Controversial Opioid Guidelines from CDC Praises 1970’s Treatment – Epidemic of Death From Prescription Opioids


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The Centers for Disease Control and Prevention (CDC) is proposing new guidelines that may be announced Monday for prescribing opioids for chronic pain –  recommends physical therapy and cognitive behavioral therapy.  Back to the 1970’s.

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The Washington Post published the data on this epidemic of deaths caused by doctors earlier this week:

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CDC urge doctors to curb opioid prescriptions:

“The risks are addiction and death, and the benefits are unproven.”

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The guidelines are not intended for those with cancer pain or end of life pain. 

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“… the new guidelines noted that evidence for opioid use for ‘chronic pain outside end-of-life care remains limited, with insufficient evidence to determine long-term benefits.’ “

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“The Washington Legal Foundation, a public interest law firm dedicated to protecting the free enterprise system, accused the CDC of trying to formulate them secretly by failing to make public the work of its original advisory committee, the Core Expert Group.  The CDC disputes that accusation, but issued the recommendations in draft form Monday and will have them reviewed by another advisory panel after receiving more comment over the next 30 days, Frieden said.”

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“That will delay final adoption beyond the original goal of January. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, said Monday that the delay is a victory for the pharmaceutical industry, which, he contended, has waged a “very well organized effort…to block release of the guidelines.”

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Look at the graph of the sharp rise! in opioid deaths and do read details from my post on this in October. Once the FDA publishes  guidelines, insurance carriers will refuse to pay for doses that exceed that arbitrary “guideline.” Insurers have already begun refusing to pay and refusing to allow prior authorizations after denial— arbitrary. Without a second medical opinion. Without understanding. Just marching orders. This is just the beginning.

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The CDC has a Core Expert Group that reviewed published opioid studies. The guidelines are for primary care providers, not for pain specialists, but despite my decades of experience in pain management since 1983, teaching at UCLA Anesthesiology Interdisciplinary Pain Center and MD Anderson Cancer Center, your insurers don’t care.

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Insurers practice medicine, not your doctor, and CDC guidelines will create sudden change – they already have, without your consent. This is just the beginning.

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Some of my readers wrote long comments to me after I posted on this in October. Please don’t write to me. Vote for your best interests. Take action if this affects you. Americans don’t seem to care about our health care system except to get rid of Obamacare —- they would deny and cut back the only insurance millions have. Cut back healthcare, don’t propose better. Please ask how many insurance companies wrote Obamacare – the public was not allowed in those sessions, only major  insurers. After all, someone has to be able to pay for this without bankrupting insurers, and the government cannot keep up with rising costs of medications and high tech care.

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Opioids are ancient drugs, costing pennies to make, yet they are among the most expensive medications I have ever seen, outside of cancer chemotherapy. Why should insurers go bankrupt to pay for overpriced drugs? I have not seen the public getting involved and taking action for better pain management. Research goes to cancer and heart disease. 

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Look at the graph, the massive deaths in this article, spiking higher and higher every year, prescription opioids..

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“………Last week, the National Center for Health Statistics reported that the number of overdose deaths from legal opioid drugs surged by 16.3 percent in 2014, to 18,893, while overdose fatalities from heroin climbed by 28 percent, to 10,574. Authorities have said that previous efforts to restrict prescription drug abuse have forced some people with addictions to the medications onto heroin, which is cheaper and widely available.

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Overall, deaths from drug overdoses reached 47,055 last year, a 7 percent jump from 2013, the data showed.

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On Monday, Stanford University researchers who examined data from Medicare Part D prescribers reported that “by sheer volume…total prescriptions are dominated by general practitioners,” not small groups of “prolific prescribers.” General practitioners include doctors in family practice and internal medicine as well as nurse practitioners and physician assistants….”

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Opioids were never prescribed for chronic pain until 1991, now they are overused. Opioid overuse does not occur in European and British Commonwealth countries, and opioids are difficult to find for cancer pain in third world countries. Something is wrong when millions of Americans are given opioids. Yet the CDC presents the damaging guidelines without offering a better solution than the old 1970’s routine of physical therapy, behavioral therapy, procedures, pumps, nerve blocks, stimulators that almost all patients I see have already tried and failed.

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Further, today in the New York Times, Gina Kolata points out:

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“Men and women of all races and ethnic groups and nearly all ages were affected by drug overdoses, but the national numbers were affected mainly by increases in deaths in 14 states: Alabama, Georgia, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Mexico, North Dakota, Ohio, Pennsylvania and Virginia. The other states had no significant increases compared with 2013. Among the five states with the highest rates of drug overdose deaths — West Virginia, New Mexico, New Hampshire, Kentucky and Ohio — two, Kentucky and West Virginia, had no significant increases from 2013.”

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We need better than 1970’s recommendations.

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The material on this site is for informational purposes only.
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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided

by a qualified health care provider.

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This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Dystonia with CRPS – Intrathecal Baclofen Training Needed


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People with Complex Regional Pain Syndrome (CRPS) may develop dystonia, which is a twisting, perhaps crushing, movement of the hands and feet, spine, muscles. That is called dystonia and there is a specific treatment: Baclofen given into the spinal fluid.

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All too often, people with CRPS encounter pain specialists who have little or no experience with CRPS, but they have been trained to do procedures: blocks, pumps, spinal cord stimulators. Doctors need to be trained how to diagnose dystonia and when to use a different type of pump.

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CRPS is different, and I suspect many doctors must not see enough cases to become familiar. I would plead for special education to train physicians — especially surgeons because trauma or surgery may trigger onset of this poorly understood syndrome. But we must train all PA’s, NP’s, PT’s, RN’s, pharmacists, all healthcare providers about CRPS.  For some, CRPS may be a life ending pain, and deserves early diagnosis and better treatment.

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There should be special centers for treatment of CRPS where patients are more likely to get best care and where research can be done.

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Treatment must be better than what I saw yesterday in a new patient who has been needlessly disabled for five years with crippling dystonia.

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Dystonia is treatable but was not diagnosed, despite many interventions, pumps, stims, blocks, repeated blocks, by teams of pain specialists and rehabilitation centers in Southern California and Georgia. Crippling dystonia was not recognized.

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Without centers for treatment of CRPS,

too many will not get the care needed to return to life.

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DYSTONIA EDUCATION NEEDED

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INTRATHECAL PUMPS

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Dystonia may occur in those with CRPS.

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I don’t follow the literature on pumps, but I have not seen anesthesia pain specialists or neurosurgeons doing intrathecal (IT) pumps since I left MD Anderson Cancer Center in 1994.

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Training to diagnose and treat dystonia should be in medical education programs, especially the interdisciplinary field of pain – a field that should not be left to the interventionists.

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The only treatment for the crippling, twisting movement disorder called dystonia is intrathecal baclofen, not oral. Baclofen must be pumped into the spinal fluid.

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I told my patient the diagnosis on the telephone before I saw him. Next, there is the fight to get insurance to allow referral to the neurosurgeon to co-manage that part of his care. We cannot say if he could have been back to work five years ago, only that twisting and crushing hands and feet can cause an agony on top of the pervasive burning.

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The gift of human life from better research and training in treatment of CRPS would be the best thing for productivity, health, and well being.

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Support better health care in this country so people don’t have to be disabled for decades with treatable conditions.

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And vote for your congressperson to support compounding pharmacies that are invaluable.

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It is an beyond belief that pain management is taught in only 3% of medical schools in 2016. We don’t need training in opioids. We need training in this vast field in every medical school. I’ll bet returning veterans have more CRPS than any other group. How many go unrecognized? How many doctors know what allodynia is?

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The material on this site is for informational purposes only.
.
It is not legal for me to provide medical advice without an examination.

.
It is not a substitute for medical advice, diagnosis or treatment provided

by a qualified health care provider.

~~
This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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