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Dr W Porter McRoberts MD and Dr Paul Wu MD discuss the role of opioids in pain management.
Dr W Porter McRoberts MD and Dr Paul Wu MD discuss the role of opioids in pain management.
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Dr W Porter McRoberts MD and Dr Paul Wu MD discuss the role of opioids in pain management.
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Why not just shot us chronic pain sufferers in the back of the head behind the building ?
We don't even let animals suffer in pain
Doctors. What is your recommended process/procedure for stopping long term use, (over 14 years), of doctor prescribed opioid pain medications for my chronic pain? I have been taking these opiates properly since 2002, they haven't worked for a long time, and I want to get as far away from them as possible. I know that after taking these meds for almost 15 years, my body is dependent on this medication. I also know I'm not an addict. Thank you.
Ahhhh but you will give it through a pump, fucking hypakrite .
But what if there been only dose reduction over a 15 year period? With good effect?
I found that it is possible for a patient to not over medicate most of the time. By taking a large drink that would take several hours or half a day to consume ie. 32 oz low sugar Gatorade G2 and adding one and a half dose tablets to melt into drink. Then sipping on this drink for half of the day, it allows the patient to ingest smaller dosage per sip, compared to a entire tablet. Also like your implanted pump, the medication lasts much longer and it does not encourage tolerance. I also found that adding poly ethylene glycol 3350 one half cap per drink, combats the side effect of slowing metabolism in the gut. Important to note is this drink, should be sipped on as needed for pain relief, but the patient should then drink water as a main source of hydration to prevent drinking the medication too fast. another approach that works is if a patient has built up a tolerance to their prescription and is at the maximum doses of a medication and is at high risk of running out early, this patient can be treated by going into a hospital for 3 to 4 days, and completely stopping this medication, then substituting them on a stronger medication for a very short term. Then ceasing the stronger medication after 2 or 3 days, and allowing the patient to go back to the much weaker medication and be released home. This will allow the patient to not experience withdrawals, but to lower their dosages quickly and return safely to their medication with a total reset. For example, patient on Ultram, max dose, goes to hospital and Ultram is ceased then Morphine is given, patient withdrawals from Ultram but morphine blocks pain and discomfort from withdrawals, then on third or fourth day Morphine is stopped, patient then goes back to the lowest dose of Ultram one tablet per 12 hours. Them patient goes home and slowly builds back up to maximum dose of Ultram and 4 months to 6 months later patient gets inpatient switch to bring doses back down. These things have worked for someone I know, tried and tested, however, the patient has chronic pain, and found it very difficult to cease Ultram alone without a replacement. Also patient has found that Ultram works better with Tylenol 3 alongside it. Seems like patients doctor tests for marijuana, and other things, while patient does not use Marijuana, due to allergies, but questions why research shows that marijuana reduces pain medication abuse in some states. Also patient questions, why some doctors treat patients like problem patients for merely being on opioids, yet patient can easily go to neighbors and purchase from other patients unused pain medications like Tylenol 3. It makes no sense that some doctors are more compassionate, and other doctors behave like they thin they are law enforcement by being super strict and closed minded. Patient also questions why is it that most deaths are caused by methadone and oxy's and heroine, but all opioids are blamed as a group for deaths, when in reality there are many weaker opioids that are not listed as causes of morbidity, its the three main offenders only, Heroine, Methadone, and Oxys that are responsible for the 95% of all opioid related deaths. Yet the medical community refuses to acknowledge this fact, and group all opioids together making Tylenol 3 seem equally deadly, as heroine, and vice versa. First of all if taught patients can dissolve their medication into a liquid and drink it slowly to reduce their doses, and prevent over use. Secondly, most deaths are NOT caused by all opioids equally, they are from Methadone, Heroine, Fentanly, and Oxy's. 3rd doctors need set guidelines mandating them to all be just as generous as other doctors with prescriptions and not permitting doctors from being overly strict with patients on the more harmless types of opioids. 4th patients should be allowed inpatient stays to treat dosage reductions, using stronger opioids as a switch. Lastly everyone knows that the majority of deaths with opioids are due to patients who are weaning off a medication, then they suddenly get access and take a higher dose, that a week ago was normal for them, and its too much now that they have weaned down, depressing their breathing. We know this is the cause of overly restrictive access and lack of medical care for these problems, when you abuse and neglect patients who are in pain by placing them in pain and withdrawals you risk their lives and easily you can place blame on the patients, when they are ignorant, and some doctors know better, but feel pressured to restrict the more harmless opioids forcing some patients to buy heroine and stronger more dangerous ones from the black market or neighbors. The USA is supposed to be a world power yet its medical care system is in some ways an embarrassment to the world, when Americans can not go to a doctor and get pain relief and have to risk their lives with Heroine and black market drugs for pain relief, this is a police state mentality and neglect of patients systemically. Instead effective treatment should be made available nationally, including ones that do not criminalize opioid dependency and instead treat pain adequately and compassionately as well as educate patients and families the risks and how to avoid them. No patient should be in pain and no patient, should be denied pain medications for pain, unless there is complete proof this patient is using many substances to get high only. There are many patients with pain who do not try to get high, and they have a endless struggle to find pain relief only because the medical community fails them.
what is a good ssri to take while tapering or attempting (1st time ) ?
There is money from the government being paid for this push against opioid pain management and I can promise you that is the ONLY reason pain management doctors would run people away from their practices. For a person like me who has run the gambit of the few pain management treatments that are available; I can tell you that it's the doctor's and politicians who are criminal for pushing against the ONLY treatment many of us have. Money is the only answer to this push by doctors. A branch of the medical profession does not kick itself in the teeth overnight because they have large hearts.
these guys are getting paid off. i hope they both get spinal injuries.
you care more about saving junkies than keeping innocent people from suffering horrible fates? let them overdose.
needing more opiates only happens in small amounts of cases and most likely you two dumb asses mistook a bunch of soccer moms for chronic pain patients and you turned them into junkies. suboxone and methadone work great for chronic pain. yes they're are side effects. you send all chronic opiate patents for a sleep study to see if they have csa. then you can take precautions. testosterone dropping is so ridiculous in comparison to real chronic pain.
and guess what? chronic pain patients have lowered immune systems. having a foreign body in you or having the operation is going to lead the same amount, if not more, deaths. you're looking at the safety of taking a few pills a day to a surgery which has so many risks…then mechanical failure of this piece of shit and if it doesn't work or is no longer needed, another surgery has to happen. go look up the amount of people killed in surgeries from infections, malpractice and negligence.
Wow, 1st of all, I must say these are the exact type of Doctors that give all other doctors bad names and reputations. If they didn't have white coats on with their own titles – "pain specialist", I would of guessed they were your typical "know everything and treat everything with 1 solution engineer types" – a very shitty combination when your main product is people. I cannot believe doctors like this believe they can fix every type of pain with 1 solution and have no issues tossing around their biased opinion about every person out there who takes pain medication. Not only am I beside myself, but just FUCKING WOW.
So, now that you have been out of medical school a couple of years you have the entire pain spectrum for every patient figured out? Back pain, nerve pain, phantom pain, etc… Everything figured out that fast? How could every other doctor before you or those practicing elsewhere be so stupid in comparison when you have had the absolute 1 "Cadillac" solution available to mankind this whole time? And who would of thought it would be so easy – just step right up to have a PUMP surgically implanted into your body and the exact dose every time you need it to make every single type of pain just go away. 1 size fits all? Come in any color we want or does it have to be your exact favorite color as well to work best? We don't have to be concerned with a foreign object being in our body or anything sticking out of it? No risk for infection, barely noticeable in any body cavity or under the skin anywhere? Only has to be changed once every 7 years you said – so guaranteed no pain for 7 years, 100% effective, any defects or risks with functionality? I bet this is extremely affordable too – insurance or not, anyone and everyone can get this miracle device installed and never worry about any type of pain again – how long is your waiting list yet? Does every state qualify or do you own the 1 and only patent to this device? Damn… did you invent this or have stock options in the company selling them?
Acute pain is also the only type of pain you should be concerned with, yet chronic pain is like acute pain over and over again on a daily basis. It is obvious where your attitudes and opinions are based off, perhaps you should argue among your peers who have been practicing longer, have more evidence with direct patients instead of inflated DEA/Government findings trying to scare you into the "Opioid Pandemic" – just like the war on Drugs, like how all those people smoking Marijuana were destined for a life of crime and higher end drug use, yet that is legal in 4 states now and will be nationwide in the next decade.
There is just so much bias and opinionated bullshit in this video, I honestly cannot believe these two had the balls to sit down and actually put it on camera. This is a perfect example of doctors being stupid, thank God we can choose from many of them because most of them do not have this shitty biased closed minded attitude about 1 subject they think they know everything about yet forget who it is they are treating and for what purpose. Feel free to line up for a doctor who is more worried about you statistically becoming a junkie criminal who might overdose if they try and treat your chronic pain with anything other than their "Cadillac" implanted pump – you have fun with that.
My back is that sore I would do anything to get my life back
i have been on DIHYDROCODEINE tablets 30mg for past 20-YEARS, whenever i try to stop them, i get unbearable AGITATION where i literaly cant sit or stand still for even 20-seconds, + cant sleep literaly turning + writhing around in bed totaly unable to sleep, i constantly feel "EXTREMELY WIRED/MY NERVES FEEL EXTREMELY WIRED TO THE HIGHEST DEGREE! this HYPER WIRED + EXTREMELY AGITATED STATE always prevents me from stopping my tablets, (why does this happen)? even when walking around i still feel extremely agitated + hyper WIRED TO THE MAX. WHY? "it is literaly UNBEARABLE". when i then go back on my tablets it then STOPS, i can then sit still + stand still + sleep peacefully again + lose this EXTREME AGITATION/HYPER WIRED STATE.
So tell us what alternative you recommend. What is long term in your mind. Both of you docs are young and probably did not have the wonderful opportunity to beat your body up via hard labor. You were still in medical school in 1991. I have been on a cycling dose of morphine sulfate and percosets for fifteen years. I am on 1/2 the dose now than I was on 10 years ago. I am on relatively the same pain as then but at lower function. I would increase my dose by 25% if it were strictly up to me but its not of course. This is in my view a very conservative appriach. But you are the experts. Please tell me what five year evidence based studies to research regarding the pump option. I get your opinions and I believe you care. But you make the same error that md's have made for decades. You don't respect or trust your patients. Perhaps I do not produce additional mu receptors but how about testing for it. Why not test for actual mg utilization in each patient?
BTW thank you for bringing up the issue of hypogonadism, I had my testosterone levels tested and found that they were near zero. Male methadone and suboxone patients (as well as pain patients) are not being adequately warned about this situation. It can be treated with testosterone replacement, but you have to know this is something that can happen and it seems like very few pts are aware of this.
Good conversation, but I wonder what they would think of my situation. I am on methadone for addiction, I have been on the same dose for years and it has actually turned my life around. I don't use drugs or even drink. However, even though I am not given it for pain I notice that it seems to be a fantastic pain killer. I have scoliosis and all my back pain disappears for a good 6-8 hours after I take my dose in the morning. I know that pain patients use methadone in multiple doses per day as opposed to one like me. Since I have not raised the dose at all in years and it continues to work why would this medication not work well for pain patients?
These pumps have massive complications more often than not.
You guys are too cute!
For me opioids are my only choice to manage my pain. I do not take the short opioids (hydrocodone, Percocet, oxycodone), I do take methadone (which is long term). I have a genetic disease in which one of the problems is dislocations. In my case I dislocated over 150 + times a DAY (hips, left shoulder, fingers, toes, ribs, knees, SI joint, and wrists) and I have a chronically dislocated joint (right shoulder has been for 2 years now). I was taken off methadone a little over two years ago because I had been on it for about 10 months and we thought it wasn't working well enough. When I went off it I went into a downhill spiral to the point of where I was hospitalized and put onto a diluadid pain pump. I have now been on methadone since Ocotber 2014 and my pain Doctor even trusts me so much that he gives me a range I can take each day depending on how much pain I am feeling (3-5 ml twice a day). I know it isn't realistic to take all my pain away however I just need enough to function and methadone does that very well for me. The issues with all these new opioids laws it restricts the chronic pain patients who desperately need these medications to live a qualitative life. You can not become addicted to opioids even when you are on them as long. I am proof of that. It should be on a case by case basis not a one size fits all approach where opioids are so restricted
I suffer from Fibromyalgia and try very, hard not to take pain medicine such as hydrocodone or other medications. However I am so glad this video was done and I am so thankful for Dr.s like these who actually seen to want to treat their patients safely and with dignity. This video helped me understand these kinds of. medicines much better and gain some understanding of how i should manage myself with pain medications.
I am a disabled nurse, I was attracked by a patient in 2005 at the state hospital. I have done everything to feel better, rolfing, acupuncture, massage, chiropractic, steroid injections, which took away my immune system, which led to autoimmune disorders. Yes, anti depressants are on bored/ I have tried Cymbalta, neurotin, Lyrica, prolotherapy, and now I am on narcotics' that give me relief I have already tried PT as well as dance. I do not ask for any other medication's per month. Yes, my doctor holds the key every month . will I be in bed all month or at least be able to move around and take care of my ADL's. With rest and my meds , I am able to control pain. The goverment watchs' doctor's licence if they try to help, we the pain patient.
I'm a chronic pain patient who has been on opioids for sixteen years. I had an intrathecal pump placed very early in this process. My spinal cord was damaged in the process, instigating more pain from nerve damage and spasticity. I had a four month spinal headache. Atonic bladder resulted and now after many UTI's and kidney stones, probably half of which progressed to pyelonephritis, my kidney function is a concern. After trying multiple opioids, baclofen, and clonidine and titrating to maximal dosing, I never got ANY relief. Eventually, I started on oral opioids which have made a tremendous POSITIVE impact on my life. I've been on a high, but stable dose for almost ten years with tremendous improvement. It has literally given me back my life.
There are some patients who DO have trouble managing medications responsibly. The majority of us do not. It's really not giving us enough credit to say that adults cannot manage medication and it would be unfair to expect them to do so. Patients who benefit from opioids are less likely to be referred to a clinic such as yours. We fly under the radar be because we follow instructions and improve. A specialty practice such as yours often becomes jaded as they see the patients that fail multiple therapies and are referred up the medical food chain until they land at your office. If you could only spend a few minutes with patients like me who genuinely benefit from medication, you'd see how harmful the current regulatory environment is to us. We are being punished for the poor choices of others.
I can see from watching this that you are compassionate physicians who have seen what happens when people do NOT benefit or cannot manage their medication properly. You're trying to do differently to help patients and that us good. I just ask that you not forget that there ARE patients who do very well on opioids – with some on high doses.
If taken as prescribed, one doesnt necessarily need more, many MD;s are also writing for benzodiazepines, muscle relaxants and methadone for these "doctor hoppers" and making it more difficult for honest people to obtain their meds !!!
If the pain pump works, I think that's great. I do think most people will have to take some sort of adjunct or rescue pain med in addition to the pump. Most of what these doctors are saying is nonsense. If you take ANY type of medicine, you will build a tolerance towards it. I'm diabetic and I often have to increase my insulin dose because my body becomes tolerant to it. Should I stop taking insulin because I have to keep taking higher doses? It's just stupid. Pain is a disease in and of itself. Chronic pain patients are drastically undertreated and it's a shame. The safety profile for opioid pain medications is overwhelmingly safe. And most chronic pain patients are perfectly capable of taking their medicine responsibly. I'm sorry that the doctor thinks people will misuse their medicines, but I don't think the facts bear that out. And why is he holding his right arm so awkwardly on the table?
hello i live in nj i take pain medicine and also nerve damage medicine and i have pain in my legs and alot of swelling and nothing is helping. I feel like im scared to talk to my dr. I dont know why. but i have been sick for 11 years and my quality of life is not what it was i was in a bad car accident and i have tried on my own just to c if i could get off of them and the pain would go away and my pain is really there and i have to go back on my medicine. So i just am in a standstill here with my pain in my legs
Do not agree with this assessment regarding people being unable to control their pain medication intake in response to pain. First, extended release medication works in 12 to 24 hour cycles orally or longer with patch. This reduces the need to "chase pain" or administer medication throughout the day. Secondly, "break through " IR or instant release medication helps to manually reduce pain as it presents itself in conjunction with ER meds considering that the body is in constant flux from a biological perspective with flare ups, external factors, etc…
If a patient has a good relationship with his or her doctor, including a professional demeanor by the doctor themselves, communication is present, being the key to fine tune a situation as needed, considering the integrity of a patient's condition generating pain and good solutions.
In this video, the classic sales technique of creating absolutes within a very textured and complex realm regarding pain and patient responsibility to sell their "pump" which is invasive and involves surgery off the premise of patients being incapable of administering their own medication showcases a growing trend in the Pain management industry. Similar logic to gastric by pass surgery where an obese person has their stomach essentially removed. This would be akin to stating: "All obese people are unable to stop eating and therefore anyone who is overweight should have their stomachs removed". At the bottom of this "Pump bypass" is likely money (speaks of insurance) and a means to stay relevant in an industry (pain clinics) which are feeling the pressures from rising rates of overdoses and media attention/public opinion/government.
As a person with non cancer chronic illness who takes pain medication (including chemo drugs for auto immune disorder), personal responsibility isn't an impossibility whatsoever. If one is in need of pain reduction, a good doctor who has properly assessed a situation will have made sure the patient has "room to breathe" regarding the right medication to facilitate pain reduction. There wouldn't be any situation of "torture" . To add, those who need pain medication (at least myself) do not get "high" or find the meds pleasurable beyond standard relief. Perhaps the doctors and pain clinics should be more responsible in screening away drug seekers and those who are playing up their pain for access to pain killers rather than offering extreme blanket solutions. Naturally, there are those who would benefit from a pain pump, however attempting to make it the industry standard is somewhat frightening. Surgeries bring in big money for clinics but what isn't being shared is the inherent dangers including malfunction, infections and other silent features.
This is all great! Just like giving up drink. I gave up drink many years ago.
One problem here: I do not like taking pain medication but I have to
or my pain is so bad I would rather end my life.
I am a chronic pain sufferer and I suffer from pain that is so horrendous that it is like being burned by alive by the hci in my stomach due to a botched gastric bypass surgery. I will try anything and am open any suggestions.