December 2, 2019
Chronic Pain Meets Chronic Hucksters
By Michael D. Shaw
“Chronic pain” is generally defined as pain that lasts at least 12 weeks. The Cleveland Clinic states that “Chronic pain is pain that is ongoing and usually lasts longer than six months.” The Clinic adds this distinction between acute and chronic pain:
“Acute pain usually comes on suddenly and is caused by something specific. It is sharp in quality. Acute pain usually does not last longer than six months. It goes away when there is no longer an underlying cause for the pain.”
“[Chronic] pain can continue even after the injury or illness that caused it has healed or gone away. Pain signals remain active in the nervous system for weeks, months, or years. Some people suffer chronic pain even when there is no past injury or apparent body damage.”
In June, 2018, the World Health Organization released a preliminary version of its eleventh revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). This version becomes official in 2022, and, among other things, includes a systematic classification of clinical conditions associated with chronic pain.
However, just as chronic pain’s designation in the ICD-11 is being publicized, so too is this affliction being tied up in the movement to curtail opioid use. In March, 2016, the CDC released its Guideline for Prescribing Opioids for Chronic Pain. A few months later, Stephen A. Martin, MD et al. published a scathing and well-documented critique entitled “Neat, Plausible, and Generally Wrong: A Response to the CDC Recommendations for Chronic Opioid Use.”
Here are a few key points from Martin:
1. These recommendations are in conflict with other independent appraisals of the evidence—or lack thereof—and conflate public health goals with individual medical care.
2. The threat of addiction largely comes from diverted prescription opioids, not from long-term use with a skilled prescriber in a longitudinal clinical relationship. By not acknowledging the role of diversion—and instead focusing on individuals who report functional and pain benefit for their severe chronic pain—the CDC misses the target.
3. Patients, providers, and advocates all agree that there is a subset of patients for whom opioids are an effective treatment method for their chronic pain, and that limiting or denying access to opioids for these patients can be harmful.
It took nearly three years, but some of the authors of the Guidelines backed off a bit in a New England Journal of Medicine article entitled “No Shortcuts to Safer Opioid Prescribing.” To wit…
“An unintended consequence of expecting clinicians to mitigate risks of high-dose opioids is that rather than caring for patients receiving high dosages or engaging and supporting patients in efforts to taper their dosage, some clinicians may find it easier to refer or dismiss patients from care. Clinicians might universally stop prescribing opioids, even in situations in which the benefits might outweigh their risks.”
Meanwhile, Physicians for Responsible Opioid Prescribing (PROP)—an influential anti-opioid activist group—has been doing its level best to discourage the prescribing of these drugs. Executive director Andrew Kolodny, MD and PROP have been repeatedly criticized—and rightly so—by the American Council of Science and Health and others. Pompous humbug Kolodny thinks chronic pain patients are PR pawns for Big Pharma.
But wait, there’s more. PROP’s president Jane Ballantyne, MD has worked as a paid consultant for the Motley Rice law firm, which stands to make billions of dollars in contingency fees from opioid litigation. This revelation came out in a revised conflicts of interest statement.
Ditto Anna Lembke, MD. Pain News Network also reported that:
Ballantyne and Lembke are not the first PROP members to revise their financial disclosure statements or to work as paid consultants in opioid litigation. PROP founder and Executive Director Dr. Andrew Kolodny recently revised his conflict of interest statements for the Journal of the American Medical Association (JAMA) to include his work in opioid malpractice lawsuits.
So, the chronic pain patients suffer, while the anti-opioid mountebanks and rapacious plaintiff’s lawyers prosper. And, we haven’t even mentioned doctors caught up in the Feds’ misguided war on opioids.
But, this is a familiar refrain, isn’t it? Ever since LBJ’s War on Poverty never defeated poverty but surely made megabucks for politicians, consultants, lawyers, and hangers-on, our modern-day war on opioids is doing the same thing—and hurting thousands of chronic pain sufferers in the process.