The art and science of managing pain has challenged practitioners of both traditional and alternative medicine for centuries.
In Maine, the widespread abuse of opiate-based drugs used to treat pain has complicated health care providers’ efforts. It’s a problem that has evolved into a public health and public safety issue.
Part of the challenge is that providers must rely on patients to explain their symptoms.
“Pain is a totally subjective experience,” said Dr. Ben Zolper, who heads a team of pain specialists at his Northeast Pain Management practice in Bangor. “It’s not a measurable event, not something you can put a number to. If someone says ‘I have a broken leg,’ an X-ray can confirm that. But when patients come in and say ‘I have pain,’ they are the only ones who can confirm that.”
Maine Public Safety Commissioner John Morris attributes a 5.4 percent increase in crime in Maine between 2010 and 2011 to addicts committing crimes to feed their cravings for illegal and prescription drugs.
Zolper and his colleagues have built their practice on the premise that pain is not a diagnosis, but rather a symptom of some underlying medical problem.
“We have an anti-pain pill philosophy that reflects standard medical practice,” he said. “We do a history, a physical, imaging and then an examination of treatment options. The goal is to devise a treatment strategy that allows us to cure or moderate the problem so the patients don’t need pills and can still have reasonable function in their lives. Our solutions often involve exercise, physical therapy and the use of other classes of drugs.”
While Zolper’s pain management team of four physicians and four nurse practitioners seldom prescribes opioids in managing pain, Dr. James Whalen, an orthopaedic specialist now in his 33rd year of solo practice in Machias, has never prescribed opioids, and never will. Whalen would like to see a statewide ban on prescriptions for methadone, suboxone and OxyContin.
“There are two universal facts about addiction,” Whalen said. “The first is its habit of use often outlives the initiating reason for use. The other is that people with addiction issues are invariably intelligent and skillful at persuasion. … Addicts know how to exploit physicians and providers to achieve their pills.”
Like Zoper, Whalen sees pain as an indicator of some other problem.
“It tells me there is some underlying issue that you have to figure out,” Whalen said. “And, as a physician, you are supposed to have the intellectual capacity to figure it out.”
Zolper said his patient base includes people with pain who either don’t want any part of opioids and their addictive side effects, or have been on opioids and are eager to be weaned off their dependence on them.
“In my experience, the average person does not want to be on pain pills,” Zolper said.
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Spoken like a person who has never had to deal with anything like chronic pain. The problem is opiates have to have a NEW prescription every month! Due to abuse also due to abuse by some many doctors will NOT refill unless you go to there office this is not easy for many people with pain as moving HURTS!! Then many of these people have to travel farther to go to a doctor that deals in pain as many local docs will not prescribe opiates over a long term or even take these type patients.
So once agin those BREAKING the law have made it vastly harder for those who have not to live.
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For the majority of patients, what happens is that people think they should NEVER have pain. Surgery? Procedure? Guess what? A certain amount of pain needs to be expected and dealt with. There are plenty of non-narcotic means to fight pain, and though an initial perscription for one is sometimes necessary, providers need to be OK saying “no” to those patients calling and asking for refills. Two weeks out from surgery and still having pain bad enough to require narcotics? Not likely in the majority of cases. Not that there are never complications, but people want to recover without an ounce of discomfort, keep demanding strong medication so they’re never uncomfortable, and the next thing you know-they’re hooked. It’s an issue for the providers in that they don’t want to be accused of not taking good care of the patients, but don’t want to hand them the medication that may cause them a lifetime of addiction.
In 2007, my last surgery, I was hospitalized for 8 days. In the last 5 days of my stay I had not taken any pain meds at all. When I was discharged the doctor wrote me a scrip for 30 days supply of percocets. I asked him what that was for, and he replied that it was for pain manabement. I asked him if he had even read my chart because I was not going to fill that prescription and promptly tore it up.
Sometimes I think they do that in order to avoid a call in the middle of the night when patients go home and suddenly need pain meds. But I would think 4-5 pills to get them through a “spell” or two would suffice for someone such as yourself who went as long as you did without pain meds. Tylenol and ibuprofen work wonders for pain and do not lead to dependency. Good for you-too bad more patients didn’t refuse the prescription when in their mind they really knew they were ok.
“Tylenol and ibuprofen work wonders for pain…”
I wish they would work for me but, unfortunately, we are not all the same.
I take narcotics for pain management and can go for days without taking anything and have no symptoms of withdrawals. I don’t know if everybody is like this, but I choose not to abuse my prescribed drugs and think that might have something to do with my not being addicted. I have been on narcotic drugs for many years. I can’t imagine a day when I desperately need my medications and can not legally get them. I hope that day never comes.
I’ve discovered I need to rotate between non-narcotic pain relievers. I tend to build a tolerance to them. If I rotate between Tylenol, Motrin, Aspirin, and Naproxen, I can usually do fairly well. I discovered this quite by accident when I was pregnant and couldn’t take a migraine medication I had for occasional migraine headaches.
I ‘discovered’ that Tylenol (if taken early enough in the headache) squashed it pretty well. I started experimenting there after and discovered that listening to my body (wrecked back surgically-corrected, chronic muscle and joint pain issues from overuse) and careful exercise worked wonders.
I’m not saying it works for everyone, but I think sometimes society has been so conditioned to expect no pain that it’s just easier to use narcotics.
” the treatment for it is necessary but should be limited or controlled vigilantly so a dependency does not result.”
This. The restrictions do NOTHING to prevent abuse they only make life harder for those who NEED the drugs.
That is absolutly the truth..Why do the authorities or pharmacies ‘doublethink’ the doctors?
Same reason they get in the middle of so many things from Firearms to what you do on your private land. It makes someone FEEL like they are being useful. What is the cost for this and why does it always seem the small group gets the most attention while the masses are ignored?
I agree. The answer to your question seems to be; The “government” adjusts laws to protect the stupidest, the greedy and the people who own the franchise. These laws discriminate (in my opinion) against the responsible, the legitimate users, and the capable.
It seems to be another instance of no personal responsibility. “It’s not my fault, it’s the doctor’s fault”.
I’d like to know how many of the punks who are robbing pharmacies ever had a prescription for oxy that expired, and now they are addicts looking for more. How about none. It is plain and simple, punks taking illegal drugs for sport.
They deserve no sympathy what so ever, and it is more liberal BS to blame the doctor.
Tom Brokaw wrote a book called “The Greatest Generation”. If he were to write a book about the current generation it would have to be titled the “It’s Not My Fault Generation”.
Interesting that this article is framed as the opiate problem being the result of abuse, and not the result of poor prescribing habits and lack of education on the part of doctors. It would be easy to make the argument that they are as much at fault for the opiate problem as those who become addicted to the medicine that they provide.
I mentioned that in my above post. Providers need to be able to say “enough is enough”. Try other non-narcotic medications, heat, massage, meditation, rest, and how about TIME? Major surgery requires time to heal and people need to know a certain level of post-surgical pain is normal.
“…people need to know a certain level of post-surgical pain is normal.”
Absolutely. The pain of others is always bearable. It is the pain we experience ourselves which is unbearable.
As a consumer of medical services I want the option of a pain free recovery. As a person of means, I can get that by leaving the USA for my care. Only people forced to use the broken US health care system, must suffer the attitudes of the above self described Maine nurse.
My medical care must be between me and my physician. I want him, not some nurse with a mission, to tell me my pain is “normal.”
Heh, heh, heh…I understand your point, but many an RN has saved a patient’s life by questioning a doctor’s opinion of the best course of treatment.
As much at fault? Really? I don’t think so. You’re talking about highly intelligent people that have gone to school for many, many years, been supervised by higher level professionals, etc., etc. VS. (to put it simply) all the rest of us (who have not had that type of education). Your wording suggests a 50-50 split in fault. I disagree. There will always be “bad” doctors in the world, but I don’t believe for a second that doctors “are as much at fault” as the people who are addicted.
I had many surgeries and I can say this. Pain medication has its role in this world. Who wants to go back to the days when they gave you a bullet to chomp on during and after surgery? Using narcotics for pain in the post operative period didn’t turn me into a pill consuming addict. I doubt that’s the case with most people.
It would suck being addicted to bullets
Yep. But it would sure be a kick to see addicts swallowing mouthfuls of them trying to get a gun powder high.
It’s Zolper not Zoper…it’s really sad the BDN can’t get the MD’s name right!
Many people could easily treated for pain with medical marijuana. We need more doctors who will recommend this instead of writing scripts for opiates.
You have a good point ……………… BUT ………………… Why do you think it is illegal at the Federal level, not because they think it is really bad for us, but because the Pharmaceutical Companies pay big money to OUR Politicians just too make sure that only they control what drugs we can use and of course they make their $Billions.
Interesting to note that if you become a registered Marijuana user, you are considered a prohibited person by the federal government and cannot purchase a handgun. They actually notified all federal firearms dealers of this.
Yet another reason not to register with the State.
Most people are not registering with the state these days. It’s just between the patient, the doctor and the dispensary or caregiver. They removed the requirement to register with the state.
Exactly. This country is owned and operated by corporations with the pharmaceutical companies controlling every aspect of our healthcare system. Our politicians are bought and paid for to be the puppets they have become.
Yes because we really need more stoners, and it never leads to illegal drugs.
One thing that would help with prescription abuse, medical marijuana or otherwise, is if your drivers licence were suspended during the period you’re on it. Anything that alters your judgement or response time is no different than drinking and driving.
People who use marijuana to control pain are not stoners. Putting that aside, I’d rather have more stoners around than all of these opiate and bath salt addicts. These people are scary beyond words and they are the ones tearing away at society.
There are actually more and more studies being done in states where medicinal use is legal and they find that it actually enhances the driving experience because people tend to drive much slower and are paying close attention. But, most MM patients that I know don’t get “stoned” to control their symptoms.
In fact those dealing with true chronic pain find that smaller amounts actually work better to control pain. This is what the prescribing doctors are saying and this is where the latest research is pointing. Most people dealing with chronic pain want to be able to get their lives back so that pain no longer controls their every action. Most don’t want to be in an altered state, just in a normal pain-free state that so many others take for granted.
You need to get better informed. You are repeating government propaganda that is close to 50 years old. There are multiple studies that have been done or that are underway now that we have so many states who have legalized medical marijuana. There is no evidence that marijuana is a “gateway” drug. That was dispelled some time ago. You know nothing about this subject and are just repeating misinformation that is very far from being accurate.
Stop stereotyping the patients of Maine who because of illness and injury use this valuable plant to relieve physical, mental and emotional suffering so that they can have normal productive lives or so that they can spend their remaining days on this planet with some degree of comfort.
Funny, I quit smoking the weed because every time I used, it intensified my pain. Asking around over the years since, found out that my experience is quite common.
The denial espoused that this plant is harmless and must be legalized for everyone to use as a miracle substance is hilarious. The self importance and pontification of every “medical marijuana” proponent I personally know gives credence to the “stoner” stereotype that can’t hold down or obtain decent employment as a result of “discrimination” due to drug testing. Worshipping and exalting this plant as a miracle will not convince those of us who have been on both sides of this fence this plant must be legalized.
Pure poppycock …
When you smoke a large amount to get stoned it will not control pain. That is why doctors recommend one or two inhalations. Anymore and it will do the opposite affect than is desired. Also if you mix it with alcohol or cigarettes you will not get the full medicinal affect. The less one uses, the more receptors there are. The more you use, the less.
I did not say that it should be legalized for everyone, although I am leaning that way. I merely needed to point out that you know nothing about having a life-changing illness or injury, and the use of marijuana as medicine. The things you wrote were not true.
I know people from every profession that are MM patients. Most of them are highly successful but some because of their physical, mental or emotional illness or injury are unable to work. I actually don’t know one person (other than those with terminal illness )who are MM patients that don’t have a job. I know one MM patient who just spent the last year in college and got a 4.0.
You have not been on both sides of the fence. You have been a recreational user who was not trying to get a therapuetic affect. You were trying to get stoned and not control life-robbing chronic pain.
All that aside…you think are present system of pain control is working well? Getting people hooked on opiates and then keeping them addicted to methadone? How’s that going?
You assume much in your response. I have had chronic pain for almost a decade. Met a doctor that provided a holistic approach where there was a very heavy physical therapy component when properly taught and done provided enough relief that I managed my pain with OTC drugs such as aleve.
One hit of potent MM as so politically described would induce muscle spasms to the point of being barely able to move. The quality of weed forty years ago and what is available today are opposite ends of the spectrum.
The large majority of MM advocates I personally know and grew up with are stoners that never made anything with their lives and left a lot of scar tissue behind them. You cannot deny these people exist. They carry very little credibility and cling to this cause. It’s a front and a poorly disguised one at that.
I do believe there is a case for MM. Until there is a concerted effort to self regulate and police yourselves, it will be perceived as a method of legalized DRUG trafficking. I really do not see that happening given what I have seen and experienced.
Many of doctors who are doing a holistic approach are the ones making the recommendations. For many it is a combination of many things and MM is just one component. These doctors also advocate exercise, stretches, yoga, deep breathing, relaxation techniques, proper diet, hydration, psychotherapy, vitamins and supplements, as well as other mainstream pharmaceuticals.
Each person is different and their body reacts differently. For many, the best pain control comes from MM edibles such as tincture, olive oil, granola bars, candies, etc. There seems to be better pain control when ingested and not smoked. Just with any other medication, some people are not helped by MM or in some cases made worse. That is rare I believe, but it does happen.
There are so many strains now that are specifically for different types of illnesses and injuries. Under proper care, one can find the strains that best treat their physical problem. New MM are told to keep a log and record reactions to each strain whether good or bad so that they can get the best response.
Of course there are stoners jumping on the MM wagon, but there are far more who have a legitimate condition that causes suffering. I’ve thought a lot about this and even if they are recreational users trying to get under the medical arm, I’d rather have them registered, tracked and buying from a reliable, legal source than dealing on the black market. I personally think many go on to harder drugs because they are buying from drug dealers who are always peddling other goods.
The large majority of people these days are in full support of MM, and many are for legalization. We have become smarter Americans and no longer believe the government propaganda. All of the myths have been dispelled and more people have become educated.
Apparently you have friends who are stoners trying to go under the MM arm. The people that I have worked with are legitimate patients with physical, mental or emotional illnesses and injuries. They are my main focus and they are the ones that I speak up for because there are far too many people who are suffering needlessly but will not try it because of the things that you have mentioned. I work tirelessly trying to educate people so that those who are suffering can find relief.
These are the guys with patients condemned to untreated chronic pain. Only when they themselves experience it do they get it.
Most of those addicted to pain medications know the exact symptoms to present that get the best results from Dr.’s. They practice their symptoms and network with each other. They also have been known to alter their prescriptions and know the pharmacies that won’t check them too closely. 10 Oxicodone can easily be changed to 100.
There should be a system of checks and balances in use that doctors can access to find out if their new patient is also seeing another Dr. with the same symptoms. There are signs that they should be aware when the patient knows just a tad too much about the dosage and medication they are seeking.
Oh, great. I finally find a medication that works for my documented neurological condition, and these guys want to forbid my neurologist from prescribing it, because some people get addicted.
Think about the mechanism of getting “addicted.” Some people choose to seek out drug dealers on the street in order to get more of a medication than they were prescribed, or to continue it after the prescription ends.
Meanwhile, I’m taking the prescribed dose, getting enough symptom relief so I can continue to work my 45-50 hour weeks at a demanding professional job. I choose NOT to hang around the low-life parts of town, and don’t sidle up to creepy guys with their pants hanging off their rear ends to ask for illicit drugs. Why should I be penalized?
Every time I go to my doctor to get my pain medications, I am treated like a common criminal because of the people who choose to abuse them. I have a long history of pain and the medical documents , x-rays and MRI’s to prove it but am still treated like a second class citizen. Believe me, if you need narcotic pain medications to make it through the day, you do not like them or want to be on them but don’t have a choice. If they are used for pain as prescribed, they do not give you any kind of a “high” if you are taking the proper medications and are on the correct dose. They merely make the pain more manageable.
The problem is these medications work for pain but are abused for pleasure. That said why should people who could be helped by oxys, percs, etc. suffer so these “Docs” can feel good about themselves?
http://www.usatoday.com/news/nation/story/2012-06-27/florida-painkiller-drug-bust/55877040/1
Several doctors in FL arrested for trafficking. If any problems with the link, and it is an incredible story….search ‘Doctors accused of drug trafficking in Fla
Hats off to Dr. Zolper! After three years of being on opiates for pain, in the wake of a work related injury, I found Dr. Zolper. His treatments allowed me to see that there were alternatives to the pain pills. After several of his treatments and getting off the opiates, I discovered that there was relieve from my pain without the use of pills. In fact, I never got any better until I stopped using them. With the help of Dr. Zolper, and other doctors like him, I am pill free and intend to stay that way forever. Of course I have my days where I am in pain, but all in all, the pros of being off the pills, far out weighs the downside of their use. I know so many people who have ruined their lives with opiate addiction. Not to mention, the death of a good friend because of the abuse of opiates. Take it from someone who has seen both sides of the coin, when it comes to the use of pills for pain. There is a better place to go besides the pharmacy to fill that script, I promise you. I will admit, it wasn’t easy getting off the pills, as I quit cold turkey. In fact it was one of the hardest things I’ve ever had to do in my life. However, there is a better place on the other side of that pain.