Monday, January 22, 2018

Policy Update: New SPPAN Resource for Clinicians; Must Read Op-Ed; VT Rules; NPS Meeting; and More

header_email_sppanMost legislatures around the country have adjourned for the year, but the world of pain-related policy and advocacy is not slowing down.  Here are a number of highlights:

New Educational Resource for Clinicians—Opioid Dosage & Morphine Equivalency
Read SPPAN’s first resource in a series, Opioid Dosage & Morphine Equivalency: Implications for Meeting the Standard of Care when Comparing CDC Recommendations to State Policies. This tool examines the US Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain, and its effect on a variety of important clinical practice issues. Our goal is to help prescribers better understand how the CDC guideline’s recommendations match or conflict with state policy.

Must Read: Pay for Integrative Pain Care–AIPM’s Past President Powerful Op-Ed in USA Today
The juxtaposition highlighted in Dr. Bonakdar’s USA Today Op-Ed—receiving the Surgeon General’s letter as part of the “Turn the Tide” initiative on the same day that the author received two denials from two different insurance companies for biofeedback and acupuncture—is powerful, to say the least.

AIPM Executive Director Involved in Programs to Address Two Public Health Crises
AIPM Executive Director Bob Twillman recently spoke to groups in Illinois and Nevada about the challenges inherent in addressing two concurrent public health crises—prescription opioid abuse and chronic pain. The key point of the presentations was that using an integrative approach to pain management is one way to address both problems simultaneously without worsening either. Challenges to implementing this approach were highlighted, with a call for attendees to support policy changes to overcome those challenges.

SPPAN Director Advocates for Needs of People with Pain at NY’s MedTech
It was refreshing to see this panel included in MedTech’s annual meeting, Innovation Impact: Keeping New York’s Finger on the Pulse.  On September 27, Amy Goldstein, SPPAN Director, along with Charles Argoff, MD, and Scott Kelley, MD, were panelists as Mario Nacinovich, M.Sc., moderated “Feeling the(ir) Pain: Understanding Patient Needs as a Crucial Way Forward in Ending the Opioid Epidemic”  Ms. Goldstein and Drs. Argoff and Kelley, shared the realities of how simple solutions for complex issues can lead to unintended consequences. For example, without focused education and training early-on around integrative, multidisciplinary pain care, clinicians do not have a full toolbox at the ready to care for their patients.

Vermont Considering Significant Changes to Rules Governing PMP and Opioid Prescribing
The Vermont Department of Health is considering substantial proposed revisions to rules concerning both the Vermont Prescription Monitoring System and the Prescribing of Opioids for Pain.  Both proposed rules, if finalized as written, will significantly change current law, affecting both those living with pain and the prescribers who care for them.  Both proposed rules are scheduled for hearing on October 21st; further, both proposed rules will be accepting written comments until October 28th.

National Pain Strategy–Public Access Upcoming Meeting
The Interagency Pain Research Coordinating Committee (IPRCC) meeting scheduled for October 31, 2016, will be open to the public and accessible by live webcast and conference call. The meeting will feature invited speakers and discussions of committee business items including a progress report on implementation of the National Pain Strategy, updates on the Federal Pain Research Strategy, and new pain initiatives. Notification of intent to present oral comments must be submitted to submitted to Linda Porter, Ph.D, at, no later than October 17, 2016, and deadline for written/electronic statement by October 24, 2016.

If you have any questions or comments about any of the above information, contact us at:

Amy Goldstein, MSW, SPPAN Director,
Katie Duensing, JD, Asst. Director, Legislative and Regulatory Affairs,

4 responses

  1. Howard Dobel
    October 12, 2016 at 5:21 pm

    It is tragic enough to suffer severe pain over a period of decades. The rules and laws that you are putting into place all over the country are causing people to commit suicide. Life is not worth living in that much pain. The pain sufferers already do everything they can to avoid the nightmare of being physically dependent on any medication. These laws are intended to stop people who are going to commit suicide from using their medications to do so. What on earth makes you think for 1 minute that they will not simply choose another route to suicide? And as for the people who want to get high on something all you are accomplishing here is causing them to turn to other potential intoxicants, many of which are much more dangerous than prescription medication. In fact there are other prescription medications which are non-narcotic and not abusable that can be used to commit suicide. And there over the counter medications like aspirin. What you are failing to address is the fact that people are going to continue to commit suicide no matter what you do. It could be argued quite successfully that you are going to drive up the number of suicides in chronic pain patients because you have made obtaining relief from the pain so problematic that getting in a bathtub full of hot water and slashing some major arteries, or blowing their brains out with a gun, or any other manner of committing suicide will be their choice. Sooner or later the medical profession is going to have to grow up and face the philosophical conundrum presented by the fact that we are free agents able to our own Wills no matter what your particular personal moral and religious beliefs are. None of us have the right to own another individual. If America is about anything it is about that. Keep an eye on suicide statistics 4 people in chronic pain as you make it increasingly difficult for them tooth pain relief albeit at the cost of physical dependence. And what makes physical dependence on a pain medication any diferent than being dependent on a beta blocker.The chronic pain patient does not experience the side effects of pain medication as a high. In fact they get very sick of it, and have a tendency to try to reduce the amount of medication they use 2 only that which keeps them from leaping out of Windows. the

    • Howard Dobel
      October 12, 2016 at 5:25 pm

      The word tooth was garbled by google speak and should read to obtain.

  2. Gale Martinez
    November 6, 2016 at 10:47 pm

    I am a Registered Nurse on an Oncology Floor for 20 years of Nursing and a parent of a Nurse and a School Teacher. Plus helping to raise 3 lovely young teenagers who are my grandchildren. The 14 year old has Juvenile Arthritis and gets weekly shots of Methotrexate. His mother has Multiple Sclerosis and works so hard at a busy hospital and has pain, numbness but pushes through to keep her kids in sports. My point is genetics causes many health problems with the Inflammatory Disease.
    I have been married 38 years to the same person. Let us not judge until you have been in so much pain that you have to cry yourself to sleep. Or not be able to sleep because when you lie down with pain in my spine, hips and knees hurt so bad that I flip and flop all night long. My mother died when I was 16 years old. Leaving me to help my Dad raise the 3 younger kids out of 7 siblings. Genetically we all have Major Inflammatory Conditions leading to surgeries and disabilities. I have physically worked since the age of 15 years old to help raise my siblings and have worked so hard all my life. Now I feel like I am being monitored to a point that my pain is NOT controlled because the doctors are afraid of getting in trouble.
    I am now 57 years old and waiting to have my 3rd surgery for tears in hips and knee. Multiple Steroid Injections in my Cervical Spine, imagine having 4 pokes of steroid with a 7 inch needle to insert to the Faucet Joints. Now waiting to get my low back injected for about the 10th time. The steroid effects my mood, sleep, skin turns red for about 3-4 days flushing face and worst of all anxiety that makes you want to jump out of your skin.
    Now I have to use FMLA at work to decrease my hours due to the pain and limping I portrait at work that is even noticed by my patient in his 90’s. Now I am considering other positions? Sitting for long periods hurts, standing to long is painful and over 5 miles of clocked miles in an 8 hour shift on a busy floor helping, lifting, bending and trying so hard to be the best nurse I can. My smile gets less everyday. Although moving makes me feel best and distraction helps. I have down months of Physical Therapy too, it really just causes more pain. My plan is to use swim therapy.
    I am hoping to at least work until I am 62 years old, but I originally thought I could help out our retirement and work until the recommended age of 66.5 years per the government for full benefits. I feel like I am failing my family, I have a large house which I love to clean, a large yard and would love to garden without pain or at least some relief. This is not the way I saw my life going and it make me so sad and angry to have work so hard only to suffer.
    To the gentlemen Howard in the previous message regarding thoughts of suicide is a very true fact that when you are in so much pain that you can not function fully with out Opioids just so you can raise your family, care for your home and continue to work. I feel like I have to suffer because when I take NSAIDs I get Ulcers, Diverticulitis Flair ups or abdominal pain IBS. These conditions go hand in hand of the real problem of Chronic Inflammatory Disease.
    I have tried alternatives and you should see how many time I am made to going to multiple doctors because the power has been taken away from my PCP. Not by my choice. I have to go for a different visit for every joint. Talk about insurance fraud??
    Very sad to suffer and I hope that anyone who takes an MD’s privilege away because of the drug abusers have ruined it for legitimate hard working people or any patient who goes to all there doctors appointments can not be given relief due to the narcotic problems brought on by others.
    Feeling disappointed.
    My solution is to have a Pain Specialist Appointment once a year and bump it back to the PCP who knows me best.
    Thanks for letting me vent. I hope I can help another person in chronic pain!

  3. Jeff Cook
    November 17, 2016 at 12:21 pm

    I could not have said this better. This new “Crusade” to save us from our selves has only made my life a living hell. I can’t help it that I have a chronic pain condition but yet I’m viewed as a weak, pathetic drug seeker. We are doubted, viewed with suspicion, viewed as master manipulators and consequently negatively treated as a high risk patient. This alone has given me some very depressed days because I have my integrity constantly challenged.
    The reality is, at least in my life, I don’t really get a “High” from the very low amount of opiates that I take. Yes, when I first began taking opiates there was that warm fuzzy feeling but that has long left me. Now, I can hardly perceive a feeling other than the fact that my pain is lessened, which is the whole point! There are so many misconceptions about all of this because no one stops to really listen to the patient. All anyone (Doctors, PR actioners, etc.) can think about is their own liability and business interests. And because of that, so many patients are truly suffering. Its time to stop and look at this issue from ALL perspectives and give patients a voice at the discussion table.
    I’ve long contended…are we looking at an “Opiate Crisis” or a “Suicide Crisis”? Suicide by overdose is the easiest way out and that’s why we are truly seeing a crisis in my opinion. I’ve been prescribed a low dose of opiates for 16 years now and have not been affected negatively nor had a desire to increase my intake. Both of which are the battle cries of the doubters. So, what is the REAL crisis here?

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About Amy Goldstein, Director of State Pain Policy Advocacy Network