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My thoughts

My thoughts about opioid therapy

6/22/2022

 
My most recent article published in Practical Pain Management "We Have a Chronic Pain Problem, Not a Prescription Opioid Problem" explored the efficacy and safety of opioids for chronic pain as well as the need for more pain rehabilitation programs.

Below are a couple of additional thoughts not included in the article.


Opioid users don’t know what they don’t know – “try it, you may like it”
Unfortunately, there isn’t a crystal ball when it comes to pain treatment. There's no way of knowing how a patient will respond to any specific type of therapy. And tapering can be hard. Chronic pain patients can be weary of tapering opioids for fear of increased pain and the general fear of the unknown. 
 
It’s important for patients to accept the possibility of worse pain and other symptoms during a taper. It’s also important for providers to remember to treat the entire person in pain and not just manage the taper.
 
Transitioning to self-management built around pain rehabilitation takes time. It’s a marathon, not a sprint and requires work from both provider and patient. It’s like the old joke “How do you get to Carnegie Hall? Practice, practice, practice.”
 
Opioid treatment is a decision between provider and patient
The use of opioids is a shared provider-patient decision based on risk and reward including the history and needs of the patient and should be applied on a case-by-case basis.
 
If the decision is to reduce or stop opioid therapy, tapering should be done with education about the benefits of opioid reduction and provider oversight. If the decision is to use opioids, they should be prescribed at the safest lowest dose. Either decision should include pain rehabilitation and self-management strategies.

Find rehabiliation programs and self-management tools
Read about my experience at the 3-week Mayo Clinic Pain Rehabiliation Center

Learn more about opioids, pain management, and the Compass Opioid Stewardship Program

Read my published articles. Hear my story.

6/16/2022

 
  • We Have a Chronic Pain Problem, Not a Prescription Opioid Problem
  • A Letter to Pain Providers: 10 Do and Don’t Tips from a Chronic Pain Patient 
  • Are You Missing Two-Thirds of Your Potential Pain Treatment Plan? 
  • Five things I wish I knew earlier in my journey with chronic pain 
  • Hopping Off the Pain Merry-go-round
  • My Time at the Mayo Clinic Pain Rehabilitation Center 
  • Stop Whining and More No-Nonsense Tips from a Chronic Pain Champion​​ ​
  • Compass Opioid Stewardship - Learning to Champion Chronic Pain

Be kind to yourself

6/15/2022

 
There's still a core you despite the pain.

What you can do
  • Write down your positive qualities and accomplishments – what’s good about you. Sometimes we can be own worst critics.
  • Balance expectations.
  • It’s okay to not be perfect – everything doesn’t have to be in place.
  • Say “no” if you need to.
  • Accept help.
  • Forgive yourself (sometimes we are our own worse critics).
  • Eat healthy.
  • Sleep better with these tips.
  • Talk with your loved ones about your needs and challenges without complaining. We don’t want sympathy, we want understanding.
  • Reward yourself and celebrate your successes, no matter how small.
  • Check out these helpful self-compassion exercises and practices from Dr. Kristin Neff.
  • Read this article "The Role of Self-Compassion in Chronic Illness Care".
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Beware of supplements

6/13/2022

 
Did you know?
  • Supplements aren’t regulated by the FDA.
  • China is the main supplier of supplement ingredients.
  • More than 50% of the U.S. adults take supplements.
  • Products labeled natural aren’t necessarily safer.

Editor’s note: This article was written based on my experience and what I have researched about the topic.  Everyone is different. The decision to use supplements should be a decision between doctor and patient.
 
As part of the week-long Mayo Clinic fibromyalgia program I attended in 2016, I met with a pharmacist to review the long list of prescription medicines, over-the-counter medicines, and supplements I was taking at the time. My medicine cabinet looked like a GNC store.
 
I was instructed to bring the actual bottles with me to the appointment, so I packed the bottles into a gym bag (yes, I was taking a lot of medicines and supplements) and went to see her.
 
I was surprised as she read each bottle, making comments and recommendations about each pill – including product quality, labeling issues, ingredient safety, and dosing.  
 
When the appointment ended, my medicine and supplement list was much shorter with her recommending stopping most of the supplements and my gym bag much lighter – throwing away the pills was going to stop taking. I kept only one supplement - Vitamin D.
 
Limited oversight
Unlike prescription or over-the-counter drugs, which must be approved by the Federal Drug Agency (FDA) before they can be marketed, the FDA doesn’t review supplements for safety and effectiveness before they are sold.
 
We don’t know where the products are made, how they are made, what is in them, and if the dosage is appropriate.
 
Safety is left up to the manufacturers and distributors of the supplements.  
 
Bottom line
You assume all risk when using supplements.  While some may be valuable, many aren’t and some may even be harmful.
 
Learn more
  • American Roulette — Contaminated Dietary Supplements
  • Natural supplements can be dangerously contaminated, or not even have the specified ingredients
  • Hundreds of Dietary Supplements Are Tainted with Prescription Drugs
  • Dr. Pieter Cohen Explains Dietary Supplements and Regulations
  • What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD
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Stop the pain talk

6/9/2022

 
Do you talk about your pain or complain about it? What do you do if other people ask you about your pain?

Pain talk is a maladaptive pain behavior – worsening symptoms by adding more attention to the pain.
We can't move forward if we're constantly reminding ourselves of the pain or if we 're surrounded by negativity.

I choose not to talk about my chronic pain to myself or with others, including my doctors (unless there is a new symptom that need acute treatment).

Learn more
  • Chronic Pain Won’t Stop Me! , Chapter 4 (my free e-book)
  • Should You Stop Talking About Your Pain? (Dr. Evan Parks)
  • Reducing Pain Talk: Coping with Pain Series (Institute for Chronic Pain)
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cognitive behavioral therapy for pain

6/5/2022

 
Our thoughts, emotions, and behaviors can make pain worse or more manageable.

It's called Cognitive Behavioral Therapy or CBT.

CBT is based on the core principles that our thoughts, emotions, and behaviors interact together with the pain; that we can become trapped in unhelpful thoughts, emotions, and behaviors; and that we can modify our thoughts, emotions, and behaviors to make our experience more manageable.

It's what changed my pain experience and my life.

Best yet, CBT is a do -it-yourself therapy. You can use it anytime. You don’t need help from anyone once you learn it. And there are no negative side effects.
​
Learn more and do more
  • What is CBT?  (McGovern Medical School)
  • Chronic Pain Won't Stop Me! (My free e-book)
  • ​A Magical Cure for Pain? No – it’s just Cognitive Behavioral Therapy  (Dr. Rachel Zoffness)
  • Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach​ (WebMD)
  • Brief Cognitive Behavioral Therapy for Chronic Pain: Patient Guidebook (Department of Veteran's Affairs)
  • Cognitive Restructuring Worksheet (University of Washington)
  • Replacement Thought Examples
  • The Pain Management Workbook  (Dr. Rachel Zoffness )
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Image courtesy of McGovern Medical School

    Author

    Tom Bowen is a chronic pain patient who turned into an advocate, educator, and collaborator.

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