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    Charles - "Research and the search for a Gold Star"
    BrenBren30813 posted:
    Hey Charles, I'm posting this here and on the good 'ol pain management exchange, because I think your input would be valuable to many here and there. Thanks in advance for reading - B

    Charles, or anyone with experience and tangible research data...
    My new pain therapist will be helpful in training me in biofeedback and sleep methods, but he is stomping on some ground that makes me feel that he is one of those doctors seeking a "gold star" for the treatment of patients OFF opiods. I will go to him for cognitive therapy, I believe in than! But I don't trust a doctor who says that spinal cord stimulators have a higher success rate than long term narcotic regimes...IS HE SERIOUS?? I know that Charles has presented data, so I want to obtain it and print it out to take to my next appt.

    I told him that I'm extremely unsettled by the fact the SCS implant has such a low success rate, and before any doc is going to implant a foreign object in my body, I need to meet those patients he has had success with (learn the rates from his procedures in general) and hear testimonials. He went on to tell my that he has a friend who had 3 back surgeries and the implant has gotten him back to his career/life. Then he told me another woman w/ pelvic pain couldn't get the trial because she had so much scar tissue from surgeries. He is a pain psychologist and claims to have no "ties" w/ the doc downstairs from him, who does the implant and offers the trial WITHOUT any pain medications.

    I feel he is trying to get me away from my current doc (who actually referred me to him) and get me to go downstairs to see a new pain doc (in the same group as he is) - By the way, that doc in his group does not offer narcotic therapy. He told me there is such a thing as "hyper-algesia" - where patients on chronic pain meds for the long term receive more pain (increase in pain signals), as the narcotics will no longer work as well and increase pain. He is steering me away from the medications because I'm "only 34 and I will not tolerate medications for much longer (they won't be as effective)...and what will you do when your 50 and these meds don't work anymore??"

    I feel the more docs I see, the more they want to convince me to do invasive procedures, get off pain meds, take even more anti-depressants, and BOOM (like that) I will be PAIN FREE!!! Wow, that is so inviting, but I do have a brain that tells me not to go to a doc that won't offer pain meds, even in the trial period of an SCS implant....What happens if it fails and I'm in more pain??? THIS SUCKS...I'm sick of ignorance, and doctors seeking a gold star, and feeling so much better after getting yet another patient off of narcotics....

    By the way, he says that "studies have shown that pain patients who have taken long term narcotics, reflect that a patient can be successfully weened off the drugs in 4 months, and have a significant reduction in pain!! WOW sign me up...but Charles, you have more sense/experience and from what I've learned here...THIS IS A CROCK

    Please respond, present any study - even if it has drawings - to show this guy before I get yanked into a galaxy of star-seeking physicians!

    Thanks for your time, B
    earlyretirement responded:
    I have read your message (new to this) but with this fairly recent change with how there doing there message boards now I have seen Charles on a different exchange, maybe the Chronic Pain one. but with so many now it's seems to be a little more difficult to track people. I only butted in because I noticed you didn't have a response yet....sorry. I have read some of the research articles he has posted and seems very knowdegable at that and the one of hyperalgesia-lengthy but informative....again I apologize but you may need to search around the other exchanges to find him but I believe they have a directory I haven't quite figured out yet...Good luck
    rico903 replied to earlyretirement's response:

    If you can find any kind of directory please post it. I'm fairly new here and can't find my way to the different boards.
    earlyretirement replied to rico903's response:
    I did find it and a little embarassed about it because it's right at the top of this page, directly on the left...called "member directory" LOL.
    cweinbl responded:
    Hi Bren. It's called "hyperalgesia," and it refrers to an exceedingly rare condition in which people either fail to obtain relief from narcotics, or the drugs make the pain worse. Most physicians will practice 40 years and never see a case of hyperalgesia. If you had it, you would have experienced no relief at all from your narcotic pain medications, or an increase in pain associated with them. So, is that true in your case? Do narcotics make your pain worse?

    Doctors today are highly motivated to avoid appearing on a DEA list for prescribing large numbers of narcotics. Sadly, the patient suffers so that the doctor can feel safe from federal investigators. In reality, the only doctors investigated by the DEA are those that prescribe massive amounts of certain narcotics. The average physician will never draw that much attention. And, most physicians in general practice wil have two or three dozen patients using powerful narcotics, for very good reasons. That's not enough to make the DEA sniff in their direction (no pun intended).

    Some doctors also fear patient litigation related to narcotic accidents, overdose cases or bad reactions. Again, only a tiny percentage of these accidents occur. But the other patients suffer needlessly when doctors fear prescribing appropriate medications.

    I functioned so well on powerful narcotics over 20 years that I was able to manage a university division and still have time for my family. Opiates are natural substances in the body. They damage no organs and can be safely used in large amounts over a lifetime, if necessary. If narcotics help you, if they work well, you should not be stopping them unless you have a better replacement. Do you?

    The success rates for the intrathecal pump and the spinal cord stimulator (at 12 months) are about 50%. For patients with prior spine surgery it is more like 40% and for those who have never had surgery, it is more like 60%. But, frankly, a 50% or 60% surgery success rate is TERRIBLE! Would you have knee replacement surgery if you had a 50% chance of failure? Would you have LASIK with a 50% success rate? Would you have ANY elective surgery with that high failure rate? And, each time a stimulator or IT pump fails, more surgery is required to remove the ineffective device.

    Bren, I'm not sure I would stop the medication as long as it helps. Cognitive therapy is terrific. Physical therapy is great, as long as it helps. Continue to keep an open mind.

    The reason that most people on long-term opioid therapy experience an increase in pain is tolerance, not hyperalgesia. Tolerance is easily dealt with by increasing the medication dosage. When a maximum safe dosage is achieved, you rotate to a different opiate. After a couple of months, you rrturn to the original drug and it's more effective again. Frankly, this hyperalgesia nonsense is pure BS from someone who wants his patients off of narcotics for his own reasons, not for the benefit of the patient.

    If you want to try going off narcotics, that's up to you. As long as going back to narcotics (if it doesn't help) remains your decision, you have nothing to lose. But, I would want that in writing. Good luck!
    cweinbl replied to cweinbl's response:
    Contact me at , with questions or concerns.

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