For many chronic pain sufferers their cries of anguish are not just due to the pain, but due to their inability to have their genuine pain treated adequately.

For the longest time,the “opioid crisis” has made it difficult for many patients to be adequately treated.

As you know, if you have been listening to many of our shows over the past two years, The Center for Disease control also referred to as the CDC has established a Guideline for physicians to follow in order to, as they call it, best treat patients with long term chronic pain.

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Most of what is in the CDC guideline is appropriate and done with good intentions in order to treat chronic pain in a safe and professional manner.

The problem lies in being able to follow the guidelines in the real world

All treatments for pain as well as for any disease should follow protocols that begin with the least dangerous and most efficacious treatments.

In the case of chronic pain this could include procedures such as yoga, mindfulness training, acupuncture, hypnosis and non-steroidal medications such as ibuprofen and naproxen.

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The latter two are rather inexpensive, but often are contraindicated in patients such as those with bleeding problems or peptic ulcer disease. There are other medicinal treatments such as antidepressants, for example that can help many/. However, in many cases, these simply do not afford adequate control of the pain and limited range of motion that plague chronic pain sufferers.

Then there are the more expensive treatments such as massage therapy, physical therapy, occupational therapy, trigger point injections and epidural injections.

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Even these may not work adequately in the case of chronic pain. Apart from that, thay can be expensive and they may not even be covered by medical insurance, medicare or Medicaid.

So when all else fails, what is left. I don’t want to bury us all in rhetoric and descriptions of the next level of pain relief. Carmen and I have already gone over this on multiple shows.

Without the availability of other treatment there is still available a treatment whose name constitutes a 4 letter word. It’s spelled O=P=I=O=I=D. Well its actually a 6 letter word. But it might as well be a 4 letter one the way it has been treated by

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many in the media, politics and within the medical community as well.

The media has concentrated on the opioids and how they have purportedly affected the general public. We have heard daily on all news media how the opioid crisis and drug addiction is affecting our population.

But very little has come to light about how this has affected those patients, millions of patients, whose chronic pain can be excruciating and unbearable, have been made to suffer in the oft misguided plan to slow or end the misuse of opioids in America.

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As I said in the beginning of the show, there are patient’s whose only available treatment for their chronic pain is at present, opioid therapy.

But many have been limited in the amount and types of medications that they can get prescribed by their physicians, filled by their pharmacists and produced by the manufacturers.

I remembered a joke about a person who decided to try his hand at investing. So he started slow by investing a few hundred dollars in a stock that, on quick perusal looked good to him. He called his stock broker.

and purchased the stock. Next day he calls the stock broker who tells him that the stock has gone up

and the investor has made a profit. So the gentleman, hearing this tells the broker to purchase more. Each day he calls the broker and asks how his stock is doing and the broker gives him the same answer. It going up. Finally after several weeks he tells the broker that it is time to sell so he can reap all the profits.

IT IS THEN THAT THE BROKER SAYS TO HIM “To whom should I sell, You are the only one buying.”

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Phone rings.

Broker: HelloInvestor: Hello This is George Craniopolis. After looking at the market I would like to by $100 of Serendipity Stock. I think it’s a winner.

Broker: Okay Done.

Next day

Phone rings.

Broker: Hello

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Investor: Hello This is George Craniopolis. How has my stock done.

Broker: Let my look. Hmmm.

Okay It’s gone up.

Investor: Great. Get my $100 more of the stock.

Broker: You bet.Each day George calls the broker and asks how his stock is doing and the broker gives him the same answer. It going up.Finally George decides to sell and reap the rewards. He calls the broker one last time.

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[Telephone rings]

Broker: HelloInvestor: Hello George here. It’s time. Sell all my stock.

Broker: How, George, you were the only one buying.

The moral here is Before making expensive decisions do your homework. Not everything is at it seems.

When the U.S. Attorney General says that 80% of all heroin addicts started with Prescription opioids, it is not the same as saying that 80% of those prescribed opioids go on to become heroin addicts.

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Indeed the actual number is more around 4%.

But still today, many chronic pain patients are suffering.

Not just from the pain itself, but from the stress of getting their medication in the right dose for their pain level and their decreased quality of life.

Very few have stood up in their defense.

Until now!

I JUST READ AN ARTICLE THAT APPEARED IN THE PAIN NETWORK NEWS TITLED:

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HUMAN RIGHTS WATCH INVESTIGATING U.S. PAIN TREATMENT

Human Rights Watch  happens to be an internationally well-known not for profit organization that reports on human rights violations around the world.

Recently, for example the organization reported on the torture of prisoners in Sri Lanka, forced labor in Thailand, and corruption and mass arrests in Saudi Arabia.

Human Rights Watch is now launching an investigation into the treatment of chronic pain patients in the United States. The impetus for the investigation began when researchers were studying the treatment of cancer and palliative care patients – and began to see poorly treated pain as a human rights issue.

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According to Diederik Lohman, Director of Health and Human Rights for Human Rights Watch, People that they interviewed who didn’t have access to appropriate medications for their pain were essentially giving testimony that was almost exactly the same as the testimony that they were getting from the victims of police torture.

He then went on to say that the group realized this was actually one of those issues that almost no one was paying attention to.

People were facing tremendous suffering that actually could be relieved pretty easily through very inexpensive palliative care and pain management.”

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In many third world countries, Lohman says opioid pain medications like morphine are difficult to obtain, even for patients dying of cancer.

As they continued their investigation they started hearing more and more stories of chronic pain patients in the U.S. who had been on opioids, who were being told by their physicians that they were going to be taken you the medications.

And they started hearing stories of patients who were having a lot of trouble finding a doctor who was willing to accept them as a patient.

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As many chronic pain patients know it is also quite difficult to find a pharmacy that will fill the prescriptions for a myriad of reasons that they are given.

Mr. Lohman said that Human Rights Watch is well aware of the addiction and overdose crisis in the U.S.

But he also said that the “right balance” needs to be found between keeping opioids off the street and making sure medications are still available to legitimate patients.

They stated that part of the investigation will focus on the role played by the opioid guidelines released by the Centers for Disease Control and Prevention in 2016, which discourages doctors from prescribing opioids for chronic pain.

Although voluntary and intended only for family practice physicians, the CDC

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guidelines have been widely adopted as mandatory rules by other federal agencies, states and insurers.  

The impact of the guidelines was sudden and powerful. Within a year of their release, a Pain network news survey of over 3,100 pain patients found that 71 percent had their opioid medication stopped or reduced.

Nearly 85% said their pain and quality of life were worse.

“The CDC clearly knows what's going on and they haven’t taken any real action to say, ‘That is not appropriate, involuntarily forcing people off their medications. That’s not what we recommended,'"

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According to Mr. Lohman “When a government puts in place regulations that make it almost impossible for a physician to prescribe an essential medication, or for a pharmacist to stock the medication, or for a patient to fill their prescriptions, that becomes a human rights issue.”

So Human Rights Watch is looking for testimonials from chronic pain patients who have been forced or encouraged to stop their opioid medication by physicians or pharmacists.

They’d also like to hear from patients who have been forced or encouraged to seek alternative forms of treatment, but who then found those treatments financially or geographically inaccessible.

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The researchers hope to complete the investigation by the end of the year.

So if you are a chronic pain sufferer and have been affected adversely by the new regulations and the guidelines and you would like to share your story with Human Rights Watch please email researcher Laura Mills at millsl@hrw.org.

We have often heard the terms stress and anxiety So what’s the difference between the two mental-health issues?

We have often heard the terms stress and anxiety used interchangeably but are they the same. Let’s look at this topic a little more in depth.

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First there are similarities and this is what makes it more confusing. They are both traumatic states of emotional and psychological strain that are driven by a vague feeling of impending doom or upcoming deadlines. 

Big difference number one between anxiety and stress is that stress almost always comes with an identifiable cause.

Stress is often caused by a particular situation or frustrating thought. This means that, in effect, stress is a reaction to a stressor and disappears when the situation is resolved.

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So even those who lead high-stress lifestyles may find time to decompress.

This means that the seemingly all-consuming state of worry is not actually absolute.

People who are stressed , during those periods of decreased stressors are able to have fun.

They’re able to not worry about things going on, and they’re able to live their life to a certain extent

And, this ability to turn off the light on stress, so to speak, is a key difference between it and anxiety. 

Let’s move on to anxiety.

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When people use the word “anxiety,” they’re likely referring to one of two things:

A general feeling of anxiousness called situational anxiety and a clinical anxiety condition.

In the case of situational anxiety when an incident happens in your life that results in feeling extremely emotionally distressed, being very worried about the future and the present, and having emotional responses and fears that seem out of control.” You could call it extreme stress.

Approximately 18 percent of the country’s adult population (40 million people) suffers from an anxiety condition.

Anxiety conditions, however, are different and are among the most common mental

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illnesses in the country; approximately 18 percent of the country’s adult population (40 million people) suffers from one—though only 37 percent of those who suffer receive treatment at least according to the Anxiety and Depression Association of America or ADAA. 

The most common type is generalized anxiety disorder or GAD.

This affects a little more than 3 percent of the US population, with women twice as likely as men to have it. 

When someone suffers from GAD, “their worry thoughts and physical symptoms of anxiety do not dissipate in frequency or intensity.

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Other types of anxiety include social anxiety disorder, panic disorder, and agoraphobia which is the fear of places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

All anxiety disorders can cause “excessive worry, thoughts and feelings of apprehension that make the person feel very emotionally distressed, and make them have a lot of fear about things that may or may not happen.”

But how can you really differentiate between anxiety and stress.

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Differentiating between stress and anxiety can be difficult since their physical long-term manifestations both include “decreased energy, gastrointestinal distress, insomnia, low immunity, and depression.”

An anxiety condition will be more consistent and pervasive, with no need for any situational stimuli

If you have an anxiety condition, you likely experience the symptoms of situational anxiety, except “on a nearly daily basis, most of the day,” instead of just on occasion. 

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Basically, anxiety can just happen and persist without any warning signs.

Untreated anxiety can lead people to “feel very on edge and restless, have a hard time concentrating, easily tired, irritable, have muscle tension or have difficulty with sleep.

And, if you’re having a hard time carrying out the functions of your daily life at work or at home, even things like doing the dishes—due to distress derived from anxiety, its probably time to do something about it.

Your question may be Okay, so how do I treat what I’ve got?

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It’s essentially figuring out your own self-care needs, like “positive social supports, healthy eating habits, physical activity” as well as anything that creates opportunity for new and enjoyable experiences.

But if stress is not well managed then it can build and manifest anxiety.

The two can then feed off each other—the anxiety will cause more things to be interpreted as stressors, which will continue to compound the anxiety until “the individual is overwhelmed and run down physically and emotionally.”

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One way to treat anxiety is often called the “the gold standard” and it is cognitive behavioral therapy or CBT.

Cognitive behavioral therapy is a short-term therapy technique used by counselors and therapists to teach individuals to change their unwanted behaviors by changing their thought patterns. But you can learn a lot on your own.

The premise of cognitive behavioral therapy is that our thought patterns , what we call cognition, and interpretations of life events greatly influence how we behave and, ultimately, how we feel.

CBT was initially modeled 40 years ago to treat depression.

But there are now effective cognitive-behavioral models for treating panic

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disorder, post-traumatic stress disorder, generalized anxiety, insomnia, social phobia, childhood depression, anger, marital conflict, substance abuse, schizophrenia, bipolar disorder, borderline personality, dental phobia, eating disorders, and a whole lot more.It emphasizes the need to identify, challenge, and change how a situation is viewed.

According to CBT, our pattern of thinking is like wearing a pair of glasses that makes us see the world in a specific way. CBT creates an awareness of how these thought patterns create our reality and determine how we behave.

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The perceptions and interpretations of depressed persons are distorted.

Depressed individuals are likely to engage in "cognitive errors," such as a negative mindset, jumping to conclusions, catastrophizing, and thinking only in black and white.

These errors in thinking are automatic thoughts that come spontaneously.

The individual accepted them as truths instead of distortions.

What CBT does is focus on modifying the automatic thought by challenging the validity of the thoughts against reality.

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When an individual stops negative, self-depreciating and catastrophic thinking, their distress decreases and they are better able to function in the desired way.

So the real purpose of cognitive behavioral therapy is to change thinking and behaviors that prevent positive outcomes.

Specific skills that involve recognizing distorted thinking, modifying beliefs, relating to others in different ways are practiced, and eventually the individual can learn to behave in the desired way.

When an individual experiences a stressful event, automatic thoughts come to mind and can lead to negative moods and emotions.

A person might overreact, worry, and even feel sick.

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The person makes a faulty assumption or an incorrect conclusion on the meaning of the event based on no reliable truth but rather the automatic thought process that is often not even recognized.

And here is where the problem is.

This faulty thinking becomes a feedback loop unless interrupted and tested against reality.

You must learn to recognize how distorted thinking directly affects moods and emotions, and learn how to change rigid thinking patterns.

A quick example involves a person who fears going to the dentist because they believe they will suffer severe pain or even death from a dental procedure.

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Maybe the fear began with a negative early childhood dental experience.

A person with this phobia may lose sleep, experience extreme anxiety, and may simply neglect caring for his teeth.

So the person thinks (maybe even subconsciously) that because they had pain with a filling all dental visits will be painful

This individual will need to learn to address the faulty thinking (because I had pain with a filling all dental visits will be painful) and develop a plan to overcome the fear.

CBT is problem specific, goal oriented, and is designed to achieve remission and prevent relapse of a specific disorder.

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There is a self help learning course for CBT on the internet.

If you are interested in learning the technique got to bit dot L Y forward slash CBTHelp. That’s bit dot L Y forward slash CBTHelp

Changing your eating habits, not just the way you eat but when and what are vitally important not only to your physical health but your emotional and mental health.

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Make yourself a goal of learning about nutrition and how to better your health through foods. We would like to remind you about a documentary on NetFlicks with many portions also on Youtube. It is called What the Health.

Good habits start by doing things that you enjoy. Want to exercise? Start dancing. Want to really get into it. Start a carrier that helps you self improve.

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