up 7%, Far More in PA and NJ”, 8/20/2014) , we have moved from #14 in the USA for prescription overdose deaths to #7, in just a year.  Yikes!

And if you look at the details more closely, you see that 55% of the people who died or had a problem with opiates got the pills “from a friend or family member” ( “Results from the 2010 National Survey on Drug Use and Health: volume 1: summary of national findings”. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2011).  Yikes, again!

People are having their scripts filled and then handing them over to their friends or families?  Um, I don’t believe so and I will tell you why in a minute.

But first I want to comment on these statistics: As you can see, the article about where people get their pain pills from is from 2010, and it is cited in a CDC report from 2011 (Policy Impact: Prescription Painkiller Overdoses”).  At the top of this article it states that

“This web page is provided for reference purposes only. It was current when produced, but the most current data can be found on the Drug Overdose Fact Sheet.”

It should be noted, however, that even this information is not current.  If you follow the links, you find that, ultimately, this too is from 2011 (Prescription Drug Overdose in the United States: Fact Sheet) – oh, the article itself is dated July 2014, but the statistics cited/linked to are from 2011.

I don’t know what to make of it.  I can understand the spin that anti-pain medication folks want to put on the (non)issue, but I have always had the utmost confidence in the CDC to get their facts straight.  And they did, they are just not current.  I can only imagine that this is due to bureaucracy.

So suddenly there is this big brouhaha about an epidemic of painkiller abuse and overdose deaths.  As I continue my search for what’s behind this, I will get back to you on what’s driving this glut of “scare porn”.

But one thing that struck me is that NO ONE who quoted these stats in the various articles I read in order for me to cite them (thanks to a friend/mentor who suggested I do so) made any mention of what year the stats were from that they were quoting.  That would cut down on the hysteria, I suppose.

Then there is the attempt to link this to heroin overdoses because, as quoted in a Medscape article dated 10/3/2014 (Opioid, Heroin Deaths Continue to Climb, CDC Says” ), Leonard Paulozzi, MD, MPH, a physician and researcher with the CDC in Atlanta, said

“…about 75% of heroin users say they started out by using prescription opioids.”

Is it just me, or is anyone else reminded of the arguments against legalizing marijuana here?  “Heroin users say” is about the most preposterous start to a debate about prescription opiates I have ever heard.

I take back what I wrote earlier about the CDC – my confidence in them is getting lower by the minute.  How many heroin users smoke weed?  Anecdotally, I can tell you that at every place I worked at as a d&a counselor, most – if not all – addicts routinely “tested hot” (tested positive) for that.

So would’ve the counselors, by the way, had the company tested them too!

There is no relationship between pot use and heroin use, any more than there is, say, between eating potato chips (which most of us do) and heroin use.

Between eating potato chips and pot? Well of course, but it’s the pot causing the munchies, not the munchies causing the pot smoking. See how stats can be twisted to say anything you want?

How many users take benzodiazepines and muscle relaxers?  I will counter that with another question: how many people are familiar with the expression “holy trinity” as regards to addiction?  Holy trinity: opiate pain meds, benzodiazepines, and muscle relaxers.  Get you high as a kite and then often kill you.  I guess those drugs are next in the line of fire.

Are we going to make those difficult to get, too?

Oh! How many heroin users smoked cigarettes before they tried heroin?  Smoking is way down in PA (Current Cigarette Smoking Among Adults – United States, 2005-2012″ by the CDC ) but, according to sources already cited here, heroin use is not, so…

And what about beer?  Come on, people, let’s use some common sense here.  Many (most, in my opinion just from work/life experience) people who use benzodiazepines, muscle relaxers, smoke cigarettes, drink beer, smoke pot, do NOT then go on to use heroin.