Friday, December 11, 2015

Sensitivity Irrelevant to Chronic Pain Says PROPS Doc


This blog is based on the New England Journal of Medicine article.

by Jane C. Ballantyne, M.D., and Mark D. Sullivan, M.D., Ph.D.

I left a comment at the NE Journal of Medicine website, and I responded to Pat Anson’s editorial at the Pain News Network

   © by Jen Jasper in Broken Body,
   Wounded Spirit: Winter Devotions


Ballantyne and Sullivan: “Opioids are a case in point: they have good short-term efficacy, but there is little evidence supporting their long-term benefit.”

To say there is “little evidence supporting the long-term benefit of opioids for managing pain” is simply not true. There are plenty of us who are able to function better because our pain is managed with opioids. You simply do not hear about them because good news is no news. Maybe you meant to say there are few studies. For which I reply, “Where is the EVIDENCE that long-term opioid treatment doesn’t work for managing for chronic pain?”

Ballantyne and Sullivan: “But is a reduction in pain intensity the right goal for the treatment of chronic pain?” 

I doubt few chronic pain patients, if any, expect their pain to be completely alleviated regardless of the treatment pathway. But they do expect reduction in intensity. Patients with this goal are far wiser than you are.

Whether pain is acute or chronic, it is a symptom. Assessment for location, onset, duration, character, AND intensity of any symptom is considered the standard of care for good reason. I hope I don’t have to explain why.

People experience chronic pain for two reasons, the underlying cause is untreatable, and/or misfiring in the brain causes pain to persist that otherwise wouldn't. Our brain extrapolates information and responds to chronic pain differently, but it is still pain. So, I ask Dr. Ballantyne and Dr. Sullivan, “Do you seriously believe assessing pain intensity is not important?” If you truly disagree with your peers on this, you are breaching the standard of care. You might want to think about this too editors and publishers of the New England Journal of Medicine. Is the message of bias against a certain patient population the one you want to send?

Ballantyne and Sullivan: “Patients who report the greatest intensity of chronic pain are often overwhelmed, are burdened by coexisting substance use or other mental health conditions, and need the type of comprehensive psychosocial support offered by multimodal treatment approaches.”

Often? I disagree. As part of a citizen’s leadership group of chronic painpatients, I see these people, I am one of these people, and you are way off base. When you make such statements, YOU become part of the problem.

I agree that people who live with chronic pain can feel overwhelmed. I am feeling overwhelmed reading this article. Why don’t you ask the pain doctors who include this aspect of their care for their opinion? Sure, we experience situational depression and anxiety, just LIKE YOU DO! But you are describing people with addiction, very real, but needing a different treatment, also woefully unavailable. Why should I even have to ask, “What does addiction have to do with pain intensity?”









Ballantyne and Sullivan:Multimodal therapy encompasses behavioral, physical, and integrated medical approaches.”

It does take a multimodal approach to manage chronic pain. The pain patient certainly knows that better than you do. We have resorted to, and been the victim of, charlatans that claim they have a cure. I have found meditation to be helpful with coping, but that doesn’t cure the conditions that cause my pain. Ask how many of us  keep several ice packs on hand for fear we won’t have enough. Ask us how many times we have been blistered by a heating pad because that was still less pain. Ask us how many use ointments, OTC products, TENS units or are willing to have electricity delivered to our spinal cord, just so we can have a REDUCTION IN OUR PAIN INTENSITY! Maybe you should ask the patient about the remedies they have tried before you write such an "insensitive" article. 

And, shouldn’t opioids be included as integrative care if they reduce pain so patients can participate in complimentary therapies? Oh that’s right, you don’t think a reduction in pain intensity is an important measurement.

While we’re at it, “When was the last time your physician asked about your spiritual awareness, or your circumstances at home?” And, just on the chance that they did (because they are in tune with treating the body as a whole) were they able to provide you with resources? If they could provide access to alternative treatments, are they affordable for everyone?   

On December 2, 2015 my friend Jan Chambers, President of the National Fibromyalgia& Chronic Pain Association and collaborative leader in the PAINS Project, of which I am a participant, had this to say.

NPS misstatement by PROP's President Ballantyne

Drs. Ballantyne and Sullivan incorrectly state that the U.S.established a National Pain Strategy (NPS) to address the enormous burden of chronic pain to 100+ million American adults. In fact, the NPS draft was completed by summer of 2014 but has not re-emerged from the U.S. Dept. of Health and Human Services since then (18+ months) despite requests by many patients, citizens, professional medical groups, and patient advocacy organizations. Chronic pain patients are worse off now because many doctors refuse to treat them; one result of unintended consequences from recent opioid abuse deterrent policies. Lack of a NPS and research funding hurts everyone. With no access to care or new, effective treatments, people with chronic pain are literally cast aside by society and treated inhumanely. The authors would like us to believe that NPS initiatives are in place, reducing suffering and brain-seizing pain, when they ask the ludicrous question, “But is a reduction in pain intensity the right goal for the treatment of chronic pain?” I guess that life-altering and debilitating chronic pain must not be such a burden after all.


If you are a doubter, be grateful, you have not experienced such pain, because one day you may. I have witnessed the change in perception in my own circle of family and friends. If you need a narcotic, it isn’t so bad after all.


“The only pain that is tolerable is somebody else’s.”
~David Sherry, MD, pediatric rheumatologist


Put your thinking hat back on. Don’t be part of the problem, be part of the solution. Embrace this adversity as an opportunity for change before you seriously harm someone, including yourself.

~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."  
Celeste Cooper, RN
Author—Patient—Health Central Chronic Pain ProAdvocate

Celeste’s Website: http://CelesteCooper.com

Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog


All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

7 comments:

Jyl Milner said...

I find it hard to believe that a medically revered publication such as the NEJM would publish such an irresponsible article, yet here it is! I agree with every word you said in your rebuttal. Chronic pain is difficult to treat, yes, but even more difficult to live with. Opioids currently present the best hope for chronic pain patients and, as you pointed out, may make complementary therapies possible. I take a "cocktail" of meds to control, or at least manage, my chronic pain, and that cocktail includes daily opioids. I am not addicted to the med to the best of my knowledge. You are right - tolerance does not equal addiction.

Thank you for bringing this to my attention. I am sure other chronic pain patients will want to speak their minds as well.

Celeste Cooper said...

You are so welcome +Jyl Milner. I am glad to share the news that has been related to me. We are all conduits.

Marin Mazer said...

Actually there is a HUGE difference between becoming ADDICTED to medication and being DEPENDENT on medication. Being Dependent on medication is like a diabetic dependent on insulin or a heart patient dependent on warfarin. My pain have been control on the same exact medication for years. I don't abuse my meds and my doctor knows it. She also knows there is a clinical difference in treating a pain patient and how an addict relates to the same protocol. To not treat a person suffering is against the term to do no harm.....this article and the knee jerk reaction to the current issues involving some people misusing or abusing pain medication can be resolved for everyone. Educate yourselves for the sake of all people living in agony.

Marin Mazer said...

Actually there is a HUGE difference between becoming ADDICTED to medication and being DEPENDENT on medication. Being Dependent on medication is like a diabetic dependent on insulin or a heart patient dependent on warfarin. My pain have been control on the same exact medication for years. I don't abuse my meds and my doctor knows it. She also knows there is a clinical difference in treating a pain patient and how an addict relates to the same protocol. To not treat a person suffering is against the term to do no harm.....this article and the knee jerk reaction to the current issues involving some people misusing or abusing pain medication can be resolved for everyone. Educate yourselves for the sake of all people living in agony.

Celeste Cooper said...

+Marin Mazer you are right. Patients do have a role to uphold when it comes being active participant in their care. I am so glad you have a compassionate and caring doctor. I do too. But, many including myself, have not always had access to such kind, caring and educated people. Physicians get little training on managing pain or myofascial disorders. We are beginning to see a trend in medical schools that will hopefully, eventually, resolve this problem. It all goes back to trust and communication. I hope you will leave your comment at link to the NEJM article provided in my blog. We need to speak up, we need to stand together, and the general public needs to see there are far more of us that are able to function because we are having our pain treated with opioids, and we do not abuse them.

Kim Miller said...

This particular article outraged me more than most (and there are many of them these days). The discounting of pain intensity just was the final straw with these people! Ballantyne's role in PROP and the draft CDC guidelines, now this! I was/am certain this can't REALLY can't be a doctor, no way! Horrific that human beings were reduced to subjects of study in a lab, it seemed to me. No more than rats, and I hate what they do to animals, but we're talking about PEOPLE here!

Any pain program should START by evaluating the pain intensity. If you are in INTENSE pain, how are you even going to get up, get a shower, and get to the appointment? SOME reality has to come into this woman's equation, at some point! Life as a chronic pain patient cannot be studied as numbers and generalized examples, it has to be managed and therefore, studied, on a case-by-case basis because every patient is different and every patient's pain is different.

Celeste Cooper said...

Bravo Kim. Agreed

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