Rabid Watchdogs

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As the Baha Men so nicely phrased it in their 2000 hit single, I can’t help but wonder Who let the dogs out?

Look out Upton Sinclair – muckrakers like you have nothing on the likes of John Fauber of the Milwaukee Wisconsin Journal Sentinel in his “Watchdog” article entitled Chronic pain statistic called exaggerated, misleading. He and his media colleagues, those watchdogs of the public good, have already brought down multiple notorious underminers of the American way of life – scum of the earth – pain professionals and patient advocacy groups.  But for journalists like John Fauber, recall that even Upton Sinclair knew that “It is difficult to get a man to understand something when his job depends on not understanding it”.wUptonSinclair3

How is it that we have come to take for granted that destroying people’s reputations is honorable work these days but working as a consultant with the pharmaceutical industry is tantamount to selling one’s soul to the devil? Now, the pharmaceutical industry doesn’t do itself any favors with the constant commercial barrage, and especially direct to consumer adds,  that makes them look like snake oil salesmen for indications and diseases that sometimes are made up to fit a treatment. But I am sure that given that everyone gets 8 minutes with their doctors that some priming of the pump has, in their view, become a necessary evil to facilitate dialogue between patient and provider. But by and large, the American pharmaceutical industry should be something Americans take pride in. They innovate, and through research discover new and effective, often life-saving therapies for all sorts of medical disorders. They put newer and better tools in the hands of doctors that save lives. It is our health care system that makes them function as a (sometimes slimy appearing and aggressive) business. But are they really a lower form of life because they don’t act like charities? And they need consultants to share their clinical and scientific knowledge, experience, and expertise with them, and for this they sometimes pay handsomely. Of course the pain leadership was needed and of course these guys commanded large consulting fees – they are the best of the best. Do I detect a note of jealousy in all these reports?

who_let_the_dogs_out

If so, what these rabid watchdogs should be jealous of is that not one of the pain leadership ever said anything they didn’t believe for an honorarium. I guarantee it. There are actually complex human beings in the world who can maintain their ethics and their common decency even when they are being fairly compensated for their service. But I digress; this is big news, you have uncovered the big lie: the pharmaceutical industry made up the problem of chronic pain!

Allow me one more comment media watchdogs: I know when you or someone you love needs pain services the practitioners you persecute won’t withhold their services and sit in judgment of you as harshly as you have them.

You smell a rat. Guys like you, thank God we have you to save us from the pain doctors, oh and those degenerates at the Institute of Medicine. This time you’re really onto something. This one is big, almost as big as Weapons of Mass Destruction.

OK here it is…there might not be exactly 100 million people with chronic pain in the United States. You know what members of the media? I don’t care if there is one person and one person alone in this country with severe chronic pain if it is you or your mother or sister or wife, then you too would have wanted the Institute of Medicine (IOM, Relieving Pain in America 2011 report here) to come along and try to reverse the millennia of poorly treated pain, the lack of empathy and the complete academic and clinical disregard for pain and the people who suffer with it that characterized the field since time in memoriam. This figure was a projection, admittedly on the high end.

The watchdog implication would have the world believe that the projection of “100 million Americans suffering from pain” is related to the desire of those at the forefront of pain management/treatment to unleash a drug abuse epidemic on the American public to keep those honoraria flowing in. Was it used to sell narcs? Does everything lead back to people trying to line the pockets of the big bad makers of PAINKILLERS? Try this figure on for size…pain is the most common reason people go to the doctor. And not everyone is hoping to score some opioid as a result of the encounter.

People are suffering. The IOM was trying to get research and science and clinical interest in the topic jump-started. In so doing, the pain field made many mistakes. The term undertreatment was a mistake. It implied that pain would be eradicated if we simply did more of something…we did, and it didn’t work, because pain is poorly treated…inexpertly treated, incompetently treated…not under treated. The increasing of any one intervention, be it opioids, meditation, group therapy, epidural steroid injections, antidepressants, anticonvulsants, surgery or standing on your head isn’t  going to help even the majority of sufferers. We need peace between warring factions, we need education and advocacy and we need more – not less – freedom for pain practitioners to practice artfully. The environment of fear makes for conservative treatment that stifles practitioners’ creativity and doesn’t help people as well as they otherwise might. And if the Milwaukee press doesn’t believe it, perhaps you should spend a day in a legitimate pain clinic and spend time with the suffering patients that are turned away from multiple primary care providers and even pain interventionalists that are scared to death to write for a controlled substance.  Once again, shame on the journalistic sensationalism.

Congratulations on writing another attention grabber – after all, that is your job, which “depends on [your readers] not understanding” the whole truth. My job is treating pain and ensuring that both patients and referring providers learn and understand the therapeutic nuances and risks for each individual patient – this education often times extends to third party payers to mitigate risk with appropriate monitoring and perhaps treatment with less common therapies than the norm. There within lies the nemesis between true clinicians and the media.

As always, comments are welcome, especially from canines!

 

 

 

 

21 thoughts on “Rabid Watchdogs

  1. Jeff, nice article. I wholeheartedly support scrutiny over COIs and have advocated for greater scrutiny on the ethics boards of several national pain organizations. In the case of the IOM, I fail to see the story. I also see no value in attacking the people who are advocating for positive change as it serves to undermine the collective goal we all share. I have seen nothing but overwhelmingly positive results come from the IOM report in terms of attention to the problem of pain and greater advocacy for multidisciplinary pain care (not focused on pharma). I don’t understand how the IOM committee and report could be conflated with experts stumping for big pharma. Discernment is in order. Use the attack skills where they are due, not on remediation efforts on the part of professionals who did not generate the problem in the first place.

    1. Dr. Darnall,

      It is both refreshing and vindicating to see such important comments from a Clinical Psychologist with such a strong background in this area. Indeed it is especially heartwarming coming from a clinician with nothing to gain by seeing patients placed on opioids or taken off opioids other than striving for best outcomes. Your writings clearly illustrate that you have a keen understanding of the abuse risks AND the potential therapeutic benefits of chronic opioid therapy in the appropriate patient.

  2. https://news.tn.gov/node/12499
    Is another link of state’s taking away rights. Tennessee governor taking away pain medication for all except terminal or cancer patients. No sleeping aides or tranquilizers? Must protect the criminals and let humans suffer to death? Numbers do not tell the whole story. They are manipulating the stats. Yesterdays smoking was the news. Many suicides will not be prevented no matter what measures are taken. Many more suicides will occur as pharmacies continue to fill legitimate prescriptions and pain relief becomes unattainable. Punishing the disabled is discrimination. Pain is the fifth vital sign. E.R. ‘s playing games calling chronic pain patients fakers with kidney stones and bowel blockages. Government attacking pain doctors and pharmacies is unjust and unethical. Please pray that saniety returns. I admit that I will not suffer needlessly. Don’t want to but without medication I can’t stand or sit. With it I can for brief periods. Why would I want to be a bigger burden on my family. Thank you for allowing us to speak and for the education. Shame on the judgemental authorities and governmental agencies.

    1. Hi Brenda and thank you for the link. In #5 of the 7 objectives for TN ‘Strategic Plan’ it reads as follows
      “Increase ACCESS and QUALITY of early intervention, TREATMENT and RECOVERY services.” (caps added).

      As a former resident of the Volunteer state I’d like to share my take on the situation. I lived in East TN from ’98-2007 graduating from ETSU (2005) then working for a local county school system. During that time I became sick with a rare AI disease eventually taking time off from school and work (FMLA) & returning home to Northern VA. I finally got a diagnosis @ John Hopkins in 2000. After much trial and error in pain management I returned to TN with my pain well controlled w/ MS Contin (45mg x 3).

      PM in TN was horrified that I was given morphine (too young (29) too high dose, etc, etc). Apparently they knew better than one of the best hospitals in the country not to mention one of the very few who had a clinic that specialized in treating my disease.
      They IMMEDIATELY started a taper and w/in a couple of months I was totally off morphine (135mg day) and given Lortab 5/500 x 3 day. Keep in mind that this was during the time of compassionate treatment of pain (the 5th vital sign). Before I was diagnosed, at times even after I had one, I was treated as a complainer/hypochondriac and drug seeker.

      Getting to my point about the treatment. There seemed to be a great deal of Oxycontin and hydrocodone use/abuse in the area during that time. There were several attempts by different companies/organizations to open a methadone clinic in the area. Many different groups including churches, law enforcement, ‘concerned citizens’, politicians, and most surprising, even the medical community opposed these attempts continually denouncing MMT. The reasoning?
      MMT just traded one addiction for another. It would attract criminals from surrounding communities. It was seen as coddling addicts when what was needed was to get tougher on these criminals, etc, etc. From my experience w/ the medial system in TN (NE TN at least) it is my guess that most of these medications were brought in from outside the area. Local doctors simply did not Rx pain meds despite documented injuries or illnesses in which moderate to severe chronic pain was a common symptom.

      Opiate addiction is known for having a high rate of relapse. The most successful treatment by far, proven over decades, is medication/replacement management coupled w/ counseling. Despite this accepted knowledge, the medical community in the area still clung (clings) to faith/church and the abstinence only model which has proven to be woefully inadequate when dealing w/ opiate addiction.

      Of interest, there were (still are?) many addicts in the area who were highly motivated to seek treatment. Some of these addicts even traveled all the way to Asheville NC, where the closest MMT clinics were located, [1 hour drive {one way} from the Tri-Cities area]. How were these individuals rewarded by trying to better their lives? By being targeted by law enforcement and having to face even more obstacles to treatment. These people were targeted as criminals by local law enforcement which harassed them going so far as to pull over cars returning from NC and arresting addicts for DUI !! What became of those addicts caught in Unicoi county’s ‘celebrity’ Sherriff Kent Harris’ traps? Apparently many were used as slave labor….

      “county inmates were taken to property owned by Harris to bush hog it, mow it, cut wood and raze structures there” http://blogs.knoxnews.com/humphrey/2013/07/judge-dismisses-charges-agains-1.html

      How are the assets and cash seized by law enforcement’s Drug Task Forces put to good use?
      “Former DTF Director Mike Hall’s drug task force credit card was used to charge more than $50,000 between 2008 and 2010 on meals for himself, task force members and GUESTS at local restaurants, as well as gifts, flowers and goodies for co-workers and office secretaries, credit card receipts show.http://blogs.knoxnews.com/humphrey/2012/08/das-dealings-with-drug-money-p.html

      And an even playing field once charges are filed against these drug criminals?
      “Court records and judges’ opinions contain repeated allegations and findings that 10th District prosecutors withheld evidence, tolerated and even participated in law enforcement misconduct, and violated judicial orders and defendants’ rights in criminal cases.”

      Getting tough on addicts at any price can result in a philosophy whereby the end justifies the means.

      With these attitudes and actions by community leaders, during the period of enlightenment and compassionate pain care no less, I fear now for those in TN w/ both chronic pain and addiction issues. With such reluctance to prescribe and now pharmacies reluctance to fill legit Rx for opioids I fear that patients with chronic pain are but a small fraction of the sources of illicit prescription drugs on the street. It seems that with the thousands of pills missing from pharmacies, thousands more lost in transit, and those easily bought and brought in from Mexico and overseas; the DEA and states like TN are barking up the wrong tree by targeting legitimate patients with pain. Why do the watchdogs fail to mention these sources in print and in video clips for CNN, FOX, and MSNBC? Why always focus on the patients?

      *Question for you Brenda. Have you ever encountered a doctor(s) in TN giving out opioids like candy? I never came across one of these docs, just wondered if you had. {Pathos seems to have missed them as well despite he and his wife being on the ‘inside’ of the medical system}.

      Coonhound

  3. I would like to point out something that seems to be continuously overlooked by those who are forever trying to blame chronic pain patients for their lot in life. Regardless of the number of people who suffer from pain each year, the number that never waivers is the number of people (who may or most likely, were not pain patients) who died from taking too much medication.
    Another thing that CAN NEVER CHANGE, is that the pain patients, regardless of the number of them that there are, NEVER ASKED FOR THEIR CONDITIONS. That’s right, no matter how many people are in pain in this country on a daily / monthly /yearly basis, NONE of them asked for their miserable existence for which they receive very little treatment as a result of the various laws and overreaching agencies, police, DEA and the media who have made it their job to point out just how many have died from “the devil in pill form”, opioid.
    But nowhere is anyone stating what seems such an obvious UNDENIABLE FACT; these people who overdosed on medications, many of which were obtained in unscrupulous ways, were never forced to suffer through their disease. NOBODY shoved pills down their throats. Show me one case of this happening.
    So now that the number of MILLIONS of patients that suffer from pain is in question, the number of people who were “forced” to overdose remains constant. It’s too high also, but I submit to you, these numbers have very little, if anything to do with each other. It’s a smokescreen whose correlation remains forever locked together just to keep up media hype and to satisfy radical groups, politicians and the loved ones who lost their sons, daughters, husbands, wives, and friends to the evil drugs who forced themselves on their loved ones and killed them due to no fault of their own.
    If there were 1,000,000,000, or 100 times that number, of chronic pain patients and 16,651 who died from self-induced methods, what difference does it make when clearly stopping the overdoses has not been achieved by torturing pain patients as addicts just switch to heroin or another drug to continue with their disease.

    See Link for the following page:
    “Opposition to Kentucky HB 1-Reform HB 217 aka “Pill Mill Bill”
    https://www.facebook.com/pages/Opposition-to-Kentucky-HB-1-Reform-HB-217-aka-Pill-Mill-Bill/595049517218134

    1. I have read your comment I suffer from chronic pain 5 years and now i found out I have plasticity and my red bone marrow in my spine is changing I may have myeloma a rare form of bone cancer and have been denied my pain medication for 3 months and when the pharmacist along with the system allowed me to get my pain medicine the pharmacist cut my dose to what she thought would manage my pain 2 mg it took years for a licensed doctor to find a correct dose and medication that works at first I told the pharmacist about the possible cancer and she took my prescriptions and said I will see if I can fill these after calling the doctor verified my prescription and condition then denied me .who would do that to a person maybe some of these people who died were the lucky ones maybe some of the families fell denied they have lost there love one I am sorry for them but it is a hard way to live being in pain you always hurt .you sleep very little ,but when you wake up every day only to pain did any one think of what being denied a persons pain medication is like ,the shooting pain down the legs and stabbing pain in the hips and the dull neck achs and head aches or arms or what of the people with no arms .constant not stopping 24 hours a day 7 days a week 365 days a year all you do is want the pain to stop with proper pain medication it will be lessened maybe a 6 ,but enough to maybe work a few hours ,to play with my child a few hours . I had no pain medicine on fathers day and woke up at 4 am in severer pain and cried knowing I would not be able to go window shopping with my daughter ,maybe they were the smart ones knowing what is to come or the brave ones ,there are many people being denied their pain medication ,people with cancer being treated like a junkie on the street , little children with broken bones just coming from the hospital little old woman in wheelchairs the mental abuse from the pharmacies is appalling ,being treated that being hurt is my fault , being hurt is wrong , a person having a disabling condition is not wanted in your pharmacy chain store ,made afraid of the pharmacist , that they will take away the medicine that lessens my constant pain afraid to file a complaint , call the ada or pharmacy board maybe if I get denied my medicine and treated cruelly I might do something not of normal thought it is like being water boarded or some cruel treatment because of the pain I would not treat a animal the way I have been treated Edward

  4. Here is a webinar http://www.medispan.com/videos/controlled-substances/ by an attorney and former employee of the DEA.. listen to around 40 minutes.. clearly states why the DEA is going after wholesalers ,pharmacies and doctors… the first two in particular.
    It is stated that we spend 51 billion annually on the war on drugs.. that is a lot of people getting a paycheck and a lot of self interest in making sure that the war on drugs is perpetuated.
    It is true that DEA/law enforcement can keep or sell any assets and put it in their coffers. It seems that the DEA’s increased fines of chain stores and wholesalers seems to fall in line with the impact of sequestration on the federal budget started to kick in and was DEA seeking ways to fill in those “cuts” to their budget with fines from those in the medication distribution system. There is an estimated six million that are chronic substance abuse people.. meaning that we are spending abt $8,500 each to try and keep them from abusing something.. and we have been trying this for at least 100 yrs. As opposed to the $900 we spend on each person in the country for medical care.
    But as a society, we seem to like to fight social wars.. we tried a war on alcohol (prohibition) which failed.. along with the failed wars on Poverty, Hunger, – no child left behind (war on stupid children),drugs, women and untold number of other undeclared “wars”,.. not to mention the various physical wars we have engaged in.. and the last one that we clearly won.. took two A-bombs (WW II).

    1. Thank you for posting this webinar Steve. Very informative. I was rather disturbed in seeing that I could be red flagged for at least half of the signs of being a drug seeker’!

      #1-EARLY REFILLS-One-can’t wait until the last minute to take in one’s Rx as no pharmacy can guarantee they will have your meds in stock (despite being a regular customer for years) so you can’t wait until the last day-this also rather contradicts the agreement to use one pharmacy as stated in most PM clinic’s pain contracts, in fact it seems absolutely ludicrous in the current climate of discrimination. Adding insult to injury, just being denied at a previous pharmacy is a red flag to the next one.
      #2-Long distance from patient’s residence to Dr or Pharmacy-some rare diseases require patients to travel quite a ways to find specialists w/ knowledge in treating them (try systemic sarcoidosis on for size in addition to MCTD/lupus overlap. [both incurable, simply symptom management and organ saving measures (that open one up to infections that can turn deadly ie Bernie Mac/pneumonia)]
      #3-DEA LAW=Lecturer states that there is NO LEGITIMATE MEDICAL JUSTIFICATION FOR THE ‘COCKTAIL’ of OPIATE+BENZO+SOMA. On this he was quite emphatic. I consume this ‘cocktail’ several days per month when my calves, fingers, lower back, etc seize up (hours if w/out carisoprodol/baclafen). Due to myositis component of MCTD he’s probably not too familiar with. Easy fix would be to drop the SOMA and just use opiate + diazepam for anxiety AND muscle spasm/seizing right? Problem is, In order to obtain sufficient relief w/ just diazepam I would be in a stupor and coupled w/ my chronic anemia, not be able to leave the house for days due to fatigue and intoxication, not to mention a dangerous buildup of active metabolites from diazepam that could cause my already compromised respiratory system when added to methadone (my max diazepam per day is 12g-2x2mg tablets 3x day PRN)
      I guess the DEA expect (ed) a ‘shortfall’ in asset forfeiture $$ now that the country has had enough of the war on cannabis, yes friends, even in the bible belt, gasp! TN Poll Has Three Out of Four Supporting Some Form of Marijuana Access! egad!; SO……. on to the next targets-Yes good old asset forfeiture, civil cases involving seizure are so easy to win needing only a preponderance of evidence, oftentimes only against the object, not the owner as if that makes any sense [IF even contested]. They milked that baby (AF) to death now the DEA’s beady little eyes are focused on the ‘legal’ stuff [Heroin pills according to Kolodney], AGAIN, as if it makes ANY sense. Though it only took 30 some yrs to do it, some municipalities and states are striking down or at least reforming obscene forfeiture laws much to the chagrin of the DEA, State, and local law enforcement authorities. http://www.washingtonpost.com/news/volokh-conspiracy/wp/2014/05/10/minnesota-adopts-law-curbing-asset-forfeiture-abuse

      Disabled pain patients don’t have any $$, being starved out by the govt. [SO, the physicians, pharmacies, and distributors are the ones with the big bucks so they naturally take the fall, patients just being collateral damage.. The beauty (until very recently see above link) in many of these cases, especially against caring physicians, is that once bank accounts and other assets are seized there isn’t much of a defense one can mount. The DEA are so stupid though that they will wind up killing their golden goose once again by overplaying their hand. Once there aren’t a dozen doctors left in the US willing to write an Rx for a scheduled medication its geese flambé for their last supper. Hopefully other states in addition to MN, who recently passed asset forfeiture reform bills, wise up soon and pass similar legislation giving doctors at least some kind of chance against the government’s slightly tilted game of courtroom ‘chicken’.

      BUT ALAS, long range planning, with a little help from our pals in Afghanistan, should allow the DEA to rise again; like the proverbial phoenix (no not Phoenix House, though they have big plans too, see Kolodney’s recent testimony before the Senate caucus on prescription drug abuse/heroin if one can stomach it), they shall rise again to significance to battle the new scourge of heroin (and the REALLY BIG BUCKS). http://www.c-span.org/video/?c4498386/andrew-kolodny-md-testifies-senate-caucus

      Donna-you were questioning the staying power of this particular offensive against prescription opiates, money, and how it fits ? One has to contrast it w/ how quickly the media/DEA meth craze died down (despite the fact that its use is still going strong) That’s easy peasy, cuz po’ white trash aint got no money. http://stopthedrugwar.org/taxonomy/term/53

      Me thinks Jefferson should be rolling over in his grave about now if he knew all the ways our ‘constitutional’ government was fleecing the American citizen and running roughshod over their rights. But probably no more so than Thomas Paine would be at seeing the apathy of American citizens & their indifference to any issue that doesn’t affect him/her personally. One quote of his I cannot help but recall and share due to its relevance to our conundrum:
      “He that would make his own liberty secure, must guard even his enemy from oppression; for if he violates this duty, he establishes a precedent that will reach to himself.”

      Attempts at reasoning? Dr Fudin, I respect your attempts at finding common ground as there are many issues that both sides can agree upon BUT to quote another of Paine’s assertions ” To argue with a person who has renounced the use of reason is like administering medicine to the dead. ” Anyone wishing to view the Senate Caucus on America’s addiction to opioids ‘Heroin and prescription drugs’ can click here:
      https://www.youtube.com/watch?v=gC6C9VXTIHE

  5. i think it is crucial to understand that the Addiction Industry and the Prison-Industrial-Government complex are both HUGE multi-billion dollar industries. Of course they will rabidly attack pain treatments, providers and patients. They want all that cash directed at them, which does not exactly make them unbiased or compassionate or trustworthy.

  6. It is shameful to scare the American citizens and our healthcare providers into NOT treating pain.
    I just don’t get it , why cause all this fear and keep hounding on it for this long?
    I don’t buy it that all this negative media started because of some overdoses. People die everyday on plenty of legal substances and addicts are still abusing plenty of things no matter what is available for pain. They seem to always find what they want and the black market is very much alive. Just look at the heroin coming in now? But we don’t hear about chronic pain and what these people need, except a whole lot of negative about the medicine to treat it. There’s plenty of advertising for more invasive treatments that usually cause more pain and more problems. Where does this person go after those fail? Medication that’s where and soon there will not enough doctors who will feel comfortable prescribing it.
    There is something behind all this negativity. Something feeding it, something backing all this fear enough to cause the DEA to go bananas on pain care..I definitely smell a rat and money has to be behind this. I read not long ago that the DEA was able to keep all the money from the fines they collected from the wholesale and pharmacy industry. Is this true? If so, then job security for them on the backs of doctors and patients. Very crooked.
    I get it, Dr. Schatman that honesty and integrity doesn’t sell print but why go so far with all this to the point of harming so many innocent people? The severe negativity has going on for over 3 years now.
    I have spoken to tons of legitimate pain patients and still do. There really are millions of people with pain legitimate pain out there. Disease and accidents happen everyday in this life especially with a population so large as the US.
    I honestly believe that their is more to this story of why all the negative media on pain killers.
    Whose pockets are now filling up? Addiction specialists? and the DEA? and why?
    All this negative media needs to stop, so who do WE have to pay off to get it stopped?
    The drug companies who are creating and manufacturing the pain medications have lots of money but they aren’t helping us fight this either. So where do we go to stop it?
    Unless our government really does want to eliminate the disabled from our Medicare and Medicaid system. So.. then it would be our own government doing this. If so, then it’s a political issue.
    Thank you Dr. Fudin for doing this blog post because I recently read the negative story that was done about the IOM report on pain in America and it blew my mind that anyone would go so low to undermine their work on pain and say they were paid off in a sort of way because of who was working for them. I hope we can find answers. The harm all this causing is horrendous !

  7. Jeff, I admire your courage in going after the misinformed and biased media. The original IOM estimate was 116 million adults with chronic pain (excluding institutionalized, military, and pediatric populations), which they revised downward to 100 million. Both numbers were based on a single, flawed, study. Perhaps, we should reconsider earlier, survey-based estimates of 70 million adults with chronic pain, or the smaller proportion — say 30 to 40 million — with severe or intractable chronic pain. Pick any number that seems most plausible; it is still a huge segment of the American population, representing colossal human suffering, disruption of families, and economic burden on society.

    1. Stew, Thank you for your comment and placing this in perspective. What you acknowledge here is exactly the reason I made this post. The actual number is less important than the problem which was clearly lost in Fauber’s Watchdog article Chronic pain statistic called exaggerated, misleading, as it appeared in the Milwaukee Wisconsin Journal Sentinel. Someone has to keep these guys honest, or at least question their viewpoint.

    2. Stewart
      I am not sure what “flawed study” you are referring to: The economic analysis that arrived at the 100M figure is based on The Medical Expenditure Panel Survey. The MEPS is a set of large-scale surveys of families and individuals, their medical providers (doctors, hospitals, pharmacies, etc.), and employers across the United States. MEPS collects data on the specific health services that Americans use, how frequently they use them, the cost of these services, and how they are paid for, Many parts of the MEPS are well validated including the SF-12 pain questions. This is the major source of health information for the US since 1996.This is detailed in a scholarly article that I hope you will read before you continue this misinformation. See The Journal of Pain, Vol 13, No 8 (August), 2012: pp 715-724. The authors were commissioned by the IOM to conduct the analysis, They are Darrell J. Gaskin and Patrick Richard, from the Hopkins Center for Health Disparities Solutions, and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda,Maryland.
      Chuck

      1. Chuck,
        Its not about the number of people in chronic pain, its about the quality of life issues we face.
        We need prevention care, education, and research with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population level prevention and management strategy.
        There are thousands of people out there that didn’t receive the care they should have received before their pain became chronic in nature and this could have been prevented but now they will suffer life long. Is this how we go about helping those that need the help they should have received before being passed from doctor to doctor. Now its too late for many and they face the rest of their life with ongoing chronic pain, including me. So I thank my doctor for the pain relief he has provided me, now things have gotten so bad and doctors are so scared he doesn’t want to prescribe the very medications that’s kept me as pain free as possible and I have no idea what I’m going to do next.

        Mark S Barletta

      2. Certainly, Dr. Inturrisi, I did not mean to convey any misinformation or disrespect. The single article cited in the IOM report as the source of the 116 (later changed to 100) million figure was: Tsang A, Von Korff M, Lee S. et al. Common Chronic Pain Conditions in Developed and Developing Countries: Gender and Age Differences and Comorbidity With Depression-Anxiety Disorders. J Pain. 2008(Oct);9(10):883-891. This multinational study had numerous limitations and was not specifically designed to focus on chronic pain prevalence in the United States (as discussed in my blogpost in 2011 when the IOM report first came out here).

        In fact, one of the authors — Von Korff — noted in a recent media interview that their data were not intended to be used in the way that they were for the IOM report. Apparently, the MEPS study to which you refer was done after initial release of the IOM report and I have no reason to doubt that it might be accurate; in fact, if all types and degrees of chronic pain are considered across all segments of the population, that 100 million figure could be overly conservative.

  8. The figure of 100 million is more likely to grossly underestimate the number of people suffering from chronic pain. Chronic pain is both under-reported and often under-acknowledged as an unavoidable side effect of disease processes that demand even more attention than the pain that accompanies them. The fact of an increasing population above the age of 40 tells us that we have greater numbers of people with chronic problems; our culture of responding to people in pain with a “suck it up and walk it off” attitude does not encourage many people to seek help for their pain. This is especially true even for younger people like athletes, coal miners, construction workers and others whose work or play may cause physical injury — and this group is even less likely to talk about chronic pain. How many people won’t report pain because they cannot afford health care, or because they know too many others who have reported their chronic pain without receiving help? Thanks so much, Dr. Fudin, for being the “man who bites (watch)dog!”

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