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The Truth About Chronic Pain Treatments

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I recently came across a posting by a woman on a website for chronic pain patients. She was very upset about efforts to curb overprescribing of opioids because she needed her opioids just so she didn't cry all day while lying in bed with her chronic pain.

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I understand how she feels. In 1977, when I was 25 years old, my life came to a screeching halt when I injured my back. I was in agony 24/7. The pain was worse when I sat or stood and it seemed I could do nothing else but lie in bed and take the drugs I was being prescribed. For most of the next 3 years I only did what I absolutely had to. The rest of the time I was in bed nursing my pain. Fortunately, that wasn't the end of my story. I was able, no thanks to my doctors or my health insurer, to find treatments that worked and I've been able to lead a normal life since then.

The aforementioned woman, and millions more like her, are the victims of deceptive and even criminal practices designed to enhance profits at the expense of hapless pain patients. The truth is that opioids are extremely dangerous and do not work for chronic pain. There are safer, more effective treatments that the medical establishment doesn't want you to know about and is doing its best to keep you from having.

In the 1990s Purdue Pharmaceuticals began aggressively peddling their time release opioid OxyContin to doctors around the country. Their marketing campaign focused on the "under-treatment" of pain and the allegedly virtually addiction-proof nature of their product. Prescriptions of all opioids for chronic pain skyrocketed. However, Purdue lied. They knew that pain patients could become addicted to OxyContin. In 2007, after being criminally charged by the FDA with consumer fraud, they pled guilty and paid a substantial fine.

Since Purdue's criminal marketing campaign, most physicians, seemingly oblivious to recent developments, continue to believe that opioids are not addictive when taken as directed by chronic pain patients and continue to prescribe them. We are in the middle of the worst drug abuse epidemic in U.S. history, but government officials and organized medicine act as if the problem can be contained with prescription drug monitoring programs. Because of the way the brain responds to opioids, users not only need more and more of the drug to get the same effect (tolerance), but also to avoid horrendous withdrawal symptoms (dependence). Increasingly, pain patients, when their doctors refuse to escalate their prescription painkiller doses, are turning to heroin. Opioid addiction and overdose rates continue to rise.

The opioid abuse epidemic is generating so much attention that most people have failed to notice that opioids do not work well for chronic pain. When opioids are ingested, the body makes less natural painkillers. Some patients end up much more sensitive to pain than before, a condition known as hyperalgesia. Also, pain has causes that opioids do not address. Studies have shown that pain patients who take opioids end up with more pain, more disability and lower quality of life than similar patients who never took opioids.

Treatments that have been proven safe and effective for chronic pain in randomized controlled studies include acupuncture, biofeedback, chiropractic, cognitive behavioral therapy, exercise, herbs, homeopathy, low level laser therapy, marijuana, massage, nutritional interventions, physical therapy, therapeutic touch, trauma release techniques and multidisciplinary pain treatment programs.

At the same time that prescriptions for opioids were rapidly rising, health insurance companies were busy cutting back on coverage for these safer and more effective treatments for chronic pain. The number of visits for chiropractic care, physical therapy, and psychotherapy were limited to specified numbers of visits per year in insurance contracts. Onerous medical necessity reviews were instituted that imposed significant paperwork burdens on medical providers and reduced benefits even below contractual limits. Fees paid to providers were slashed and have been frozen for about 35 years. Higher co-pays were instituted than were in effect for primary care physician visits. Insurance companies have refused to pay for many other treatments at all. Coverage of biofeedback and multidisciplinary treatment programs was discontinued. The FDA has repeatedly tried to restrict access to nutritional supplements and herbs. Pharmaceutical companies have funded studies designed to discredit alternative treatments by using inadequate dosing or inexperienced practitioners.

Add to all that the fact that physicians receive almost no training in treating pain--less than two hours on average in medical school. This leaves them vulnerable to the misinformation peddled by ever-present pharmaceutical sales reps.

Given all this, it's hardly surprising that pain patients and their physicians believe they need access to opioids. We need a law that would require insurers to cover all proven treatments for pain to the same degree that they cover pharmaceutical treatments, require physician education and substantially increase fees for providers to ensure continued availability of these currently endangered treatments. I've proposed such a law, called the Pain Treatment Parity Act.

My recent book, The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free, thoroughly documents the need for this legislation and contains the full legislative proposal. If you'd like to work with me on this legislation, please contact me at cindyperlin@gmail.com.

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Cindy Perlin is a Licensed Clinical Social Worker, nationally certified biofeedback practitioner and the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free. She is the founder and CEO of the (more...)

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