Nevada Pain Physicians Fight for Patients.... Arizona Not So Much

I work with a group of pain management physicians in Nevada to fix the damage the CDC Pain Guidelines did to pain management. I find it sad that every Arizona pain physician I've talked to didn't understand the CDC Guidelines and failed to follow the Opioid Epidemic Act.

Update from a Friend to Patients

 The other day a hearing was held in D.C. of the Senate Health, Education, Labor and Pension Committee specifically to discuss “Managing Pain During the Opioid Crisis.” The panel, which includes Nevada Senator Jacky Rosen, heard from Cindy Steinberg, National Director of Policy and Advocacy for the U.S. Pain Foundation and Policy Chair of the Massachusetts Pain Initiative;  Helen Gazelka, M.D., Chair, Mayo Clinic Opioid Stewardship Program; Andrew Coop, PhD University of Maryland School of Pharmacy; and Anuradha Rao-Patel, M.D.,  Lead Medical Director for Blue Cross-Blue Shield of North Carolina. 

The primary question of the meeting was – should the federal government get into the business of determining maximum dosages for opioids -  and the answer was a resounding “no.”  Senator Murkowski from Alaska noted that her constituents are being denied legitimate prescriptions by their pharmacists, and others noted that the CDC guidelines are having severe unintended consequences in the form of primary care docs no longer prescribing at all, and many states not having adequate numbers of pain docs.  

There was lots of discussion regarding coverage for “complementary treatments” like acupuncture, PT, OT, aquatic therapy, injections, etc. but an acknowledgement that opioids can and should be available to those who need them.  

There were several statements to the effect that “there’s no evidence that opioids are effective for long term pain management” and those were summarily rejected by both Senators and two panelists (Ms. Steinberg and Dr. Coop).  Senator Bill Cassidy from Louisiana, a gastroenterologist who noted that there’s also “no evidence” that the epidural injections he received for his cervical issues were effective yet they were in fact effective for him.  So in other words – absence of evidence is not evidence of absence.

At the the end of the hearing - the panel was asked what should be done with the CDC guidelines - and while the Mayo Clinic representative stated that she used them extensively, all agreed that they have been mis-applied and should be revised.  I take that as very good news indeed.