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Living With Facial Pain

Does your country have an opioid crisis?


#1

wishing you wellness


#2

Ellen I think the crisis is media portrayal and misinformed hype rather than a crisis of usage. Does that make sense?

I’m in the states and my neuro who manages my migraines and ATN with me has migraines herself. She gets it in that fundamental way people on this site do, in that way that can’t be explained. She has even commented to me that those protesting pain meds obviously have never dealt with real pain.

So I’m lucky. I searched high and low for a doctor who has migraines, found her, and now she’s ignoring the hype in favor of caring for her patients. She told me they can come after her if they want, she’s ready for them, she’s done no wrong and will continue to treat her patients her way.

On the flip side my moms regular doctor has basically become terrified of writing prescriptions in general. This whole crisis thing feels like a witch hunt to me.


#3

Thanks Azurelle.
I hope you Mom is able to manage OK
When I went thru my file at the pain clinic there seemed to be a duplicate
notice that I was off my narcotics (the mildest there is,codeine)and the
government got a copy.Just wish I was smart enough to ask for a copy.It
just kind of surprised me.
And yay for your doctor.We need to find a way to celebrate the doctors that
continue to treat their pain patients with what works best for the patient.


#4

Understand what’s happening world wide is considerably different than what is happening in the USA. While the rest of the world is struggling with prescribing protocols ( something that is happening here as well but is lost in the discussion) as the meds have often been used improperly and to long.) The USA has another issue. It’s a math problem. 80% of all opiates produced in the world are consumed by less than 5% of the world population.

Prescribing protocols are changing. The biggest reason is the average physician lacks the training and experience to properly prescribe. Would it surprise anyone except the medical community that the single largest cause of chronic pain in the USA is improper prescribing of opiates? That is the reason limits are in place for amount and length of time physicians (no specialists) can prescribe. These are rules coming down from State accreditation societies not the DEA. No different than telling your dermatologist he can’t do Brain surgery.


#5

Those are false numbers since by the tern produced they’re talking about big pharma. No one is keeping track of what else is being produced all over the world. There are plenty of opiates being consumed everywhere that are not found on quarterly sales charts.

There’s also the stat that 90% of all prescription drug abuse starts between the ages of 12 and 19. I would lay odds that population isn’t being incorrectly prescribed opiates. They getting them illegally.

State accreditation societies do not have the ability to set rules or enforce them. They provide up training and guidelines only. It is still up to the doctor to do the right thing for the patient. To prescribe narcotics a doctor must have a DEA number and for some meds a XDEA number. This is already tracked by the DEA on a yearly basis as are the meds prescribed under that number. Currently 37 states track every narcotic prescription filled by patient name using the PDMP, the prescription drug monitoring program.

Did you know your name goes into a database every time you fill your pain med? Along with your doctors info and DEA number. Your entire narcotics history is readily available to " authorized individuals " for use.

With that in mind how can there possibly be a crisis? All the information needed to see who is doing what with narcotics in the USA is readily available. Creating more guidelines is useless. Creating random limits is useless and in some cases hazardous for the sick person. You can liken it to gun control, nothing is stopping the criminals because they’re criminals who don’t follow the rules and guidelines anyway. This applies to illegal guns and illegal drugs in the same manner.

Opiate abuse and crisis is not a healthcare issue. Its a criminal issues and an addiction issue that’s been spun to seem like it’s a healthcare issue. The “war on drugs” is a loosing battle so now they’re trying to blame highly educated medical professionals for what is fundamentally a law enforcement failure.


#6

Speaking of chronic pain… There is a school of thought that says by improperly prescribing pain meds for acute pain, that is by UNDER prescribing, chronic pain is then created because the body has been in pain too long and learns to over react to all pain rather than just acute pain. There are so many studies and articles available I didn’t choose a link to include here, just do a search for acute pain to chronic pain. If you’re an Aussie there are several studies you could think about joining.


#7

Trust me the state boards can and do set prescribing guidelines and do enforce them. There are several physicians in our state who have either been suspended, lost their license completley, or are on oversite watch for over prescribing, improperly prescribing and a host of other violations. One is “going away” for 40 years. (multiple involuntary manslaughter convictions he liked prescribing methadone) I’m very happy to be off that board next year. here is one such set of guidelines:

http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf

Your “highly educated medical professional” has less than 2 hours of training in the use of opiates for chronic pain. The medical school I taught in has more now but essentially the morphine unit equivalents are now limited from days to several months without a “specialist” in most states because so few are trained.

Essentially he ONLY source of “illegal” prescription narcotics is a prescription. If only those who needed them got them there wouldn’t be a glut of them on the illegal market. That is why it is a USA issue. We are essentially the only country in the world that widely prescribes as to create a glut of them.

Other countries have an opiate problem in that while they do a better job of getting the meds into the right hands they too are mis-prescribing leading to overuse, dependence and other issues. They are addressing it much as we are. But old habits die hard such as prescribing opiates for neurologic pain despite the knowledge neurologic pain is caused by the bodies defective opioid receptors (different use of the term than medication through three opioid receptors, mu, delta and kappa whose genes have been cloned (Oprm, Oprd1 and Oprk1, respectively). Opioid receptors in the brain are activated by a family of endogenous peptides like enkephalins, dynorphins and endorphin, which are released by neurons.)

Yes you are correct there is a problem in the US with illegal narcotics that is unique to the US.that needs addressed but ignorance from prescribers is a bigger problem when it comes to quality patient care. THAT is the international problem. sadly the US is way behind. No its not Big-Pharma (everyones favorite whipping boy) There isn’t enough money in opiates for them which is why almost all are produced offshore and importted as generics.

BTW underestimating pain meds when appropriate as you noted IS a problem not as big as hyperalgesia or mis-prescribing but yes a problem.


#8

I am not sure.I was under the belief that Tasmania(home of the Tasmanian
devil!) is where the poppy fields are .Not because of the cheapness of
land-but because of the temperature.But I do not know anything about the
production of oxycodone and the like.
My question-how come codeine takes the edge off for me?
If it will not work on nerve pain.?
Maybe that is why my diagnosis changed to persistent idiopathic facial
pain.Which means not very much as far as my pain goes.
At the VERY same day I was removed from codeine-by doctor who is trained
in the new protocols.
With nothing to relieve the pain.
My family doctor stepped in and prescribed.
Or you would not be hearing from me on this board anymore.The pain is that
bad and has not been dealt with over the time period of 2 years.The codeine
numbs it down and add the baclofen and gabapentin somehow I get through the
day.But not so that I can work or anything.Or wear dentures.
I will read over these notes again.I just think something is missing but my
fuzzy brain has not been able to figure it out.
Thanks for being here.


#9

One of the difficulties with “nerve pain” is that once the who receptor system is damaged by narcotics is bringing your immune system back to normal is VERY difficult. The codeine NEVER did a thing for your pain. It only effected how you perceived your pain (assuming it was neurpathic.) It was still there and likely getting worse. Baclofen and Gabapentin actually help the pain. FWIW it took over three years for me to recover from the damage pain meds did to me. (it was over 20 years ago) It was worth the wait. From being close to a vegetable totally unable to function because of pain, in a wheel chair, etc I have today an almost normal life. I go fishing almost every day if nothing else. For auzerelle opiates are helpful because the change in the opioid recpetors does control migaine (true migraine) It would be at best unethical and at worst criminal to deny her.

This is a huge issue (the other thread wasn’t closed because of the pain med discussion but rather because it went way off the original topic of what happened to Red) but every country (we have over 50 represented here) has a unique problem in dealing with the “Opioid Crises” What happens when discussion goes beyond our personal experience, questions, support and problems and especially this area is that feelings are hurt, judgments are made (usually wrong) and things become political, “issues” cloud support, and worse patients disengage from something that can help them. (peer to peer support) NO ONE should ever feel they are on the hot seat (though I tend to put them there from time to time) This is just a caustic topic that does no one any good. IF you need narcos and condition is one that responds appropriately to them, then you shouldn’t be denied. But far too often we “need” them because they dull our senses and remove us from a nasty situation without really helping the problem that needs solved.

I care a lot each member here. Because of that and years of experience I know these
type discussions do need to pop up from time time but that they also need quickly tempered and slowed down. I have a lot of confidence in integrated pain management, it is successful well over 80% of the time BUT it is also a field less than 6 years old (which in the medical world is like minutes old) One thing has become abundantly clear though and that is Chronic pain should only be managed by those who are trained and specialized in it. The road to hell is indeed paved with good intentions and we have a lot of docs with script pads that really have little to offer other than good intentions. Its sort of like teenagers in love - whats good sometimes turns out really bad…

It will be okay eventually, Ellen, not by the timing we all would like especially you, but it will be okay.


#10

Thank you for your comment.
Again without this board I would be nowhere.
I was being seen at the best pain clinic in Canada.-that I know of.One doctor left-and new one just tore what was done and took me off of opiates.
I can PM details if you want-not joking.
Apology came and then asking whether I needed the script.
So-what is up with that?
Is it the government pushing pain doctors to prescribe what they want?
This doctor just forgot that I was one of two that would be left on opiates.
Which is quite the frustrating situation for me.here I have a pain management doctor who meant to keep me on opiates-but forgot-and then had a bunch of reasons why I should not be on opiates.But originally had planned to leave me on them.or the doctor was just making up a background story.It is beyond my understanding.
So either the doctor does not believe it is nerve pain or the doctor believes it is nerve pain but chose to keep me on opiates anyways-at a reduced dose-we agreed one pill down.Which then ,within 10 minutes of having that appointment and getting my prescription from the receptionist the amount had gone to instead of one pill less per day, it went to 1 pill a day.
Again
I have records and can PM you if you want to know more.
When I had the bad reaction to lamotrigine the doctor sat with me while I described my pain pill routine(hygiene is the terminology now)the doctor took down all the info-NO DISCUSSION ABOUT BEING TAKEN OFF OPIATES- and when I got to the pharmacy the pharmacist was the one who told me.
It was after that that I found out what had gone on via an e-mail chain with the doctor.
I do feel like I am acting like an addict-in that I am royally ticked off about this whole situation.But Since nothing was done for my pain-then why should I not be so royally POed?
There is no one that can seem to diagnose me so then where does that leave me??
And how about the many others???
I should just care about me at this point in the game,but really ,I think that for me it has gotten to be too late.
I am caught in this horrible situation.
But when pain clinics will not prescribe opiates to anyone-that is pretty messed up.

So-do I have neuropathic pain?
Do I have nerve pain?
That is the question.
Without an answer.
next pain clinic will be one that does not prescribe opiates-because NONE of them do.Can you imagine a pain clinic-all pain clinics-that do not prescribe narcotics?
That is insane.
So I will be getting an injection-maybe.
Will that fix the problem?-no
Will it make things worse-I dunno
I would like a valid diagnosis and then a treatment for the diagnosis.
But-if none of the neuropathic pain meds work then where does that leave me?
By the way-gabapentin was for hot flashes and then back pain.Increasing the gabapentin does nothing for the pain-it just makes me sleep.Which is what is was given for originally-to sleep through hot flashes.
Family doctor wants me off of baclofen because it is not proved to work over a period of time.And I don’t have muscle spasms.
But I can tell that muscle relaxants do help with the pain.
I do not believe I am the only one that is taking opiates on this board.
As far as I am concerned once the medical profession cannot figure out what the problem is then give the patient what drops their pain down to a livable amount.
If I get to a 3 out of 10 for 1 hour , an hour after the meds ,
at least that lets me do some paperwork .Otherwise I would just be coiled up in bed.
Pain goes back up after the hour but at least I got something done.
I am glad that whatever was wrong with you got resolved.
Happy fishing.


#11

I don’t understand why you say gabapentin actually helps pain and opiates do not (mask it). Gabapentin is an anti-seizure med that alters brain chemistry, it has a very narrow window of use to start with most of which has nothing to do with pain. Opiates block pain signals from being received by the brain, which fundamentally is the same thing just from a different starting point. Either way your brain perceptions are being altered. And isn’t that the point when treating chronic pain? The need to interrupt how signals are being received?


#12

If you try hard enough, any medication can become abused and considered a crisis. Check this out:

Last December (2016), Ohio’s Board of Pharmacy began reporting sales of gabapentin prescriptions in its regular monitoring of controlled substances. The drug, which is not an opioid nor designated a controlled substance by federal authorities, is used to treat nerve pain. But the board found that it was the most prescribed medication on its list that month, surpassing oxycodone by more than 9 million doses. In February, the Ohio Substance Abuse Monitoring Network issued an alert regarding increasing misuse across the state. And it’s not just in Ohio. Gabapentin’s ability to tackle multiple ailments has helped make it one of the most popular medications in the U.S. In May, it was the fifth-most prescribed drug in the nation, according to GoodRx. (https://www.statnews.com/2017/07/06/gabapentin-opioid-abuse/)

So what’s next? No gabapentin prescriptions? Limited availability? No refills? I go back to the idea that the issue is not the medication or the majority of the prescribers, the issue is criminal in natural and addiction-based. Those treating true pain are proven to not become addicted. Which circles back to the idea of education for all involved, not regulation.


#13

Hello Sis!
I have to add that while they are calculating Opiate overdoses, they are also including heroin in their calculations. Since when can a doctor prescribe heroin? They don’t. If you deduct the heroin overdoses and heroin addicts from the equation, you would see that the real problem is with heroin, not opiates.


#14

I think that is why I am having a hard time with all the “facts” that are presented for this opioid crisis.
The facts are so wishy washy
And-yes-my city has a gabapentin problem ,too.
Gabapentin does make me dizzy-it just does not do a thing for the pain.Not sure what it does for my cat.She is on .2ml a day.She sleeps more,too.


#15

The biggest thing to remember about any “crisis” and it’s supporting facts and figures: figures don’t lie but liars can figure.

Thanks for the heroin info! I hadn’t realized it was still being figured that way. Heroin is the big scare tactic! As if one accidentally starts using heroin…


#16

Not sure I’m talking/ or adding much to this… No scrap that, no one experiences pain/ symptoms due to a lack of medication. Your body was in crisis prior to any medical intervention. You go to your specialist and he gives you that or this, you may feel better, but has he helped your situation? Your now on ongoing prescription, but most don’t ask why me? in the first place. It doesn’t matter what complaint what drug. The question should be why me? But then you’ve got the prescription so feel better, so why strive to answer the question? we’ve been conditioned to go to the doc, who has the answers when we are ill, thanks doc. No he’s hiding in the most part symptoms, and only that.

The medical profession is entirely ignorant in the cause or at least the treatment of most illness yet we put our trust in them. Diabetes 2. metformin, at least in this direction things are slowly changing but give someone metformin- I’ll carry on regardless. Medication doesn’t change life style. TN is not the only illness to confound the medics, and they are dealing to date with symptoms, in the absence of evidence of cause short of space occupying lesions, and vascular lesions, I’m not including those that precede MVD.

As an example, some what less painful, tennis elbow, plenty of previous research, inflammation of the tendons, now no inflammation found during surgery. Things change in research depending on who, why. Why is this, interested parties. What doesn’t change is what you eat, what your stress levels are but these should in a health crisis, and if we all looked at ourselves we would be found wanting. An opiate isn’t going to address the latter. More folk should take their own health in hand, you doctor isn’t going to, with the tools in his bag.


#17

I don’t disagree with you about taking personal responsibility for your life choices moth but that’s not going to fix a majority of chronic conditions and almost no acute conditions. Asking why me is not going to help tuberculosis but daily medication is. Asking why me and then following through with changes helps with diseases that have triggers like migraines and seizures and asthma but its not going to do what daily medication does.

Medications are critical to your health and well being. Any doctor worth the title should be looking at root causes but as you said its up to the patient to do something about it. But without proper medications its often impossible for a person to do anything to help themself.


#18

yeah I’m not all to keen on that why me line of reasoning. the implication is that I deserve my pain and should be punished for not asking myself why me


#19

Not true. The numbers are separated (except maybe in the press) 40% of overdose deaths (And that’s only deaths actual overdoses are a tad higher with the prescription meds) are prescription related:

https://www.cdc.gov/drugoverdose/data/overdose.html

The fastest growth however is with Methadone, Oxycodone, and Hydrocodone.

I’ll agree there is an enforcement problem. But lets be honest for a minute. There is not a single one of us who uses opioids for pain management that has NOT abused them. We have all bumped our dose instead of four hours as prescribed we have all bumped the time, maybe by a half hour and often by more. Instead of 2 - 5mg, we have taken 3 (maybe even 4 or more) because we are in crisis mode. the next step to serious overdose is real short one. Ans YES those little cheats are abuse. Most prescription overdoses are “accidental” as are the deaths

If you pull: Substance Abuse and Mental Health Services Administration. Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. The DAWN Report. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2013. Available from URL: http://www.samhsa.gov/data/2k13/DAWN127/sr127-DAWN-highlights.htm

You will find some very disturbing statistics. 2 million Americans abused or were dependent on prescription opioids and 1 in 4 people who receive prescription opioids long term for noncancer pain in primary care settings struggles with addiction. (Dependence is another issue) Those overdoses are on the rise while heroin is stable.

Thats a crisis by any definition but the real crisis is that so many people are receiving such poor treatment for their chronic pain.

@azurelle, you are correct both the anti siezure meds and opiods treat pain by effecting the pain signals BUT there is a significant difference in how they do it with opiods the pain stimulus still exists, so the pain remains. Your entire brain is dulled so you just aren’t reacting to whats happening Not only with pain but everyday tasks. You have to remember pain is the body telling you something is wrong, if its not fixed it stays and continues to increase which is much of the reason for the opioid crises. More pain require more pain medication which starts a constant spiraling sequence that eventually tops out where nothing is capable of controlling the pain. Gabapentin and the like work differently. IF the pain (and that is a BIG if) is caused by damaged nerves (what are commonly described as over-firing nerves) they will slow down the firing to near normal and relieve the pain. If they work, they work well if they don’t patients deserve answers and they getting them. The good news is that while the Gabapentin type meds that were never developed for this purpose in the first place work sometimes, the process is well enough understood now that specific medications are being developed specifically for the nerve firing issues.

Interestingly enough Ohio is one of three states that had a significant increase in prescription Opioid deaths in the last reporting cycle everybody else decrease or remained relativley stable. No doubt they are over reacting on a state level.

Better treatment of Chronic pain is the answer and poor treatment the problem. The though of loosing opioids is I’m sure terrifying to anyone facing chronic pain. But instead of fighting this problem (which for most needing them is a problem of perception not reality), we need be pushing much harder for real solutions.


#20

Are those really stats from 2011 that you are pulling?
Maybe I am reading wrong.
Thanks