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Re: An integrative approach to managing chronic pain from a Docs POV

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I have multiple sclerosis and deal with debilitating chronic pain as a result of the disease. My doctor is a well respected Neurologist who is also a Qualified Medical Examiner relied on on a National Basis by both the Courts and medical profession for his expertise. In addition to alternative pain management strategies, I receive two opioid prescriptions to manage my pain. The new reality of our society that my medical care and the treatment decisions made for me by my respected physician  will now be determined by and because of individuals with addiction/abuse issues or for any other reason than the qualified opinions and decisions of MY physician is outrageous to me. When the treatment of individuals with no addiction history that have legitimate medical need for treatment that is approved not only by their physician but also are determined to be legitimate and necessary by MS organizations and advocates are denied because of the inappropriate and/or illegal acts of others, then these positions MUST be re-examined. It is unconscionable. Consider the consequences for others with chronic or life threatening illnesses: cancer patients? Burn victims? 

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Re: An integrative approach to managing chronic pain from a Docs POV

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@GailL1wrote:

I am just wondering what those of you who have chronic pain and are now beginning to feel the pinch of more regulated opioid meds to relieve your pain think about this physicians view of other treatments.

 

He calls this "the compassionate, whole-person, and effective approaches to controlling pain".

 

STATNews 10/31/2017 - An integrative approach to managing chronic pain can help solve the opioid cri...

 

from the link ~

In my practice, I use a tool called the Healing-Oriented Practices and Environments (HOPE) note. It involves a series of questions aimed at evaluating not just a patient’s chronic pain but his or her own ability to manage pain and general health. It complements the SOAP note (subjective, objective, assessment, and plan) that doctors usually use to document a patient visit. Then I work with the patient to develop a meaningful plan that matches his or her strengths and priorities with activities to reduce pain and improve function and wellbeing in everyday life. We set and track goals, then support the patient along his or her healing paths.

 

Some of the things he uses to help patients manage their pain in a customized plan are:

  • Acupuncture.
  • Behavioral therapy 
  • Yoga classes.
  • Relaxation and stress management techniques with help from an alpha stimulation device.

According to this doc, all these measures will help a body learn new ways to combat pain — and get off opioids. This, according to this doc, is pain management with effective, integrative approaches.

 

Interested in knowing what you think about this - I agree that always going the opioid route has created a monster but who is gonna be the judge of who might be benefiting from them - or do you think nobody does benefit from them.

 

 

 


" all these measures will help a body learn new ways to combat pain " - This is a lie to promote the businesses of quack doctors.  I know someone who tried acupuncture, and it made the pain worse.  People in pain are desperate enough to fall for these scams.

 

I am not beginning to feel the "pinch" because my opioid, Pentazocine/Naloxone, is a Schedule IV drug.  Schedule IV is like the DEA's stamp of approval.   Learn something useful here:

 

https://www.dea.gov/druginfo/ds.shtml

 

 

Old Witch
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Re: An integrative approach to managing chronic pain from a Docs POV

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@GailL1  I could not agree with you more. It's a twisty turn-y complicated subject, isn't it? No worries on the long post, but please accept apologies from me on this one, because you've just opened a vein. Smiley Happy

 

As an herbalist who has long used wholistic approaches to health, I completely understand the difficulties societal 'addiction' to instant gratification pose to widespread adoption and success of this approach. And how. For many it really is hooey: to go wholistic they will have to take their house down to the framework and start again.

 

It is frustrating to see so many being prescribed drugs that mask rather than cure a health issue while also creating new health issues (like opiods do). Like you, I can fill these pages with cautionary tales about such things. Like you, I don't give the wholistic approach much future market share. Not because it isn't a valid approach. Not because it doesn't work: it does! (I can tell numerous success stories) But because, for example, few menopausal women want to grow their own motherwort, make their own tincture and use that instead of estrogen replacement therapy. It takes too much time; what if I get it wrong? And the bottom line: they don't want to take responsibility, just give me a pill, please.

 

This convenience has costs. Case in point: a 100 pound overweight woman I know, and a birth control taker for decades, then an estrogen replacement therapy user, just had non-genetic estrogen receptor breast cancer removed. Again: this isn't genes acting out. This is, effectively, a lifestyle disease. Birth control pills, obesity and estrogen replacement therapy are all convenient, but are also all implicated in this type of breast cancer. She knows this today, but will this knowledge carry through to an adapted lifestyle? For her sake, and her grandchildren's sake, I hope so, but I'm not betting on it. She was already on opiods, and now, post-surgery she's on even more, so I rather doubt she'll ever shake this monkey. Now, she's never been one to take charge of her diet or lifestyle and has always been one to pooh-pooh my healthy living suggestions as too hard. And here she is. So that's one kind of opiod user.

 

I'd call Jim (the guy whose opiod story I linked to) another type of opiod user. This is a Yale graduate, a body builder, an A-type, a system fighter, the type of guy who takes everything to extremes and who has a long history of taking responsibility. And you read his story: he's not able to kick the drugs and go full-on wholistic either. His chronic pain from 90 surgeries is too great. (I think that's the correct number, as astounding as that number is.)

 

So I think one of the things this story is about --I can see it in the margins and between the lines-- is addiction. At the risk of being labeled a whacko, you know, if I haven't been already Smiley Happy, my view: the opiod situation in America, the over-prescribing of pharmaceuticals, the decades-long seducing of the populace into a lifestyle of convenience, the marginalization of herbal, natural and wholistic approaches has all been about power. Not my power. Not your power, but corporate power. While it may well be too late for many seniors on opiods, it will never be too late to work together to overthrow the power barons in this country. You see, I'm a wholistic thinker as well as doer. Smiley Happy

 

 

PS Yes: write that book. Just don't stop posting here, please. Smiley Happy

 

"The key to success is to keep growing in all areas of life - mental, emotional, spiritual, as well as physical." Julius Erving
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Re: An integrative approach to managing chronic pain from a Docs POV

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@Epster

 

Yep, I could give you some stories that would make your hair stand on end - addiction is not just about the addict but the mounds of human wreckage that is left in the wake of addiction - to whatever substance.

 

However, I think this doc is not talking about addiction per se but about the over prescribing of opioids for pain management.  An addict thinks - if a little is good, then more is better.  For many people trying to make it through each day with a chronic illness in pain, they just want some relief where they can function somewhat normally.  

 

This  integrative approach is for those people and has little to do with helping the addict, at least until they are detoxed and then some of the methods might work for them too.  

 

There is a movement underway as part of this opioid national emergency to retrain doctors in what they should be doing by steps when a person comes to them for the treatment of chronic pain or when pain is a result of some other ailment.  IOW, try something else 1st than an opioid Rx.  That could be the last step if nothing else works, maybe.

 

Part of me says, yep that's the way to go but then I think, for a society that loves instant gratification, that finds it hard to change daily living things even though it might be better for them, I think, for many people all this integrated plan is just a bunch of hooey - will they put in the work to make it work, if it works?

 

As for those, most of them, who have been on opioids for a while, they will have to go through detox to varying degrees - what then?  Will we divide them up into classifications - one for those who have pain (internal) and another for those who need more long term counseling on just living?

 

Treatments and long term remedies don't seem the same to me and I hope it doesn't to those who are making the rules,dishing out the remedies and most of all, making the spending on this problem be the most beneficial.

 

Sorry about the long post - my landscapers cut my cable line so my brain needed something to do - perhaps I need to finish that book I Started over a year ago! 

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: An integrative approach to managing chronic pain from a Docs POV

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If I could find an alternative plan to relieve my symptoms and pain from Fibromyalgia that truly works, I am surely open to trying it.  Right now, I do depend on opiods from my pain management physician.  They do help some but I still have days I basically cannot do everyday chores.

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Re: An integrative approach to managing chronic pain from a Docs POV

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I can't say who benefits from them. Here's a friend's story of doctor prescribed opiod addiction and the road back, though: https://medium.com/@jameschud/my-story-of-opiates-as-prescribed-becoming-a-huge-problem-85d4188bcd95

 

 

Here's an excerpt:

"My level of daily opiate consumption, which had absolutely no effect on me was absolutely absurd. Here is the list at that point:

 

Methadone — 120 mg/day Fentanyl — 2–100microgram patches(this is the highest potency patch available at the time, and I was getting twice the maximum recommended dose) — changed every 2 days. This is the highest dose available — doubled. Oxycontin 80mg TID Oxycodone — 40mg QID and, for breakthrough pain — as if there was such an animal — 2mg Dilaudid I.V. TID. If you know what I now know, this is a totally lethal dose for anyone who was opiate naive. I had been ramped up to this and would have gone higher if the following events had not happened."

 

Follow the link above to read his harrowing detox saga.

 

And the resolve:

"Today, I am still on a constant daily dose of Methadone — lower than before, but it’s there and I feel it. I once again tried to detox myself, and at this point, several years later, I really have so much chronic pain, that doing so makes no sense…and so it goes."

 

 

"The key to success is to keep growing in all areas of life - mental, emotional, spiritual, as well as physical." Julius Erving
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An integrative approach to managing chronic pain from a Docs POV

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I am just wondering what those of you who have chronic pain and are now beginning to feel the pinch of more regulated opioid meds to relieve your pain think about this physicians view of other treatments.

 

He calls this "the compassionate, whole-person, and effective approaches to controlling pain".

 

STATNews 10/31/2017 - An integrative approach to managing chronic pain can help solve the opioid cri...

 

from the link ~

In my practice, I use a tool called the Healing-Oriented Practices and Environments (HOPE) note. It involves a series of questions aimed at evaluating not just a patient’s chronic pain but his or her own ability to manage pain and general health. It complements the SOAP note (subjective, objective, assessment, and plan) that doctors usually use to document a patient visit. Then I work with the patient to develop a meaningful plan that matches his or her strengths and priorities with activities to reduce pain and improve function and wellbeing in everyday life. We set and track goals, then support the patient along his or her healing paths.

 

Some of the things he uses to help patients manage their pain in a customized plan are:

  • Acupuncture.
  • Behavioral therapy 
  • Yoga classes.
  • Relaxation and stress management techniques with help from an alpha stimulation device.

According to this doc, all these measures will help a body learn new ways to combat pain — and get off opioids. This, according to this doc, is pain management with effective, integrative approaches.

 

Interested in knowing what you think about this - I agree that always going the opioid route has created a monster but who is gonna be the judge of who might be benefiting from them - or do you think nobody does benefit from them.

 

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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