Chronic Non-Malignant Pain Opiate Options

You got pain?  Take a pill to ease the strain.  Chronic nonmalignant pain affects everyone.  It can be a major cause of personal and family distress.  In addition to the pain of pain many live with secondary effects such as depression which leads to family chaos, work absenteeism, and decrease in activities of daily living to the point of depression.  Prescription medication like nonsteroidal anti-inflammatory drugs (NSAIDs include ibuprofen, naproxen, celebrex and more) and opiates (oxycodone, hydrocodone, codeine, morphine and more) are the gold standard for acute and chronic pain management.  Once you have seen the doctor you are most likely to get one or both of these depending on the etiology of the pain.  Once the cause of the pain is found and treated the need for pain medication may cease.  If this fails to work, the pain meds continue.  This can be a hazard to your health.

In 2012 there were about 183,000 deaths worldwide.  In 2014 there were over 47,000 lethal drug overdoses making it the leading cause of accidental death in the United States (2012 statistics: United Kingdom: 3,200, South America/Latin America/ Caribbean: 7300, European Union: 6100, Oceania: 1900).   This exceeds the number of deaths in road accidents in most countries. Research from studies done in 2013 revealed that opioid analgesics were the primary cause of most drug overdoses in the United States.  Over three-quarters of these deaths were accidental or unintentional.  Opioids (75%) were the most common drug followed by benzodiazepines, antidepressants, and antipsychotics.  Prescription pain relievers accounted for over 18,000 overdose deaths.  Misuse of these medications often leads to illicit heroin use.  Why?  It is easier to get and less expensive than prescription opioids even though the rate of prescribing opioids has almost tripled since 1994.  This has increased the mortality rate from overdosing over 400% in women and over 200% in men from 1999 to 2010.

Pain can be managed in ways that use less prescription pain medicine.  The pill may be the easiest way and is usually the first thing a patient is offered.  There are many options to finding relief while decreasing your risk of opiate dependence or overdose. Your doctor can do the following:

• advise on other treatments and refer to appropriate specialists
• discuss risks, side effects, etc of prescription pain drugs
• educate, provide resources for education on the diseases, pain management (articles, books, videos, agencies like Partnership for Drug Free America)
• prescription drug monitoring (doctor-patient contract, drug tests)
• use of non medicinal treatment
• identify risky drug use patterns
• require visits for refills
• referral to pain management specialist
• behavioral therapy consult

Opioid dependence and overdose can be prevented.  Using opioids responsibly is the patient’s responsibility.  It is up to you to recognize what these types of drugs can do to you.  Relief of pain is the objective; however, the addictive potential must be taken into consideration.  It is important to get a correct diagnosis of the pain as there is probably non opiate treatment that can make it tolerable or resolve it totally.  Make opiates the option instead of the treatment of choice.  Best health!

Spill the Pills, Take a Knife Slice: Surgery vs. Conservative RX

Conservative treatment is the mainstay for many chronic diseases.  This means that your healthcare team will most likely encourage you to avoid surgery unless it is life threatening issue.  Why is the stigma of surgery avoidance associated with poor outcomes?  This day in time savvy surgery techniques and fewer post operative complications complications are more likely to restore your quality of life to a livable level.  In other words three years or more of taking pills with or without complimentary treatment can be more costly in the long run with a poor quality of life.

How will you know if surgery sooner rather than later is best for you?  Talk with your doctors and healthcare providers.  If you find there is disagreement, seek out more opinions until you find what is best for you.  Surgery is preventive and can improve one's quality of life in months especially if conservative treatment fails.  Conservative treatment may help, but after many years it is less likely and becomes more costly in every way primarily in worsening of symptoms.

Spare yourself countless years of needless suffering. Do your homework.  See what treatments work best for you.  Talk with your healthcare providers about new treatments, and look for doctors (specialists) who have experience in the area.  If you've been getting around with the same nagging symptoms and watching your years pass you by without improvement or feeling good on the same treatment year after year, get on with it! Consider surgery if it is an option.

Great health is true wealth!

Health Books: Must Read Healing, Part 2

Health literacy is the sure way to help you and your health care team make the best medical decisions for you. Making healthy lifestyles permanent is one of the keys to good health. The following books are recommended primarily because they teach you things you can do for yourself that you can incorporate in your lifestyle to make it healthier.

Barney & Baby Bop Go to the Doctor
by Margie Larson

Women's Bodies, Women's Wisdom
by Christiane Northrup M.D.

The Medical Advisor: Complete Guide to Alternative & Complimentary Treament
by TIME Life Books

Dr. Koop's Self Care Advisor
by Everett C. Koop, M.D.

Merck Manual
by Merck

Savvy Patient Toolkit
by Margo Corbett


The Empowered Patient
by Elizabeth Cohen

Patient Handbook to Medical Care: Your Personal Health Guide
by J. L. Richardson, M.D.

Best health!

Some Doctors Miss the Mark

For the past few years I have seen pain management specialists for chronic pain. Seeking relief after many, many years has indeed been a challenge. Each time I was referred to a pain management specialist for the neck and back pain (from arthritis and herniated discs), treatments offered were medicine (especially samples of new stuff), and invasive procedures like epidural spinals and trigger point injections. Alternative treatment was rarely offered, and if so was limited to 20-30 minutes physical therapy sessions for about six weeks every few years, upon my request.

Fortunately, my neurosurgeons saw the light. In efforts to achieve pain control and maintain function without surgery, other treatments such as massage and acupuncture were recommended. Sadly enough, these choices are not covered by my insurance. I am still waiting for over a year now for approval and payment for long term treatment (which works) instead of six weeks.

Even though some doctors miss the mark, there are others who are on the mark. As a savvy patient you must always recognize this. You have choices even if you must pay for medical services you need out of your pocket. It is a tough choice, but the best for your health. If there is something you need that is not covered by your insurance, you have choices. Make the one best for you, especially if your doctor misses the mark.


by J. L. Richardson, MD, family medicine doctor, patient advocate and author of Patient Handbook to Medical Care: Your Personal Health Guide.

Read excerpts at Google Books http://books.google.com/books?id=kPmXiNrg1pYC&printsec=frontcover&dq=patient+handbook+to+medical+care

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Treatment - Alternative & Conventional

With all the controversy surrounding whether a child with cancer should have conventional chemotherapy or alternative treatment, it can be hard to know what to do. Prayer and meditation are tops in alternative treatments patients use. It works. So why aren't more doctors recommending it along with all the other treatments? Why does conventional treatment get first choice?

Massage, acupuncture and other alternative modalities can be just as effective with better results, less side effects. Treatments and medicines used over 2000 years ago on Eastern medicine are dismissed and discouraged as fist line treatments. Evidence based studies is the buzzword for medical treatments that works best today. Drug trials over a few months to years take precedence over tried and true alternative treatments.

One size does not fit all. Treatments must be customized to each patient. This takes careful history taking, physical exam, in conjunction with other tests - conventional and alternative. All aspects of medical treatment must be respected and offered to patients so they can make a fully informed medical decision.

Even more discouraging is that health insurance rarely covers any alternative treatments. For a person with a chronic pain conditions like fibromyalgia and arthritis, insurance will cover addictive potent pain medications when routine massages and/or acupuncture and/or routine conventional physical therapy offer better pain control, and ongoing daily function. Drug addiction is covered by insurance over non addicting complimentary treatment even knowing that rehabilitation for addiction will incur extra cost and suffering for the patient.

What do you choose? Are you willing to pay extra for treatments that your insurance does not cover?

by J.L. Richardson, MD, author of Patient Handbook to Medical Care: Your Personal Health Guide.


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