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Verstehen, through shared perspectives


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JUST ANOTHER CHRONIC PAIN PATIENT

“Me, too!”  We can all find ways to join with others who share the significant abuse, pain, loneliness, poverty…..whatever has touched us with enough significance to change the way we conduct our lives.  Our thoughts.  Our treatment of others.  Our understanding of our own worthiness, or the lack thereof.  The reality of our life that will either make us, or break us, through no fault of our own.  For over 100 million people in America, that reality is ongoing.  For some it has just begun, for others it has been the story of a lifetime of pain, and of trying to cope.  These are the chronic pain patients, and I am here to say, “Me, too.”

Elsewhere on this website I have talked about the devastating pain, and the 45-plus years I have lived with it.  About how I could not take pain medications other than NSAIDs, which ultimately caused more problems to be dealt with.  About how almost 4 years ago I went to a Pain Management physician, who made it possible for me to return from the nights spent crying in pain and helplessness, wishing for death, to a productive life once again.  Yes, along with many who have committed suicide or considered it since the War on Physicians and Pain Patients, I can say “Me, too.”  Although I cannot consider suicide (and this is no credit to me,  it is just a fact), I have certainly prayed for death to take me out of the intolerable situation.  As I said, I have written about this before.  It’s all still on line, if you need to read it.

But that is not why I write now.  There is a deeper reality to being a chronic pain patient in America, one that is emotional and psychological, and causes a pain of the inner being that is every bit as devastating as a pain level of 10 on a scale of 1 to 10.  It is why the title of this piece is “Just Another Chronic Pain Patient.”

To our government, to many insurance companies, to law enforcement and even to some medical associations and physicians, nurses and practitioners, and even to our own employers, our families, our churches and our friends, we do not exist.  When we must leave the house, we dress as well as possible, use makeup, and try to appear as though nothing is wrong with us because no one wants to hear or be reminded about our constant struggle.  It isn’t a welcome contribution to our daily interactions.  Worse, we often hear:

It’s all in your head.  See a therapist, not a doctor.

You would feel better if you would just get out and do more; exercise more; volunteer more.

Quit feeling sorry for yourself and look around you.  You are better off than most people.

If it wasn’t for you and your kind, we would not have this opioid crisis.  It all began with you drug seekers.

And these are only a few of the arrows that pierce our very souls.  Like when we are not even mentioned in discussions of how pain medication should be used.  It is all about the people with substance abuse problems, or acute, short-term pain.  These are considered legitimate issues, worthy of concern and assistance.  And they certainly are all of that, but Chronic pain does not exist, is not even worthy of notice.

Nothing is said about the courage and strength of the single mom with children to support, who bravely goes to work every day looking her best, with a big smile on her face, hiding the pain that racks her body to the point that she cannot eat properly, or sleep well at night.  And she won’t talk about it, because she knows she could lose her job, or her children, or the medications a concerned and knowledgeable physician gives her so that she can go to work and care for her children.  She lives with the fear, as well as the pain.  Every day.

Speaking of every day, other patients are condemned because they may have periods of hours or even days of less pain, when they can get a lot done, and enjoy some time free of the pain.  Those times come at a high price:  when they can no longer operate at that level of freedom, they are under suspicion of malingering.  “S/he only hurts when it suits her/him.  They just want attention/pills/time off from work..” Whatever character flaw the speaker is convinced the pain patient suffers from becomes a reality for the speaker, and the consequences of their words become, by extension, a reality for the pain patient and the source of increased feelings of worthlessness, even evil. Oh, the word evil is not spoken.  But add up all the negativity, the character flaws identified by those who have little compassion to spare for the pain patient, and to the pain patient, it feels as though others see you as something evil, at worst.  Maybe only as something unworthy of compassion and a helping hand, at best.

Is it any wonder that some of us have not been able to continue living in the face of having medications taken from us, on top of the horrible feelings engendered by knowing what society thinks of us?  Is it any wonder that not many have been able to speak out and say “Me, too?”

No, I am not asking for credit for doing this.  I am just praying that if you know a chronic pain patient that you will give a second thought about the stereotypical comments that come to mind.  I don’t presume to say that all patients feel the same way that I feel, or to the same degree.  But the same thing is true about chronic pain.  Our lives are different, and we cope the best we can with the degree of pain and rejection that we suffer.  To that, we can all say “Me, too.”

In truth, there is no such thing as “Just another chronic pain patient.” 

 

 

 

 

 

 

 

 

 

 


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AN URGENT PLEA TO END THE WAR AGAINST PHYSICIANS AND PATIENTS

Crimes against humanity are widespread on this planet, and too many to count.  Over the past decade diligent researchers (by diligent I mean those who verify sources and results) have uncovered the roots of some of our more persistent and frightening social problems, and published reputable accounts thereof.  Many such problems are actually the result of conspiracies set decades ago, like the rise of private prisons for the purpose of incarcerating a specific race of young people because of socioeconomic issues (read racism), and calling it a War Against Drugs.  But the drugs continued to take over our nation—not just because of those young people, but because of the greed for money and power in the pharmaceutical companies, insurance companies, and politicians that has grown exponentially, unchecked.  Nixon’s intended outcome—that of getting minorities off the streets and severely impacting their ability to live normal lives outside of prison—also suited well the baser needs of other groups in our society.

Other groups, in fact, began to see the financial success and knowledge of physicians to be a major threat to their own greedy plans.  They deduced that chronic pain patients, now acknowledged and receiving treatment for their pain, could be both blamed as a source of street drugs and used to help bring down honest physicians (and to support the pill mill “doctors” who supplied the patients with enough medicine  to both use and sell).  Eventually, we begin to see “statistical reports” that “prescription drugs” were the cause of abuse and overdose deaths in specific regions of our country.   For a short time, they may have been.  But when the deaths began to occur in White Middle-Class families, the outcry to increase the efforts of the War on Drugs became deafening.  There had to appear to be some effort to control the drugs, so we see draconian measures being set—in some states by law, in others by regulation—that were targeting the legitimate physicians who prescribed for pain patients, and ultimately the patients who were frequently cut off without warning from their pain treatment.  Despite the outcry against punishing patients and physicians, and the evidence showing the futility of this approach to the War on Drugs, this situation continues to threaten the lives of both patients and their physicians, every day.

Despite scientific proof that Substance Abuse Disorder (being addicted to a substance) is an illness of the brain and can usually be well managed by an addiction specialist, legislators and law enforcement officials alike still only see “drunks and addicts” and still, after DECADES of failure, claim that incarceration/punishment is the only way to fight the war on drugs.

Despite, also, the logic that if you are fighting a War against a crime, you go after the source rather than innocent bystanders.  If we don’t get rid of the sources:  drug cartels, the dealers, and the creators of the drug,  how much good is it going to do to punish the people who use them?  Sadly, these sources have never been the primary targets.  Just as now we see heroin and fentanyl actually being the greater cause of overdose deaths (because they are cheap and much more potent than earlier versions), we still hear and see stories about prescription drugs being the cause of these deaths.  We are still subjected to so-called charts describing dubious statistical proof that prescription drugs are the main cause of overdoses, when more reliable research shows that it is street heroin and fentanyl.

To that, I would ask the reader to please follow the hyperlink below.  The author of this piece has provided a thoughtful and well researched discussion of what is really causing overdose deaths, and why the propaganda we are getting is so dishonest:

https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

Having read this article, consider well the facts that every year more than 400 physicians commit suicide;  that thousands of chronic pain patients suddenly deprived of their medication have either committed suicide or gone to the streets to get their medication; and that many of these have also suffered unintended overdose deaths.

These measures that make practicing good medicine so difficult, and the law enforcement mentality that believes physicians are guilty until proven innocent,  are not the only reasons physicians are either opting out of practicing medicine, or opting out of life altogether.  The War on Physicians and on Patients is real, and it is devastating.  The pharmaceutical houses and insurance companies may actually believe that we can survive without trained doctors; Artificial Intelligence will be just as good if not better, they believe….but check out this article:

https://www.scientificamerican.com/article/the-social-life-of-opioids/.

We read here that there is well-researched, scientific proof that a caring and trusting relationship between patient and doctor is a necessary, (but not sufficient), ingredient for best medical practice—AND for healing!  As one incredible physician has noted:  “They (the patients) don’t care how much you know until they know how much you care.”  Artificial intelligence hasn’t managed the caring part, and even if it does I don’t see much healing effect to be expected from a robotic hug.

The crime against pain patients who are now not only being vilified in news media, in pharmacies, and in social media, is certainly heartbreaking.  If you happen to be one of those pain patients, it is also a return to the terrors of intractable pain, inability to function productively in society, and a potentially horrible death.

If you are a physician who has spent at least half the normal human life span studying and preparing to make life better for those who suffer, life may be  becoming a nightmare.  Insurance companies dictate what treatments are allowable, how often, and how long such treatments will be permitted.  They do not refer to medical societies for their information.  They refer to bottom line profit indexes.  Legislators who pass laws (when medical board regulations would more properly suffice) that limit what physicians can prescribe, and how often—arrange that physician’s offices and lives will be disrupted, the physicians in question treated as guilty before having a chance to be proven innocent.  As usual, those who are charged with the felonies that have been put in place as a weapon in the War on Drugs never quite regain their previous status of innocence, even when proven so.

Does it matter to the insurance companies or the legislators that these laws have only created chaos and confusion, betrayal and mistrust?  Does it matter that physicians are already reeling from finding themselves backed into corners where they have to “sign on” to corporate health care entities that are run by non-medical administrators who decree when and how often they work, how many patients they will see for how long, and determine bonuses based on computer-run quotas and outcomes?  Does it matter that medical students are so disillusioned that they drop out, and that some commit suicide?

And finally, adding to the fears of losing their practices, their licenses, and the meaning attached to their life work, physicians in increasing numbers are being attacked and/or killed by frustrated, angry patients or their relatives.

Why is this ethically, morally, and even logically wrong approach to our drug crisis—which MUST be separated in our minds from medical care for chronic pain patients—continuing to exist as a modus operandi?  Why are physicians who serve our communities targeted as criminals at worst, and problem employees who must be managed at best?  Sociologically, physicians have historically belonged to one of the highest prestige vocations in America.  Their demotion to the present state is not through fault of their own, but through others’ sociopathic greed for money and power, combined with the attitude that allows so many to hate anyone who differs from themselves, to create this totally inhumane situation.

It is not “liberal” or “progressive” to respect and care for others.  It is Christian, and Muslim, and Hindi, and Jewish—it is a basic precept of many world religions and predates organized religion itself by centuries.  Of course, being human and egocentric, we do not always succeed in living up to these standards.

It is my opinion that the proof of our own individual humanity is the maturity, intelligence and self-motivation to care for others as we care for ourselves.

I could go on for pages about why so many people have lost the human characteristic of empathy, but there are enough people who retain it who could help our country become human again.  Who still respect the dignity of other human life, and who realize that “together, we stand; divided, we fall.”

It is definitely in our best interests to respect and protect the lives and experience of our physicians; it is also in our best interests not to stand by and leave them or their patients to live and die in misery when it is all so unnecessary.  And inhuman.

And, a last plea……

 

 

RESOURCES:

Alexander, Michelle.  The New Jim Crow:  Mass Incarceration in the Age of Colorblindness.  2012.  The New Press, NY

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial.  1996. University of California Press.

Bateman, Dustin.  Neurobiological & Sociological Aspects of Addiction

Levinthal, Charles F.  Messengers of Paradise.  Opiates and the Brain.  The Struggle Over Pain, Rage, Uncertainty and Addiction. 

Meier, Barry.  A World of Hurt:  Fixing Pain Medicine’s Biggest Mistake.  2013.  New York Times Company.

Parsons, Talcott.  “Illness and the Role of the Physician:  A Sociological Perspective.”  American Journal of Orthopsychiatry 24 March 2010.  Copyright © 2010, John Wiley and Sons.

Quinones, Sam.  Dreamland:  The True Tale of America’s Opiate Epidemic.  2015.  Bloomsbury Publishing Plc.

Sternheimer, Karen.  Connecting Social Problems and Popular Culture:   Why Media is not the Answer. 2nd Ed.  2013.  Westview Press, Perseus Books Group.

Webster, Lynn R.  The Painful Truth:  What Chronic Pain is Really Like and What it Means to Each of Us.  2015.  Webster Media LLC, PO Box 581113, Salt Lake City UT 84158.

WEB ARTICLES, including peer reviewed

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain  http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….    http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide:  http://t.co/4vhF63eD6N

Physician Risks:

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict:  Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics?  http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians:

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …


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CAN I SAY–“I QUIT!”?

25.  And hearing, the Master was glad, and gave thanks and came down from the hilltop…when the crowd pressed him with its woes….[the Messiah] smiled upon the multitude and said pleasantly unto them,

“I QUIT”

-Richard Bach, in Illusions, The Adventures of A Reluctant Messiah.

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How does one begin to talk about our nation’s social, economic and political problems?  What are the words that have not already been said; where are the moral imperatives that have not been rendered impotent; the facts that have not become “alt-“ and the news that has not become mere opinion?  Who, and what, can be trusted and believed?

Overcome with sensory overload, one feels sorely inadequate to the task of sorting out fact from fiction, truth from propaganda.  As time goes by and the “evidence” piles up, pro and con, on so many vital issues;  as the threats and disasters mount,  like Bach’s Reluctant Messiah, we soon long to say, “I Quit!”

Granted, Bach’s Illusions was more about our own illusion that we can and should save everyone, than it is about our present situation that seems to lack “Messiahs.”  Our advocacy, our pleas for justice, our outcry against downright sinful oppression has, in fact, become a battle to save ourselves—or to find someone who will do that for us.  Sadly, the very people we look to for salvation from our medical, economic, and social woes—to say nothing of the potential nuclear holocaust threat, the daily terrorist threats from home and abroad (I include cyber threats), and our planet’s efforts to pay us back for all the harm we have done to it—are all too often the very people whose only goal in life seems to be to wipe us from the face of said planet while causing the worst kinds of misery imaginable. How do we find the stamina to keep working for change?

During my lifetime, I have been an advocate for many social issues.  I have also worked in the service sector, seeking to do my best to make life better for my family, for my community.  One day while I was working as the nurse in the county jail, a couple of prisoners said to me, “You believe that you are helping us by working here, and by treating us like real people.  But in fact, you are motivated by the need to feel good about yourself; you need to help people worse off than you, so you can feel good.”

I thought about that for quite a while, finally deciding that yes, it did make me feel good to be of service to others.  But what was the alternative?   Would I feel better watching them starve, or be beaten, or fail to escape whatever ill came their way?  Of course not.  I finally figured out (with the help of Gospel readings, a PhD in Sociology and a Master’s in Theology, and continuing to actively live my philosophy of doing what good I could do, where I could do it) that being happy about helping others is a necessary by-product of community building.  And community building is all about making sure that the community is protected from greed, murder, neglect, shaming, and other crimes against the human family.  Because I am part of the community, I do also benefit from whatever service or good I am able to provide.

Having followed this moral imperative, however, I presently find myself threatened by the magnitude of crimes against humanity that demand my righteous anger; that call for me to add my voice to those whose anger is also shouting out against an unfeeling and unheeding leadership.  But now we are a sharply divided nation, with no inhibitions against verbally abusing people who disagree with us.  While this perfectly suits the darker intentions of our leadership, it fractures families, communities, and organizations.  Which also suits said leadership.  Perhaps, in fact, I should not refer to “leadership” because that is certainly not what is occurring in our government—far from it.  Use of the term is simply habit, and one we should not use until we have corrected our past errors and placed men and women of good character, intelligence, integrity and moral excellence in places we could then refer to as “leadership.”

I hate living in a society where the death and destruction of entire ethnic and socio-economic groups can be celebrated by the rich and powerful, and ignored by too many others—some of whom have just said “I Quit” for all the wrong reasons.  In Richard Bach’s book, the “Messiah” quit because he was trying to save the world and he was tired.  Also, we learn, because that is not the way to build community and it feeds our own brains with all the wrong information about who we are.  For too many people today, their “I Quit” is the result of feeling overwhelmed, or from a sense of helplessness against the sheer magnitude of the problems, or even from the acquired nihilism brought on by the culture of fear generated by all the propaganda.

But “I Quit” can’t be the answer today.  Not for me, and not for anyone who once had a dream about participating in creating a wonderful future for our nation’s children and grandchildren.  Today, all I could do was write this blog.  Perhaps no one will read it, and if they do perhaps they will disregard it.  That isn’t the point.  The point is that I have not given up, and I won’t quit.  Not as long as there is at least one thing I can do to make even the least important situation a better one, in some small way.

It does make me happy to do that.  And with any luck, it may also make someone else’s day a better one.  And best of all, with enough people happily doing what they can do, we may see a ripple effect of concern and support for one another that is strong enough to defeat those who prefer destruction over construction; death over life (for others), and ivory tower solitude over community.

I know it is possible.  In the face of lack of funding and support in so many disasters of our immediate past I have seen countless men and women whose first thought was for the victims.  They headed into disaster areas with disregard for their own safety, the cost of being there, and the magnitude of the disaster.  They just did what they could do, then and there, because it was the right thing to do.  They are heroes, and nation builders.  They didn’t quit.

Dedicated with love, to the heroes who care, and who don’t quit.

hands, heart


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UP TO THE TASK(FORCE) – HELP SEND DR. MURPHY TO WASHINGTON (Updated 9/8/17)

Yesterday I read a notice from the U.S. Department of Health and Human Services (HHS) that caused me to sit up, read it again, and then again. You can read it yourself, at https://www.hhs.gov/ash/advisory-committees/pain/index.html. These words, this concept in the making, gave me hope that efforts to end the drug crisis in our country are finally headed in a right direction.

Why? HHS is forming a new Pain Management Best Practices Inter-Agency Task Force and is seeking nominations. HHS has said it is looking for diversity in its Task Force membership, not just representation from large organizations. I read this as an incredible opportunity to get people who are knowledgeable, credentialed, experienced and not bound to organizational (read political) influence, leaving them free to engage in honest dialogue with others about solutions to the “Opioid Crisis” in our nation. It seems that there is potential in this Task Force for real solutions.

The Task Force will have the following responsibilities:

(1) Determining whether there are gaps or inconsistencies in pain management best practices among federal agencies;

(2) Proposing recommendations on addressing gaps or inconsistencies;

(3) Providing the public with an opportunity to comment on any proposed recommendations; and

(4) Developing a strategy for disseminating information about best practices.

HHS is not dragging their feet in this process, either. Nominations via email are currently being accepted at PainTaskForce@hhs.gov  and must be received no later than close of business on Wednesday, September 27, 2017. Such a short time to decide who to nominate! To write a letter! Fortunately, I am well acquainted with the perfect candidate for this Task Force. He is so well qualified it only took a short time to prepare an email supporting his nomination, a copy of which follows:

TO: Acting Assistant Secretary: Don Wright, M.D., M.P.H., U.S. Department of Health and Human Services        

 RE: Nomination of JAMES PATRICK MURPHY, MD, MMM, FASAM to the Pain Management Best Practices Inter-Agency Task Force

 Dear Secretary Wright:

 It is an honor and privilege for me to nominate Dr. James P. Murphy to be a member of this very important task force. I have carefully read your notice on the web site laying out the qualities you are looking for in the nominations, and I can think of no one better suited for this committee. His patients benefit from his ability to see them holistically; to manage their pain to the point of returning productivity using effective modalities; and to carefully monitor opiate intake and effect when it is used. The community benefits from his knowledge and willingness to offer lectures and workshops for the media, for college students, and for relevant groups working with any approach to dealing with the present opioid crisis. The medical community has also benefitted from his lectures, from his teaching pre-med students, and from his leadership as President of the Greater Louisville Medical Society in 2014 and Chairman of the Board in 2015.

Dr. Murphy’s medical career has allowed for diverse experiences, e.g., military medicine, academic medicine, hospital-based practice, private practice, business management, patient advocacy, and “organized” medicine. His training, credentials, and affiliations illustrate the multifaceted perspective he can bring to the group. He would have no conflicts of interest, as he is not beholden to any organizations that could hamper an independent and honest contribution to the Task Force. For a more complete listing of his credentials and experience, please see his résumé [which may be downloaded from https://www.jamespatrickmurphymd.com] .

My own perspective is that of a former chronic pain patient, a former nurse, and a semi-retired sociology professor with one specialization in the sociology of medicine. As both a nurse and a college professor (as well as a Hospital Corpsman in the Navy Reserve for 6 years) I have dealt directly with the effects of substance abuse for more than 35 years. After all of my own experience, and working closely with Dr. Murphy in academic and clinical office settings for four years, I can say without hesitation that Dr. James P. Murphy is undoubtedly the most knowledgeable, effective, and dedicated Pain Medicine and Addiction Medicine Specialist this country has to offer. You will not find a better member for the task force, nor one who is willing to give more to find a reasonable solution of our nation’s opioid crisis.

 Thank you for opening the door to nominations for this committee. I wish you and the Task Force all the success possible.

Sincerely

 Marylee M. James, Ph.D.

Adjunct Professor of Sociology, Bellarmine University, Louisville, Kentucky

 

UPDATE 9/8/17:    HHS requested a statement from Dr. Murphy as to whether he would be willing to serve on this Task Force.  He has responded  “If selected, I will serve.”  –MJames

 

To anyone who would also like to participate in nominating a candidate for this very important Task Force, please feel free to use the information above as well as your own resources to send an email to: PainTaskForce@hhs.gov .  Our nation needs recommendations from this Task Force that are realistic, just, and effective. And I believe it will happen with the right people, and the right mix, doing the work. And I definitely believe that Dr. Murphy should be one of those Task Force Members!

 


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ACA OR SINGLE PAYER? ACTUALLY, THAT ISN’T THE QUESTION

In the chaos of our present—and proposed—health care systems, it may seem strange to those who know me that I would speak strongly against repealing the Affordable Care Act in order to set up a Single Payer System. I am not even going to address the miserable excuses for alternatives to the ACA that our congress-turned-one party-turned-a handful-of-old-white-males tried to foist on our already suffering nation. That is not worth my time, much less yours. So let’s look at what we have (or what is left of it), versus what a growing number of our fellow Americans are claiming to want.

The Affordable Care Act, aka “Obamacare.” What is wrong with it? Well, since I am old enough to remember congressional debates and media discussions about it, let me share one clear memory. A certain congressman or senator (I am not here to name names and add to the hostilities) stood in front of his peers, with a binder of papers almost a foot high. That was the ACA, which congress was supposed to stop stalling and cast their votes for or against. The legislator was angry, as he slammed the binder down and asked how many had even read the proposed law. Then he stated that no one could possibly have read such a lengthy and dense document. It had been added to indiscriminately, without enough discussion to make certain that there were no contradictory sections of it. Yet our lawmakers were called upon to vote, and vote they would. And they did, and the Frankenstein monster they created was passed. And some named it Obamacare, in not very subtle derision. Then those same people hated it all the more because it carried Obama’s name. Just an aside: Some of us social science types stated in no uncertain terms that those old white Southern men in Congress were determined that no black man would tell them what to do, and they would do nothing to promote anything he tried to do. “Too harsh of you” others shushed us. Still think so?

Moving on, at the other end of the continuum of political positions we find another “older” white man (I say “older” because I am older than he is, and I don’t want to downplay his energy and passion for his job by putting him in the same age category as me and the old white Southern men). Unlike his counterparts in Congress, he has worked and fought tirelessly to benefit the nation. Actually, I err by pushing him all the way to the left end of the continuum. He is a Liberal, yes—a social democrat. By the way, have you read the biblical book Acts of the Apostles? The part where it describes how communities of Christians lived? They joined the community by pitching in all of their money and other resources, and everyone in the community lived on the combined wealth: “To each, according to his need,” regardless of financial contribution, or lack thereof.

I digress. Sorry. The social democrat of whom I speak has called repeatedly and passionately for Single Payer Insurance, and whether or not it was intentionally in the spirit of the Book of Acts, it was certainly in the spirit of “all {men} are created equal, and endowed with certain rights.” I can’t fault his reasoning for wanting National Health Care (that is what we are actually talking about), but I am very afraid that it is misplaced in time.

Having experienced National Health Care when I was injured in Israel, I can say that I know at least some of its problems. Having experienced National Health Care in South Africa for seven years, I also know many of the benefits. In the former situation, at the age of 43 I fell off of a mountain in Israel and broke my ankle in three places, anteriorly displaced the ankle, and pulled a major tendon off the bone so cleanly there was no bone left on it to regrow and heal in place. My Harvard-trained Israeli physician refused to operate. “You are too old” he told me, “and regardless you will be in a leg brace for the rest of your life.” I could not get a second opinion, nor could I afford to pay cash if he would have done the surgery despite his recommendation. So I called the orthopedic surgeon back in the States with whom I had worked, flew home after a lengthy search for an airline that would take me, and I haven’t ever worn a brace. I do have to admit, being told I was too old to have my broken ankle fixed was almost as traumatic as the injury.

On the other hand, in South Africa for seven years a very reasonable deduction was made from my paycheck to pay for National Health Insurance. I was hospitalized once for three days and paid not a cent; saw 2 or 3 doctors of my choice at any given time and never paid more than $10 copay for a visit, and not more than $2.00 (I am using US equivalents to the Rand, at the time) for medicine. I was well taken care of, even when I suffered a bout of pneumonia, and never had concerns about what would happen to me. The big problem in South Africa, of course, was that “National Health Care” only applied to people who had jobs, or whose employers paid into the system. Others were given cash at the end of a day, or a week, with no benefits. The color of their skin made all the difference.

So National Health Care is not always perfect. People in Canada seem to love it; in England, not so much, but they don’t hate it, either. Again, having the cash to pay for what the government won’t take care of always helps.

The point I have been working up to with all this foreplay is that National Health Care is only going to work when you have a government that is attuned to the needs of the nation it serves, and in some agreement or reasonable compromise about how best to serve those citizens. That does not even come close to describing our government. Putting them in charge of our health care, given their record of misgoverning for at least the past three decades, would be like putting a family of drug dealers in charge of a national pharmacy. The knowledge and expertise—even the Will–required to make good financial decisions about medical care for ALL citizens simply does not exist in our political system.

PLEASE!!! DO NOT EVEN CONSIDER NATIONAL HEALTH CARE IN THIS COUNTRY UNTIL WE CAN CARE FOR EACH OTHER, AND HAVE THE GOOD SENSE TO ELECT A GOVERNMENT WE CAN TRUST TO ACT AS ONE “BY THE PEOPLE, FOR THE PEOPLE” ETC.

We HAVE a health care plan. It needs fixing.  SO FIX IT!!! Work together, work in the best interests of the citizens of this country who have, according to our constitution and bill of rights, the right to these good things. There is much more to say about this, but that is for another blog post. First, and foremost, I say to the members of Congress: Do your jobs, fix the mess caused by earlier versions of your peers, and get together like real human beings and give us back our beloved country–the one where we were finally just beginning to accomplish equal rights for everyone.


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AN UPDATE FOR FAMILY, FRIENDS, AND THE MERELY CURIOUS

 

For months, now, I have neglected to write or keep up with you. There have been several reasons for this—ironically, none of them due to continued chronic pain. I no sooner reached the point of finally having my 45-year battle with chronic back, neck, shoulders, hands and feet pain under control, than I developed a cardiac problem serious enough to make normal functioning very difficult. At the same time, I had taken on three adjunct courses a semester in the mistaken belief that my new pain-free status would allow more activity. To make a long story short, my intolerance for many medications complicated everything, cost me a fortune at the pharmacy, and greatly reduced my newfound activity tolerance.   It has been one hellacious year, in other words.

Make no mistake. I still love teaching, and I still found that the time spent in the classroom or in my office with students on any given day was the best antidote to pain, and now also to cardiac problems and their side effects. It was only that the long hours of preparation and grading papers, along with the difficulties of getting around the university with a backpack filled with books, etc., rapidly undid all the good of the time spent in the classroom. Not that time spent in the classroom wasn’t worth it—but over time I developed a roller-coaster life with all the emotional and physical ups and downs.

Additionally, the rapidly increasing cost of living, plus my medical costs, had finally totally depleted my savings. Obviously, my social security and wages from being an adjunct were not going to suffice, and now the summer break without any adjunct income was looming. Should anyone ever question the fuel driving the anxiety and chronic pain cycle, I can document it, and add that the combination doesn’t do much for cardiac problems, either. By the end of the second semester I began having chronic pain from multiple arthritis sites. Thankfully, none of the nerve pain has recurred. But I knew it was time to look for more work for additional income, nevertheless.

I have always loved that verse from the Psalms that says “Weeping may endure for a night, but joy comes in the morning.” So many times past, deep into the darkness of whatever crisis was facing me, that verse would eventually be brought to my attention. And when it was, the promised joy and relief from the crisis would begin and move steadily toward resolution. Always. And it has happened again.

Strangely—perhaps even ironically—it was not my PhD in Sociology that was the sole credential for my new part time job. Most of you know how I loved working in medicine and finally being a nurse, before going back to school for my Sociology degree. It was that, and probably my experience with chronic pain as both advocate for patients and a patient myself, that resulted in my new job. For the past six weeks, I have been truly blessed to work 4 days a week in a pain management clinic. From day one, I have felt the joy and freedom of doing what I have always loved best, along with the capacity to use the sociological skills and information gained later in life. I do not have the ability to explain how richly this fulfillment has affected my life, including my physical abilities. I truly believe that every day of my life, every experience, has brought me to this time and place. And the joy is not limited to the immediate experience of interacting with the patients I have already begun to love, but it extends around the clock, and through the week. My exercise tolerance has improved; my arthritis pain has subsided; and my blood sugar is manageable again after a long period of ups and downs. My cardiac problems are no longer debilitating, and I rest better at night. Despite the uncertainty of life in our country, especially for pain patients and others who are most vulnerable, I retain the joy of this new situation and all that it means to me.

My gratitude for this blessed gift is pre-ordained, of course. My advocacy for pain patients, and for those pain management physicians who daily manage the tightrope walk between patient need and over-reaching government regulations, will be taking on a new life. Expect new articles on this site about the real history of drug abuse, pain and addiction in the future. Expect new energy to keep up with what is happening in the failed War on Drugs, and the failing efforts to kick-start it again with the scare-mongering about the prescription opioid epidemic (which, I point out frequently, is deliberately worded to look like it is caused by a. doctors, and/or b. pain patients.)

While I have not specifically stated it, I would like to assert at this point that there is an element to pain management that is sometimes ignored, sometimes over-advertised as a panacea for all ills, and sometimes actually realized in the lives of those who believe. I do believe, from vast experience, that God answers prayer—even when the answer is a firm “no.” I also believe that what we experience in life, both positive and negative, are the true elements of living that make us mature and strong, or they break us. Most of the time, that choice is our own. Especially when God says no.   He said no to me a lot, yet I have been privileged to enjoy incredible blessings, including healing from physical and emotional trauma, and experiences that have enriched my life beyond belief. I would not overlook the role of faith in healing, in guidance through life experiences, or in provision for meaningful relationships and work.

Much love and blessings to you all, and may your walk through life provide you with blessings, rich relationships, and purposeful work. And may your relationship with your God always guide you through it.

Peace,

Marylee


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REFLECTIONS ON THE EFFICACY OF OPIOID PAIN RELIEF OVER TIME

pain photoBefore addressing the issues of this article, I will need to explain the position from which I write. At the present time I am a 76-year old, semi-retired sociologist and former nurse. As a sociologist, it was natural for me to include the sociology of medicine as one of my major interests. As a nurse, I worked for three years in the county jail nurse’s office, several years in the emergency room, and for six years as a hospital corpsman in the navy reserve.

I was introduced to the whole drug scene while working in the jail, where it was my job to treat substance abusers who were addicted to paint, glue, alcohol, and various drugs. This was in the very early ‘80s, and the majority of the street drugs were amphetamines, Quaaludes, heroin, and marijuana. It was necessary to control withdrawal symptoms from the time the inmates were booked, to keep them alive long enough to go to court, serve whatever time they were given, and be released back into the same environment with virtually no change in their lives except those imposed on felons. The recidivism rate was extremely high—more so than for any other offense. During the time I worked there, the fastest turn-around rate for a released prisoner being picked up drunk and brought back in to Booking was 30 minutes.

Of course, in the ER and even in the Navy reserve I saw evidence of substance abuse. As a corpsman I was also involved with both diagnosis and treatment. The most heartbreaking experiences, however, occurred while I was working at a private college in Appalachia from 1997-2013. I saw firsthand the growth of the OxyContin and heroin epidemic that Sam Quinones documents in Dreamland, followed by Meth and various other prescription drugs, soon followed by the amoral pill mills that so delighted students who were already dependent or in early stages of addiction. At their age, they were the most vulnerable to the brain disorder of addiction, and the main targets of the dealers who would actually supply their first pills free, to encourage a new customer. I saw so many beautiful, bright students succumb to the promise of a pill that would make their life better, more fun, or at least easier. I was able to help some, but not all, by far. They needed experienced and trained medical attention, and I was no longer in that field. I came to despise the very thought of drugs, dealers, and pill mill “doctors”.

But there is another side to my story. In 1968 I suffered the first experience of a bulging spinal disc. Within 3 years I was diagnosed with degenerative disc disease, and with osteoarthritis of the spine, hands, feet, shoulders and hips. By 2013, there was no part of my spine that was not affected; I had major stenosis at various levels, bone spurs, episodes of bulging and decayed discs, a vertebra that had decayed discs on both sides and was standing on edge, resulting in a spinal S-curve from my waist to the upper thoracic region. Unrelenting pain caused muscle spasms in my entire back and neck, adding to the pain. A meningioma would soon be discovered attached to my spinal cord at T3-4; it is benign—the only worry being that it will grow.

During those 45 years living with pain, I never had any medication stronger than NSAIDS. Like many patients, I could not tolerate narcotics or opioids. I had to learn meditation and “mind control” (pushing the awareness of pain to another part of my consciousness). I had a great deal of physical therapy. I played the piano and organ for distraction, until I could not. I walked from 1-3 miles every day, and I worked full time as a nurse, then as a college professor, usually working between 40-60 hours a week. I spent seven years in South Africa in the middle of a revolution. The more I could distract myself with external demands, the longer I could function. Again, until I could not.

In 2014, so disabled by pain I could neither work nor sufficiently care for myself, I was sent to a pain management specialist in Louisville, KY. After I was finally convinced that he was a legitimate pain specialist who would not try to get me addicted, we were able to work together very well. I learned to trust his judgement, and to follow his lead in determining my treatment.   As a result, I have been able to teach at a local university part time for the last two years, and it has been a year since I have had pain greater than 5 on the 0-10 scale. One of the reasons that the pain has not been greater, and has not persisted, is that when it gets to that point I take hydrocodone, at its very lowest dose. My pain doctor realized that I am able to tolerate very low doses of medications for other problems (many of which were caused or exacerbated by long-term use of NSAIDS), so we tried the opiate. The complete pain relief has been astounding to me. I have never before had medication do more than take the edge off the pain. Equally important, my need for the opiate is becoming less and less frequent. My chronic anxiety levels have dropped considerably, and that also is a source of pain relief.

Which brings me, finally, to the point of this article. I hope I have sufficiently established the experience and credentials that give me the foundation for writing it. I must write it, because for too long I have been reading articles by people who have based their judgement about the dangers and/or efficacy of opiate treatment for pain on short-term, inadequate research. In A World of Hurt, by Barry Meier, he quotes Dr. Jayne Ballantyne as saying that her studies, and those of others, show that after a short term of therapy, there is little to no efficacy (5% of patients) of opiates for pain. I have seen and heard these figures often; yet pain management physicians also have records of people who have been carefully managed on opiates and other pain relieving measures for at least twenty years, who are functioning without severe pain. None of these studies satisfy me that they meet the natural science or sociological requirements of longitudinal studies. The former studies fall far short of twenty years, and the latter are a matter of record but no sufficiently rigorous scientific research has been done to establish credibility.

Additionally, our understanding of the prevalence and range of chronic pain issues, and the new brain studies that have completely revised our knowledge of addiction, have rendered those studies irrelevant. But the continued widespread references to them has created a situation that is clearly morally and ethically bankrupt: Patients with persistent, severe pain—including, in many states, terminal cancer patients—are being deliberately, systematically deprived of relief and therefore from the ability to lead potentially productive lives, or at least to spend their final days in peace, without pain. This, while other substances that are addictive are legal and can be consumed by any adult, regardless of their risk factors for addiction, whether or not there is a “need” for the substance.

What would make opiate efficacy studies reliable and verifiable? First, to acknowledge that all pain patients are unique in their tolerance to pain, their response to pain, and their response to treatment. Not everyone can metabolize medications the same way. Not everyone responds equally to physical therapy, or to psychological counselling. Not everyone has the personality to effectively meditate, or to suppress awareness of moderate pain. But all of these treatments, as well as known risk factors, are variables that must be accounted for if you are judging the efficacy of pain treatment.

Then there is the issue of the selection of participants. When I read the studies done in past years, I found they were limited to a single practice, or a hospital, or other small group of patients with no concern for variables like age, risk factors, history of abuse, previous treatment and other illnesses. The participants were not chosen scientifically in order to be representative, so results are inevitably skewed. I am reminded of early anthropological ethnographic studies where small, isolated villages were researched, then the results extrapolated to all such groups: “from the particular to the general”. We now realize that you can’t do this and arrive at accurate conclusions. Yet, on the basis of these flawed opiate efficacy studies, people’s lives are being damaged, their families are suffering needlessly, and many patients who are cut off from their medication either take to street drugs with the risk of overdose, or just commit suicide in the first place.

We do need more research about the safety and efficacy of drugs. But it must be longitudinal and scientifically designed and the results assessed to be reliable and verifiable. We also need politicians to stop enacting laws and policies based on moral definitions of issues, which we can never come to consensus about, and work on the actual economic and environmental issues that they can actually improve.

Addiction is a disease, not a moral issue. Pain is a disease, not a moral issue. And we are not speaking of just a few people affected by the neglect resulting from ill-informed laws and regulations designed more to punish the innocent along with the guilty rather than to end the War on Drugs. We speak of hundreds of thousands, even millions of sufferers. When properly identified as scientific (medical) problems instead of moral issues, we can see the potential to improve conditions. People could be adding to the economy, rather than being forced to either live off of it, or to live in poverty while their pain continues to worsen.

Big Pharma—for example, Purdue Pharma– are far from innocent in this War. Additionally, the FDA is no longer as concerned with protecting potential patients as they are in protecting corporate rights to profit; witness the countless lawsuits for drugs improperly researched, improperly advertised, and improperly presented to physicians who must rely on that information in order to prescribe successfully. And the DEA is still, regardless of evidence that they are often destroying the lives of the innocent while failing to halt the spread of illegal drugs, using pain patients and their physicians as cannon fodder in their failed war on drugs.

A significant paradigm shift is required here. Educationally, culturally, legally and morally we must illuminate the darkness of our willful ignorance about the suffering of the innocent who have become scapegoats in the failed War on Drugs due to tunnel vision about the relationships between drugs, physicians, and pain; a tunnel vision that cannot see the greed and political will that perpetuates the drug problem. Every institution of our society has failed our physicians and their patients who are in pain, or addicted. Those institutions have either failed to adjust a false worldview that blames patients for their illnesses, or have just failed to assume responsibility for their role in finding solutions to the need for a collaborative approach to these widespread diseases, and to the devastation that has resulted from long term beliefs that they are moral issues that must be punished.

For over a century, that approach has not worked. And as the saying goes, insanity is defined as continuing to do the same thing over and over again (or doing even more of it), expecting different results. From family, to education, to religion, culture, economics and government we need a major overhaul of outdated and inaccurate beliefs, and development of procedures that decriminalize the treatment of chronic pain and addiction, as well as the afflictions themselves. Medical decisions need to be made by medical experts and their appropriate medical agencies, and the Criminal Justice system could concentrate on ridding our nation of illegal drugs by putting the same time and effort into stopping the dealers who daily increase the supply of drugs available on our streets. We might even look to the successes of other countries, and determine if their methods are importable.

I cannot bear the thought of more bright and beautiful college students ruining or ending their lives before they have even begun. The data suggests that it is not stopping with college students, but that high school and even middle school students are being targeted as “customers” of the illegal drug trade. I also cannot live with the knowledge that caring and dedicated physicians, who have spent nearly half of an average 70 year lifetime studying and working for the privilege of becoming practicing physicians, have lost everything they have worked for because they have tried to help their patients. (I am quite ok with pill mill “doctors” being brought to justice for their crimes, however!)

It is Christmas Eve as I write this. A time of hope, a time of expectation that the promises of life can be fulfilled. I am a sociologist because I believe in the amazing capability of human beings to solve the problems of life, separately and together. I am also all too well aware of our capability to create and maintain cultural and social institutions and structures that protect certain groups of humans at the expense of huge numbers of their fellow humans. I believe that most of us are better than this; that we can do better, and that bit by bit we can learn to adapt to change, to each other, and to the requirements of living in our world safely, together.

Please—let’s make 2017 the year we begin to deal with chronic pain and addiction as the disease processes they are, and begin to structure our corporate life accordingly, so that together we can end the war on drugs, and on patients and their physicians, and restore the rationality of the Enlightenment without killing the compassion of empathy.

enlifghtened being

RESOURCES: Books & Peer Reviewed Articles

Alexander, Michelle. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. 2012. The New Press, NY

Bateman, Dustin. Neurological & Sociological Aspects of Addiction.

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial. 1996. University of California Press.

Levinthal, Charles F. Messengers of Paradise. Opiates and the Brain. The Struggle Over Pain, Rage, Uncertainty and Addiction.

Meier, Barry. A World of Hurt: Fixing Pain Medicine’s Biggest Mistake. 2013. New York Times Company.

Parsons, Talcott. “Illness and the Role of the Physician: A Sociological Perspective.” American Journal of Orthopsychiatry 24 March 2010. Copyright © 2010, John Wiley and Sons.

Quinones, Sam. Dreamland: The True Tale of America’s Opiate Epidemic. 2015. Bloomsbury Publishing Plc.

Sternheimer, Karen. Connecting Social Problems and Popular Culture:   Why Media is not the Answer.  2nd Ed. 2013. Westview Press, Perseus Books Group.

Webster, Lynn R. The Painful Truth: What Chronic Pain is Really Like and Why it Matters to Each of Us.  2015  Webster Media, LLC.

Hyperlinks to articles on Web:

Addiction is a Brain Disease http://www.attcnetwork.org/explore/priorityareas/science/disease/

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter 

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter 

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….   http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide http://t.co/4vhF63eD6N

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Physician Risks

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict: Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics? http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …

 

dr-murphyFrom James P. Murphy, MD, MMM;

Practicing Pain Management Physician

Board Certified in Pain Management & Addiction Management

https://jamespmurphymd.com/2014/04/25/the-dream-of-pain-care-enough-to-cope-the-seventeenth-r-dietz-wolfe-memorial-lecture/

https://jamespmurphymd.com/2016/07/24/comparing-apples-to-apples-the-morphine-equivalent-daily-dose/

https://jamespmurphymd.com/2016/06/21/prescribing-controlled-substances-in-kentucky-cme-presentation-for-flaget-memorial-hospital-in-bardstown-ky-june-21-2016/

https://jamespmurphymd.com/2015/02/13/pathway-to-partnership/

https://jamespmurphymd.com/2015/09/a-stellar-time-at-bellarmine