Abstract from paper
Long-term opioid therapy has the potential for serious adverse outcomes and is often used in a vulnerable population. Because adverse effects or failure to maintain benefits is common with long-term use, opioid taper or discontinuation may be indicated in certain patients. Concerns about the adverse individual and population effects of opioids have led to numerous strategies aimed at reductions in prescribing. Although opioid reduction efforts have had generally beneficial effects, there have been unintended consequences. Abrupt reduction or discontinuation has been associated with harms that include serious withdrawal symptoms, psychological distress, self-medicating with illicit substances, uncontrolled pain, and suicide. Key questions remain about when and how to safely reduce or discontinue opioids in different patient populations. Thus, health care professionals who reduce or discontinue long-term opioid therapy require a clear understanding of the associated benefits and risks as well as guidance on the best practices for safe and effective opioid reduction. An interdisciplinary panel of pain clinicians and one patient advocate formulated recommendations on tapering methods and ongoing pain management in primary care with emphasis on patient-centered, integrated, comprehensive treatment models employing a biopsychosocial perspective.

Read the whole paper.

Get tips for reading scientific articles.
 
Read my thoughts on opioid therapy as a patient who tapered off them.
​

I watched last night on “Torn From the Headlines: New York Post Reports,” a story about a 68 year-old kidnap victim who survived 12 days buried alive in 1993.
 
The victim was Harvey Weinstein, the CEO of a tuxedo manufacturing company. His kidnappers held him for ransom for $3 million in dark tomb –  with him surviving on just some pieces of fruit and little water.
 
What an amazing story of strength, I thought to myself as I watched the show.  We can learn a lot from this man.
 
So, I did some reading this morning to learn more. 
 
There is a quote from Weinstein from a 1993 Los Angeles Times article that hit home for me. He said, “I can’t permit fear to govern my life.” 

We can do the same when it comes to chronic pain. Sometimes, it’s the fear of pain that holds us back.
 
Read the story.

We've reached 1,000 members in my Chronic Pain Champions - No Whining Allowed Facebook support group.
 
Thanks to everyone who has shared my group with their patients and friends!
 
While I’m glad to see the growth of the group, I look forward to the day when there isn't any chronic pain. In the meantime, keep sharing.

Join us!

​Chronic pain appointments can be difficult for both patients and doctors. 
 
For patients, doctor visits can be intimidating and create anxiety.  We want validation of our pain, empathy, answers, and support.  
 
For doctors, chronic pain patients can be more challenging to treat than other patients.  We can be demanding of their time, attention, and patience.
 
While they truly want to help, doctors often have limited training (typically 11 hours of pain education in medical school), limited time (18.5 minutes per appointment), as well as limitations due to government and insurance guidelines.
 
So, how do you make the most of your appointment time and get the best treatment when you visit with the doctor?
 
Below are 23 suggestions to help maximize the patient-doctor experience  (thanks to the many ideas provided by members of the Chronic Pain Champions – No Whining Allowed Facebook support group):
 
 
In general
 

1. Don’t bring any bad experiences you may have had with other doctors to your appointment.  You don’t want to muddy your doctor relationship.  Start with a clean slate.
2. Go with a stated purpose but don’t go with any pre-conceived expectation about getting a certain treatment, like opioid therapy, or a specific diagnostic test, like an MRI.  Unfortunately, there isn’t an easy answer for chronic pain.  It’s not like prescribing an antibiotic to cure an infection.  Most chronic pain doesn’t have a cure.  You may not be able to be fixed.
3. Ask your doctor about arranging recurrent appointments (quarterly, etc.) just for pain management as well as scheduling extra time, if needed, for those appointments.
4. If you’re seeing the doctor about other medical conditions unrelated to your normal chronic pain, don’t talk about your chronic pain.  Keep it for your regular pain visits.
5. If you find you and your doctor aren’t a good match, then keep looking for another provider.  Some patients have found a nurse practitioner a viable alternative to a physician.  There are a variety of healthcare providers available to team with.

 
 
Before the appointment
 

1. Make a prioritized list of topics/questions you want to cover at the appointment.  That way you won’t forget things and you’ll stay focused.  
2. Draft an alphabetical list of medications (including over-the-counter medications/supplements).  Include the medication name, the dose (such as 5MG), how many pills you take and how often you take them, as well as the name of the doctor who prescribed them.  Include any drug allergies on this list.  Download this free template.
3. Put together a medical summary of major health events, medical conditions, surgeries, and special treatments related to your pain condition.  Make it easy to read and keep it short, one- or two-pages, so the doctor can get a quick snapshot of your past history.  Download this free template.
4. Arrange for a family member or other trusted person to go with you to the appointment to be a second set of ears and take notes.
5. If you hear something you think might be helpful in your diagnosis or treatment, take time before your appointment to find evidence-based scientific research to support it  (Google Scholar is a good search engine for this). 

 
 
At the appointment
 

1. Arrive early and bring all required office paperwork, including your insurance cards.
2. Give your prescription list to the nurse to help them reconcile your medicines.
3. Share copies of your prioritized list of topics to cover at the appointment with your doctor and support person.
4. Bring a copy of any supporting research to give to your doctor.  Be prepared to talk about it. 
5. If visiting with a new provider, bring your medical summary and any relevant diagnostic tests like x-rays.
6. Be blunt and to the point when talking but stay non-emotional, respectful, and factual.  No drama, whining, or catastrophizing about the pain.  And don’t get angry or be rude.  
7. Talk to your doctor about what is happening in your life and how your chronic pain is affecting it.  Pain isn’t a just number on a pain chart.  It’s a biological, psychological, and social experience.  Talk about your emotions, your ability to work, your relationships, and your ability to do daily activities.
8. Be specific when describing your pain symptoms.  Tell the doctor when the pain started and how it started, what kind of pain you’ve been feeling (aching, throbbing, sharp, burning, pins and needles, shocking, numbness, etc.),  how often you experience the pain, where the pain is located (lower back, head, etc.),  and what you’ve done to help reduce the pain (ice, heat, etc.).
9. Talk to your doctor about treatment goals and both medical and non-medical treatment options.  Once pain becomes chronic, the ultimate goal of treatment is often increasing functional ability and quality of life, not pain elimination.
10. Be open to discussing any suggested treatment recommendations and work with your doctor to find the right treatment plan for you.  
11. Clarify and confirm.  Ask questions if you don’t understand something.  Repeat what you heard to make sure you heard it correctly.
12. Be patient as a patient.  It may take several doctor visits and/or different treatments before you recognize improvement.
13. Be grateful.  Thank the doctor.

 
 
Bottom line
 
To get the best treatment from your doctor, be prepared, calm, engaged, insightful, and open to taking more self-responsibility for your own care.  It’s harder for doctors to treat patients who are negative or who expects the doctor to fix all of their problems.
 
I hope you find these tips helpful.