Pain Clinics as the New Exploiters of Pain Patients

It finally happened to me. I watched and reported on it for years, and now I am the subject of my column on abandoned patients. My doctor referred me to a pain clinic for continuing opioid prescriptions. He informed me that with the change in Illinois law governing opioid prescribing that his practice could no longer support the prescribing opioids. He offered me the name and number of a local pain clinic.

This unwanted change upended me late last Summer. I immediately contacted the pain practice for an appointment and was seen rather quickly.

It was then I decided to try to stop taking oxycontin, an opioid among others I had used for nearly 20 years. At first, I gradually tapered off the daily 80 milligrams I’d been taking for five years. In the first weeks, I sailed along with no withdrawal symptoms nipping hungrily at my heels.

No sweat, I had this. I mean, until the demon hubris took over, and I stupidly thought I could skip the last few milligrams I had been taking to allow my brain to adjust slowly to non-opioid-saturated synapses.

Within two days, my calamitous decision dumped me headlong into the horror-leavened universe of Withdrawal Agonistes: I sweated endlessly; my body shook with tremors weaponized by skin-crawling agitation; plagued by sleeplessness and wild mood swings–terror and rage–I endured the full panoply of the harder edges of sudden decampment from the gauzy world of opioid analgesia.

With a call to my new pain docs, I was seen forthwith and given a small dose of a narcotic analgesic and gabapentin. Tag-teaming, the meds wrestled the Agonistes to a standstill, and I returned to my narrow peninsula of normalcy.

Unknown to me at that time, my peninsula had been markedly reduced by the “new normal.”

It’s my experience that anything referred to as the “new normal” is something we used to enjoy but is now significantly reduced or made far less attractive and that we must adjust to these “new” circumstances. In advertising, “new” is always touted as better, improved over the old lot. In reality, not so much!

Not so with the “new normal.” No, this new normal is fucked, no matter how much “new” in the “new normal,” we all know that the “new” is are a fatal reduction from the old, and we must get used to it. In these times, our ability to adjust to reduced conditions is a measure of our mental health.

For me, as a lifelong pain patient, the new normal without Oxycontin or Fentanyl is an expensive chore. For many years, some researchers and addictions docs vilified those physicians who prescribed adequate amounts of opioid analgesics to provide us with a modicum of control over what was once beyond the reach of medical treatment.

Opioids save the lives of those like me who lived, if living it can be called, with the horror of constant mind and personality altering pain. Opioids provide people like me with relative pain-free space that allows us to breathe, to think, to feel without the gnawing anxiety that robs us of our lives.

Doctors routinely excoriated for adding to and hastening the so-called opioid epidemic have been forced to back away from patients like me.

We, the patients in need of care, are given over to the over-priced care of assembly-line clinics who charge way more for pain relief than what I paid in the past. Additionally, we are forced to pay for more doctor visits to get our prescriptions once a month as opposed to every 3 or 4 months.

The necessity of spinal injections compounds these increased appointments, nerve ablations, stemcell recovery, and reinjection into stressed joints increases our time spent in waiting for our docs and fees we pay for the multiplying dates and money spent.

If there were pill mills, and there were in places like Florida and Kentucky, there are now “sanctioned” pain clinics making money off people like me whose bodies are pathways for these newest exploiters to get rich off the least powerful. Whatever new regime steps in, it is sure to make tons of money off exploiting those of us in desperate need of compassionate pain relief.

My next posting will examine how “empire capitalism” impacts our pain care.

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Former Drug Czar: going after prescription opioids is wrongheaded

https://www.foxnews.com/health/former-drug-czar-opioid-epidemic-focus-missing-real-culprit

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https://truthout.org/articles/rise-in-white-prisoners-shows-prison-racism-goes-beyond-disparities/

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How does one acquire a “Thicker Skin” in dealing with highly emotional taxing careers such as a Psychologist or Psychiatrist?

“Thick skin” is a provocative notion about which all new therapists should consider, then reject.

In my work and with those younger therapists with whom I’ve taught and consulted, I do the opposite. I try to help them become even more vulnerable to all the vagaries that can, and do, arise in therapy.

Without emotional vulnerability to our patients, we have no way to enter their worlds, and, therefore, can be of no lasting help.

You may be more broadly asking how those of us who do this work keep ourselves going in the face of the natural stresses of this work. How to care for ourselves is a more pertinent question for those of us who work with people who experience extreme mental states: Borderline personality disorders, narcissistic personality disorders, and the psychoses.

Significantly, we all need our therapists as well as consultants, along with routines that help us unwind and engage in pursuits unrelated to our work. Strong friendships and a loving family are essential.

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Should a psychotherapist be completely transparent in patient interactions? More specifically, should they openly express or conceal their emotions and reactions to the patient?

The answer depends on the patient, her/his diagnosis, and the state of the relationship between us. No, in general, I am cautious about many of my thoughts and feelings as I treat them as speculative.

However, if what I am thinking or feeling is drawn into the interaction, especially if asked directly, then, yes I am transparent. I immediately pay close attention to how the patient reacts to this disclosure.

With some patients who grew up having to be exquisitely aware of a parent’s thoughts, feelings, and behavior to survive, I will be far more transparent than with other patients. Coming from a background where physical/psychological safety depended on the patient’s ability to know what’s going on, I have to be more active in helping that person tease out what they “know” and what is going on in me. I don’t want to do anything to increase the patient’s “paranoia” about me.

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I’ve been told that all personality disorders are egosyntonic, and that therefore if I wonder about having BPD I don’t, and should not see a doctor. Is this true?

Ask yourself this, Dan. Would you find the following egosyntonic: afraid that everyone despises your very presence. How about this: you fear close emotional relationships based on the “crazy” closeness that you experienced as a small child. Add to that this; you fear any signs of someone moving away from you emotionally as that signals an abandonment and annihilation that you may not survive. Additionally, suppose that intense emotions can kick you into a state of psychosis from which you fear you may never recover; another form of death. Imagine, if you can, that you wake up every morning and go to sleep every night with this underlying terror: I will be eviscerated and killed.

Imagine all that, Dan, and think about the experience, empathy, and intelligence of those who have told you that this ghastly disorder is “egosyntonic.”

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I think my therapist is retiring.She knows I have abandonment issues.I think she is testing me.Something about the way she is acting makes me feel she’s getting ready to tell me she will be leaving. Do therapist test their clients? How can I tell?

No, I can’t imagine a competent/ethical therapist “testing” any patient. The best way to handle this, and likely a good step for you, would be to talk to your therapist about your fantasies of being abandoned by her. I suspect you might find that difficult if not, you wouldn’t be posing this question here.

I believe your therapist would be pleased if you bring this up and would be happy to discuss this with you. Good luck.

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Should there be a government agency dedicated to reducing the number of psychopaths, sadistic people and people with anti-social personality disorders to improve public health and the overall quality of life?

In short, no. I can’t imagine giving that kind of intrusive power to the state. It smacks of the worst sort of authoritarianism. Education about mental illness and providing sufficient public funding for mental health services would be wondrous. I doubt, though, it will ever happen, especially with our psychopathic president uninterested in such things.

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Yuya, this is an insightful question that seems to trap most inexperienced therapists. I welcome such communications. It often reveals a benchmark of change when the patient can challenge me. This challenge is exquisitely dangerous to the patient as s/he thinks I will become angry, withdrawn, maybe rejecting, haughty or even narcissistically demand that they the retract the objections if they wish to continue working with me. These are usually transference based expectations. However, many patients run into inexperienced or un-analyzed therapists who’ve yet to resolve their issues in this fragile domain. When this happens, the rule is thus for the therapist: do not attack, do not withdraw from the patient. Accept the patient’s point of view and search for the truth of it. Once the therapist can acknowledge the delicate parts of the patient’s experience as real and crucial, then, with great tact and skill, the therapist might inquire into the transference aspects of the communication. A competent therapist will acknowledge her/his contribution to the interaction. S/he will then be able to assist the patient in looking at the historical antecedents of the criticism,, and the patient’s fears of stating her or his truth to the therapist whom they feel, rightfully, injured them.

Without knowing a great deal more about you and what you consider “paranoia” I would be taking huge liberties with you. Those liberties would be crummy psychotherapeutic help; in short, no help at all and very possibly misleading and unethical.

Could you tell me more about exactly what you mean?

For me to say anything more than this right now would be antithetical to my professional duties. Anyone who’d dare make a definitive statement about your 9-word question would be presumptions at best and woefully misleading at worst.

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Do therapists ever have sessions with clients who tell you that you’re not doing a great job and you’re not helping them? How do you feel and what do you do?

Yuya, this is an insightful question that seems to trap most inexperienced therapists.

I welcome such communications. It often reveals a benchmark of change when a patient can challenge me. This challenge is exquisitely dangerous to the patient as s/he thinks I will become angry, withdrawn, maybe rejecting, haughty or even narcissistically demand that they the retract their objections if they wish to continue working with me.

These are usually transference based expectations. However, many patients run into inexperienced or un-analyzed therapists who’ve yet to resolve their issues in this fragile domain.

When criticized by the patient, the rule is thus for the therapist: do not attack, do not withdraw from the patient; the therapist accepts the patient’s point of view and then searches for the truth of it.

Once the therapist can acknowledge the delicate parts of the patient’s experience as real and crucial, then, with great tact and skill, the therapist might inquire into the transference aspects of the communication.

A competent therapist will acknowledge her/his contribution to the interaction. S/he will then be able to assist the patient in looking at the historical antecedents of the criticism, and the patient’s fears of stating her or his truth to the therapist whom they feel, rightfully, injured them.

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