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Dr. Phil's chronic pain message
7 Replies
January - April 29

Here's what The Merck Manual (for medical professionals) 18th ed., pub. in 2006, says, p 1772:

"Opioid analgesics are useful in managing severe acute or chronic pain. They are often underused, resulting in needless pain and suffering, because clinicians often underestimate the required dosage, overestimate the duration of action and risks of adverse effects, and have unreasonable concerns about addiction… Physical dependence…. should be assumed to exist in all patients treated with opioids for more than a few days. However, addiction (compulsive use of a substance with craving and psychologic dependence) is very rare in patients with no history of substance abuse. Careful assessment before initiation of opioids should enable a physician to infer whether risk of abuse is relatively high. If it is, treatment may still be appropriate, but more controls…. are then used."

Dr. Phil had a show today - I only caught the end of it - but he was brow-beating Alexandra of the "Dr. Phil Family" for taking pain medications (I think the girl broke her back in a car accident) and insinuating she was a drug addict. And maybe she is, I don't know. However…

...for everyone with chronic pain who uses medication RESPONSIBLY, this show was a real public DISSERVICE. The REAL MESSAGE (from two "experts") was that narcotics should ONLY be used short term, and that "long term use makes pain worse." (Really?? I looked into this matter, and apparently they are referring to "opiate-induced hyperalgesia or allodynia" which, from what I read, is RARE and tends to show up quickly. It is a fairly new and controversial theory, worth a google - it may apply to you. It looks like the folks who bring you gabapentin are funding some studies on this.) I also saw something in a sidebar about Obama working on a bill to decrease availability of prescription pain medicine. If you depend on pain meds to get through the day, you might want to read up on this.

Dr. Phil's "experts" argued that tolerance will require Alexandra to increase her drug dose, and it's bad for her body. I believe that's true for all the medications that are commonly used to treat chronic pain, including the newer ones… which are constantly being recalled and subjected to lawsuits because of unforeseen problems, including deaths and serious birth defects.

It seemed Dr. Phil's show subliminally labeled Alexandra. The visual caption was "Alexandra - in denial?" but the voice-over was, tonally, a definitive statement (accusation). NOT voiced as a question. (Alexandra MAY be doing other drugs, and she may have an addiction issue - but that should NOT be mixed in and confused with her use of pain meds for a serious back injury.) More mindless labeling of all people who use pain medicine as addicts. (NOT according to the Merck Manual!) There is a flaw in Dr. Phil's logic here. But the comments show that most of the audience totally swallowed it. Vehement hatred and criticism for "addicts" from the healthy. Shame and apologies from the few who admitted to needing pain meds for serious conditions.

Again, I missed half the show - but I didn't see the "experts" at the confrontation presenting any viable information to Alexandra about WHAT ELSE they could offer to help her pain. One "expert" had a look at her X-ray and said she "shouldn't" be in pain any more, and OTC pain relievers should be all she needs once she is detoxed! Sound familiar? Everyone is screaming about pain clinics but nobody seems to be advocating for the people who are in desperate situations due to chronic pain - people who can't get ADEQUATE treatment from their doctors!


kvc33 - April 30

I think you saw a re-run episode because I believe I saw the show you are talking about in the past. I think you need to take the show in context. Alexandra has shown herself to be repeatedly irresponsible and isn't really even an adult yet. She has had three unplanned pregnancies. I think the show is really about Alexandra and not about people who use prescription pain meds to control legitimate pain. Don't take it personally and if you think Dr. Phil has done a disservice to the public then write and tell him so.


mdak - May 1

I didn't watch the show, but I have read what you wrote. I have shared with many before that I was on about every narcotic out there. My doctors told me that you are dependent on them, maybe not addicted to them. He didn't understand at first why I wanted off them. He thought I was crazy. I too suffer from a broken neck and at times the screw hits the spinal cord and other problmes with it. The pain just seem never to get better, it seem I was needing more and more to keep me comfortable. I even tried to take my life due to the pain. I finally came to the conclusion that for me these drugs were causing me more pain and more depression. I wanted to find out myself. I hated waking up in the morning needing my drugs. If I didn't take them by a few hrs. I would start havint withdraw feelings. I felt they cotrolled me. So I ask to come off and I did it at a rehab. place and I had support to help me learn how to deal with pain in other then narcotics. It went so well. I was very blessed. Yes I have pain everyday, but I have learned how to manage it fairly well. I would of probalby not like what Dr. phill had to say, because He hasn't walk in those shoes before. I get jealus sometimes because people like you all can handle narcotics ok. For some reason by body goes into severe depression with them. My Dr.s are not allowed to give me narcotics at all. I guess If I need some I will have to go to ER. I think they have seen how well I have done. I suffer from no depression and have controlled my pain farily well. I do know that we have some bad pain clinics here and t he DEA is all over them. I know it not fare for the ones that really need pain management. I know for a fact that Dr's are being told to be cautious about writing too many scripts for narcotics now. They told me they are being monitored very closely. If you have depression or psy. issues they are even having you see a psy. dr. and notes sent to them. It covers their butts.
I know we all have different ways we can controll oour pain, hats off to the ones that can with narcotics.


January - May 1

mdak - thanks for your post. I think you just underscore what Noca said about the desperate situation of people who have severe uncontrolled chronic pain. They would rather die - something many people don't understand because they have not experienced that level of pain…yet. That is why I advocate compassionate and adequate diagnosis and treatment of pain.

But mdak, please double check your information about the meds you are taking. If you are taking buprenorphine, you ARE still taking narcotics - but you are taking a new (semi-synthetic) type of narcotic that has been altered from its more natural form. (An opioid IS a narcotic.) Buprenorphine works differently in the brain than the older narcotics, but it is still a narcotic pain reliever. (And with your spinal damage, I'm sure you need it!) It was developed to treat addiction to regular narcotics.

've read a little about it, and Buprenorphine is now used for people who cannot tolerate regular narcotics, and also for people who develop "opiate-induced hyperalgesia." This situation occurs when a person takes a narcotic for pain, but the narcotic makes the pain worse, instead of relieving it. It used to be considered somewhat rare. In fact, there are sites (like the University of Wisconsin) that describe how to treat this problem; if you have it, slowly decreasing the dose of narcotic will DECREASE your pain. That should be fairly easy to figure out then! They also treat this condition with magnesium - which is something that helps a lot of people with fibro pain. Something to think about.


January - May 1

Hi kvc - At my age, there is not much I take personally. I think you really misunderstood my post and my reasons for making it. But written words are always tricky, because the tone behind them is unclear.

I'm familiar enough with Dr. Phil and The Family to know the basics. Any psychotherapist SHOULD know that a toxic group (however big or small) will unconsciously select a scapegoat (usually the most vulnerable, who unconsciously agrees to the role). The scapegoat then acts out atrociously (as a sacrifice really), so everyone else can avoid dealing with their own crazy stuff in the ensuing melodrama. Enough said.


Noca - May 2

January, do you got a Skype account or email I can contact you with? I would like to chat sometime if you wouldn't mind.


Kristina17 - May 12

This topic and what you have relayed about the Dr Phil episode infuriates me!!! I have recently undergone Ketamine infusion therapy as an inpatient in hospital over 8 days. Ketamine is a very very strong analgesic and it really knocked me around heaps. It was supposed to numb all of my pain (best case scenario) and give me some longer term relief. I was pain free for about two days, which was AWESOME and weird too, but then all the pain came back. It did not work as I would've liked but I have developed a tolerance to all my other pain meds so I have to try other alternatives!! Has anyone else tried Ketamine? I'm going to do it again and the doctor is confident it will work better 2nd time round too.


January - May 12

Kristina17 - If you google "ketamine for pain," there is a LOT of information - you have to judge what to believe, as much of it is conflicting or outdated. You might want to read what people are saying about it on the online forums. The comments should come up in the google search.

It is being tried in experimental studies on pain control. From some research I read, it is used in very severe cases - and it helps sometimes. I read one study where people who went through the hospital treatment once, without relief, did better the second time. Sounds like this may be what your doctors are hoping for with you.

Wikipedia has a good, readable article about it. They state that ketamine usually increases the effectiveness of opiates and sedatives. One doctor cited online claims to have completely cured chronic pain patients. Also, I read that ketamine is being tried with people who have developed a tolerance to their pain meds.

Hopefully there is someone else out there who can give us some additional information on this…

I really hope everything goes well for you, and that you get some relief. Please keep us posted on how you're doing.



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