PHARMACIST STEVE

My first thoughts is can the doc show you the DATA as to the intensity of your pain ?  Has anyone done a CYP-450 opiate metabolism test or a PGx DNA test – to see if you are a ultra fast metabolizer or which opiate YOUR SYSTEM metabolizes the best or utilizes the best ? It is well known that CRPS causes higher intensity of pain – it is known as the “suicide disease” and if you have someone with CRPS and a ultra metabolizers… they will need higher and more frequent doses of opiates to even attempt to get the pt <5 on the pain scale.

Here is four quotes from the CDC opiates guidelines:  – are these CDC guidelines being followed ?

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

“The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.”

“Clinicians should consider the circumstances and unique needs of each patient when providing care.”

“Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context.”

“This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.”

I would have to  dig it up, but it was well distributed back in 2016 after the CDC guidelines were published that the studies that the CDC committee used to come to their recommendations… in regards to the quality of the data used in the studies… most were rated 3-4 on a scale of 4… where “1′ is excellent and “4” is CRAP.

If your blood pressure is above what is consider a normal range of 135/85 and no amount of blood pressure meds will get it down or your high blood pressure is being ignored…  high blood pressure is called the “silent killer”…   high blood pressure will cause strokes, heart attack, eye & kidney damage. and a premature death…

Under/uncontrolled pain may cause anxiety, depression and suicide.  This chart may have been published before 2011 – but this one has been around for 10 yrs..

how many different different health issues do you have that are a separate and distinct sources of pain ?  A implanted pump will not always “hit” all the sources of pain and some sources of pain – within the body – will cause higher intensity of pain than others.. so a specific concentration of a pain med – may or may not put a “dent” in the intensity of pain from one or more pain generators.

There is no or a very high LD50 or upper dose limits for opiates and a pt that has been on them for a long time  https://en.wikipedia.org/wiki/Median_lethal_dose.. not many meds share that characteristic.

I would ask your doc… what level of pain does the CDC and state health dept guidelines suggest is an acceptable level of a pain that a pt should be expected to live or EXIST with ?

How many other chronic diseases does the state health dept and/or CDC have no target test/lab value that should be the goal in treating a pt ?

The headlines that your doc is referring to 2021 – 100,000 deaths – and that is OD’s from ALL DRUGS… it is estimated that within those numbers is 15,000 bleed out deaths from the use/abuse of NSAIDS… and 75,000 is from illegal fentanyl coming from China via Mexico

Depending on which study you wish to believe those pts that end up being addicted after getting a legal opiate prescribed is somewhere between 0.6% -2%.  So we should deny 98%+ of chronic pain pts from adequate treatment to MAYBE prevent <2% from becoming addicted ..  and probably those in that <2% are already using/abusing alcohol & Nicotine…they have a addictive personality … they will at some point find some substance that they “like the way that it makes them feel”… silences the demons in their head and/or monkeys on their backs.

That 100,000 number does not include the 100,000/yr deaths from the use/abuse of the drug alcohol and the 450,000/yr deaths from the use/abuse of the drug Nicotine

Second chart is from when the Decade of Pain law expired and was not renewed… OD’s from Pharma opiates is virtually FLAT FOR 10 YRS.. – what we don’t know, if the CDC knew and did not disclose – how many of those OD’s had a legal rx for the pharma opiate found in their toxicology –  if they would have disclosed that number – would have suggested SUICIDES…  the toxicology of the typical OD’s contains 4-7 different substances/drugs – with one typically being the drug ALCOHOL .