Management of Acute and Chronic Pain: Request for Comment
2020-05-12 2020-05-12 2020-05-12 2020-05-12 2020-05-12 2020-05-13 2020-06-02 2020-06-02 2020-06-02 2020-06-02
CDC-2020-0029-1966 CDC-2020-0029-1967 CDC-2020-0029-1973 CDC-2020-0029-1976 CDC-2020-0029-1975 CDC-2020-0029-2029 CDC-2020-0029-2628 CDC-2020-0029-2581 CDC-2020-0029-2588 CDC-2020-0029-2592
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https://api.regulations.gov/v4/comments/CDC-2020-0029-1966 https://api.regulations.gov/v4/comments/CDC-2020-0029-1967 https://api.regulations.gov/v4/comments/CDC-2020-0029-1973 https://api.regulations.gov/v4/comments/CDC-2020-0029-1976 https://api.regulations.gov/v4/comments/CDC-2020-0029-1975 https://api.regulations.gov/v4/comments/CDC-2020-0029-2029 https://api.regulations.gov/v4/comments/CDC-2020-0029-2628 https://api.regulations.gov/v4/comments/CDC-2020-0029-2581 https://api.regulations.gov/v4/comments/CDC-2020-0029-2588 https://api.regulations.gov/v4/comments/CDC-2020-0029-2592
S Anonymous Bruce Roger Roger Anonymous Pablo Lester Anonymous Sheri
W Anonymous King Sillmon Holland Anonymous Sanchez Wilson Anonymous Kay
You absolutely cannot let legitimate pain suffers just continue to suffer in pain.  As long as they are not abusing their medicines, they should be allowed to continue pain management for chronic medical condition such as peripheral diabetic neuropathy and other things that are incurable. Re: Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS)Docket No. CDC-2020-0029Salutations,As a practicing pharmacist in the independent community setting, Ive watched the countrys opioid epidemic spawn and evolve over the last 10+ years. My state has learned to be very diligent about the documentation and cross-referencing of CII opioid prescriptions; no longer is it common to see patients looking to fill scripts for unusually-large monthly supplies of opioids from a prescriber practicing on the other side of the state. Rather, now the common occurrence is a significant number patients who are asked to jump through hoops in order to treat legitimate pain. This sudden shift has proved detrimental for both patients dealing with chronic pain and patients dealing with addiction. Fentanyl has ravaged my state under the guise of heroin and its extremely troubling to see the aftermath entailed. Prescribers shouldnt have to deny care to patients because of a fear about what could happen to their license. The de-prescribing measures taken over the last few years are very effective and should remain in place to curb access of these drugs to individuals for whom theyre not intended. However, a concerted effort must be made to ensure those who need them arent suffering the collateral damage. Me must ensure that patients with qualifying past medical histories have access to these drugs and affordable addiction rehabilitation must be available for those who need it or would otherwise end up looking for street alternatives in the form of heroin. Lastly, we need to spearhead robust research into potential alternatives for chronic pain management as well as that for treating those with opioid use disorders. Substances with well-known anecdotal evidence suggesting potential use for the treatment of patients with OUD, such as mitragyine or kratom, must be studied and understood. Prohibition has rarely proved to itself as an effective solution; addressing the lack of access to adequate mental healthcare should be a top priority in addition to providing healthcare professionals with the resources and the approval in order to provide their highest level of patient care.  As a natural healthcare doctor (chiropractor) I see many people with long term chronic pain issues. And, though my patients get significant relief with chiropractic care they need safe alternatives to turn to when pain strikes and chiropractic is not enough. One of those safe alternatives is Kratom. A plant based medicine that has been used for hundreds, possibly thousands of years. Considering millions of people have taken this medicine for many years with little to no bad side effects is a testament to its safety and effectiveness. Of course, the pharmaceutical industry would like to eliminate this safe alternative to deadly opiates because of the profit motive. People are more important than drug companies making profit at the expense of human lives. Do the right thing and consider the centuries of safe use of Kratom for pain relief.      I am a retired 65 year old male. Due to several muscular/skeletal birth defects and long term wear I developed disabling spine and joint pain about 8 years ago. To date I have had 6 orthopedic surgeries. During these years I have used oxycodone acetaminophen for pain control. Oxycodone dosage has been up and down during these years. I have definitely felt the negative side effects of opiates such as irritability, increased tolerance, insomnia, and constipation. Until I retired 5 years ago, oxycodone was my only pain control medicine. After I retired, I was free from random drug testing by my employer and I started using marijuana in conjunction with oxycodone, eventually with my doctors knowledge. Upon having daily regular doses of marijuana I was able to substantially reduce the oxycodone dosage. There was a period were I stopped using oxycodone completely. Now, I use marijuana daily in conjunction with low 2.5mg doses (20mg/day) oxycodone. I realized the pain control was due to the combination of marijuana and opiate as soon as I began using marijuana regularly. Scientific publications have shown this effect. One in particular duplicated my 2.5mg oxycodone dose (1).    I am now a strong advocate for marijuana legalization and participate in state, local, and federal lobbying efforts. We need changes to federal marijuana laws and removal of marijuana from the Federal Controlled Substances List so that people like me can have access to safe, regulated,  high quality marijuana to reduce or stop their opiate use.(1) Cooper, Z.D., Bedi, G., Ramesh, D. et al. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. Neuropsychopharmacol 43, 2046-2055 (2018). https://doi.org/10.1038/s41386-018-0011-2 Today again Im thinking about whats to come in heath care involving chronic pain control At 70 years old my bodys is becoming more crippled. Changes are needed, I fear that at my age I already cannot control pain levels, sleep is becoming a huge issue. I pray that these rules involving treatment will change very soon.My doctors are clearly not willing to treat this issue  even knowing I need there help.In past years they have prescribed narcotic pain medicines for flares or injurys from my condition. I cannot submit to any more back surgery, clearly theres nothing  to be gained anymore. I do try everything else like a gym membership which I am using less now. Change is to slow in coming if at all to help me. Now with nerve pain setting into my feet its becoming hard to even walk. Im confined to my bedroom most of the time,the less active I am the more disabled I become. As a firefighter and EMT for over 20 years Ive seen the worst of this epidemic. I have also seen a lot of people that are good people have to suffer due to regulations and blanket approaches. There are a lot of people that have died due to over prescribing and abuse of narcotics. The flip side is there are a lot of people dying due to suicide because they dont want to live with the chronic pain. There are also a lot of people dealing with injuries who are too afraid to see out surgery knowing the pain meds prescribed wont cope with the pain post operation. Please realize you dont have to blanket approach this. There are solutions to stop the epidemic but also allow those that need these meds to have access to them. Thank you Most of my pain,depression, and stress comes from Military service. While managed with medication, and consultation most frustrations comes from discrimination, and poor management. These factors increase suicidal thoughts and low interest in achieving daily tasks.Its frustrating that mental health is not being addressed to a more legal and constitutional basis  I have had diabetic neuropathy for over 13 years, to the point of tears. It is very uncomfortable to have a normal daily life. I was prescribed Cymbalta, when my symptoms were mild. Later another doctor prescribed Hydrocodone 5s, as my pain worsened. I was moved up to higher mg doses(10, 15,to 30. I was finally tested by a neurologist, and we decided methadone 10mg were the best option for me, because they ease my pain throughout the day. I feel like my life can have some sense of normalcy. Currently, I do not want surgery to kill the nerves, in my feet,so I am satisfied with taking medication. I wish I did not have to rely on these pills, but I do. I take them, as prescribed, proven by my tests each visit. I do not like people thinking everyone taking narcotic pain medication, is an addict, because I am not addicted TO: CDCI suffer from bad knees.  I know this is not unusual as many have this problem.  My situation is different as I have Multiple Myeloma which is bone marrow cancer.  Surgery to correct my problem is very iffy as bone surgery and bone marrow cancer are incompatible and if done the bones take an extremely long time to heal if they heal at all.  I have tried Pain Management (PM) three times with no success.  The FIRST time I tried PM they said they could not help.  The SECOND time I tried PM they did a nerve block with no success.  Since the block failed, I was told nothing else could be done.  The THIRD time I tried PM, I was told they do not treat knee problems.  I believe PM is only for a select few.  They cannot treat pain if it is a bone on bone, but they do not inform you of this. I took an Opioid based drug for a year. I could not take 3 a day as recommended as it would make me itch all over.  I took only one in the morning to take the edge off my pain when I got out of bed.  From what I can determine all narcotic drugs make me itch.  However, while in rehab for orthoscopic surgery on my knee they would give patients 4 mg of Hydromorphone prior to physical therapy.  This is when I realized I could take it if I limited it to one a day and occasionally two if necessary.My Doctor claimed he could no longer give me a months supply.  A months supply was 3 per day for 30 days.  A month supply would last three months since I took only one per day.  I do not know if a Maryland State law was passed or if Priva Health (a physician health management program) is the problem.  I know Priva Health kicks back money to the Doctor, but Im not sure under what circumstances.  I imagine the less he provides, the more money he makes.At any rate, I have to take over the counter pain medication that will destroy my kidneys and they are slowly failing.  One of the problems with my particular cancer, it too destroys kidneys.  The combination of the two will accelerate their demise. RLR Ive been dealing with chronic pain for over nine years with multiple congenital spine issues that led to a neurological pain disorder called, central pain syndrome, leaving me in 24/7 moderate to severe pain. It took me 2 1/2 years of pushing for help, seven specialists to get a dx and appropriate treatment. I wanted to go back to my career! I had to put up with abuse by healthcare workers being blown off, ignored, belittled, demeaned, actually physically abused by behaviors such as of pulling a tray table away when my arms are resting on them, yes but why I was still wearing a neck brace, (my surgeon prescribed it for 12 weeks). I was being told how I feel and not being listened to, being yelled at when I asked, after 2.5 years Of doing exactly as I was told to for something stronger because i was suffering in pain all the time, which often involved being curled up in a ball, Teeth chattering and having a hard time to breathe. Miss treatment also included seeing a pain psychologist who mocked me because I said it was too hard getting into his anti gravity recliner because it required putting all my weight into both arms to do so. He told me, nobody else has ever complained about it, among other demeaning comments. I had 2 cervical spine surgeries That led to cervical spine and nerve damage as well as later found damage to my spinal cord. Ever since the CDC recommendations I have petrified of having my medications taken away yes I was told that is now what is recommended. It didnt matter all I went through to get the help I needed to be able to do basic things such as not being curled up in bed, breathing, being able to eat, stand, carry on a conversation, etc because of pain. If you were into Chronic pain groups on social media you would see the suffering. There are not many comments on this that you were asking for because chronic pain people are a group of people who struggle  With no just Pain, we struggle with just doing simple daily activities and having to write something, if one even hears about it, is very hard to do. So I dont just listen to those that have taken the time to write, go look in these pain groups and read about the suffering theres thousands and thousands of them. I still put up with attitudes from medical assistance and nurses at my doctors office. I have them documented. Im afraid to say anything because Im afraid to lose my compassionate doctor. And if I lost him what I find another who would be willing to prescribe me what is now a 10th of what I was taking that was recommended by the University of Michigan for my diagnoses. I cant write anymore now central nervous system becomes overstimulated and I get nauseous when I try to do too much.