Thursday, December 1, 2011

Tales From the Trenches in the War on Pain

Guest Author Correspondent: Thomas Sachy, MD, MSc

Although I practice child, adolescent, adult, and forensic neuropsychiatry, the majority of my clinical practice is in the field of pain management, and I am a strong supporter of using opioids for the treatment of chronic noncancer pain. I have come to this position after approximately 11 years of face-to-face patient interaction, along with ongoing intensive review of the medical and scientific literature dealing with opioids, and the other forms of analgesic medication, as well as the neuroscience behind chronic pain disorders.

For several years now, and especially over the past several months, there has been an ongoing barrage of news media attention focusing on the fact that overdose deaths due to prescription opioids have reached “dangerous” or “alarming” levels of epidemic proportions. In response to these statistics has come an almost mob-like crusade to track down and punish incompetent, unethical, “pill mill” physicians and their practices, which is justified and one would think this could be easily attainable. Inexplicably, these objectives do not seem to be that easy to accomplish. Why?

At the same time, there also seems to be a push to punish and/or eliminate the pain physician who by some mysterious standard is considered to be over-prescribing pain medications, and/or prescribing medications in “extraordinary” or inconceivable combinations. Of course, these assertions fly in the face of science, and the experiences of the untold myriad of patients who literally have new, functional lives, less troubled by the specter of chronic debilitating pain. These patients still have pain and they always will suffer from it; however, with the right combination of medications — including and especially opioid medications — they once more can experience lives that contain a modicum of tranquility.

As stated above, I am a neuropsychiatrist. I am certain that I see great medical benefits bestowed upon the vast majority of my patients with chronic pain who are prescribed opioid analgesics. They and their families tell me that this is so, and I believe with an objective eye that I see the benefits as well.

But, as a neuropsychiatrist I have to consider what certain others might think of these assertions or observations. They might conclude that I am…

…just a clever, greedy "pill mill" doctor,

…good hearted, but somewhat delusional or a “sucker,”

…ill-informed at best or completely ignorant at worst regarding pain management in general, or

…simply a fool who should be “laying low” instead of putting his license and livelihood at risk.

So, I am either a Fool or a Good, Bad, or Ugly Pain Physician — or some combination thereof. Meanwhile, what will follow in this series are my personal experiences and opinions regarding the anti-opioid medication hysteria that is gripping this nation, and a rational defense of long-term opioids which, if not diverted or abused, are an absolute medical necessity, if not a medical miracle, in an inflexible world that predisposes humans to chronic pain disorders and other related neuropsychiatric diseases.


About the Author: Thomas Sachy has Bachelor’s Degrees in electrical engineering and in general studies, and graduate degrees in medicine [MD] and biology [MSc]. His post-graduate medical training was in psychiatry, forensic psychiatry, and behavioral neurology. Dr. Sachy practices in the state of Georgia and has completed numerous ongoing continuing medical education activities in the field of pain management and the neurosciences, and has been featured on national TV on several occasions. He is a Diplomate of the American Board of Psychiatry and Neurology.

Proviso: All observations, opinions, advice, or facts expressed above are those of the guest author, and do not necessarily reflect the positions of Pain Treatment Topics, our staff and advisors, or our educational supporters.