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Medical gaslighting of Chronic Non-Cancer Pain (CNCP) patients

opioid pain medications

Reproduced with permission. 

Due to participation in several Australian chronic pain advocacy Facebook Groups, I’ve become acutely aware of so many people who have told their stories truthfully regarding their medical condition, and as a result:

1. They have been disbelieved by the medical professional examining them, or unfairly judged as having a minor or temporary “non-specific” issue. Perhaps this is due to time constraints experienced by Doctors…nonetheless it is a serious issue.

2. They have been denied a diagnostic procedure or scan which was absolutely necessary, and have even incorrectly been advised “…your injury has healed,” when this has later proven to be far from the truth. (This situation has happened at least twice to me!) In my opinion, this can often result in harm due to inappropriate physiotherapy or other treatments being given.

3. Prevailing medical ‘theories’ in vogue regarding the perception or reality of pain have been explained poorly to patients, such as,”…the pain is all in your head.”

NOTE: There may be certain ‘neuroplastic’ pain conditions where this is true, yet many people are incorrectly labelled – when in fact they do have an actual nociceptive or neuropathic condition that has just NOT been properly diagnosed as yet. Again, this was my experience during several years of misdiagnosis and treatment dead-ends.

4. They have been denied appropriate pain-killers, leading to loss of mobility and an inability to socialise, work, or contribute meaningfully to society. This leads to increased pain, de-conditioning, depression, anxiety and other negative effects.

Worse still, I have noticed this trend in the last 12 months or more since the Federal TGA Opioid Prescribing guidelines were introduced on 1/06/2020, many chronic pain patients whose mobility and quality of life would benefit from low dose opioid therapy (as part of an overall pain management plan), are being categorically denied this option, even if warranted in certain cases.

WHY? This is because many GP’s and Pain Specialists have clearly misread or misunderstood these Prescribing Guidelines, which actually say that “Opioids CAN be used as part of the management of chronic non-cancer pain in circumstances where other pharmacological and non-pharmacological treatment strategies have not been effective, and the impact of poorly controlled pain has been considered.”

See reference here: https://www.tga.gov.au/prescription-opioids-information-health-professionals?fbclid=IwAR0O6jL1HhpYl_HayeIUSPfudaabZKwTOZO_Xoh9VmcN2h8V2gW0PvgRFEc

Furthermore, the mandatory requirement (implemented on the 1/06/20) for patients to have a 2nd Doctor review the appropriateness or necessity of their opioid pharmaceutical treatment every 12 months, has again resulted in many longstanding or ‘legacy’ chronic pain patients. These patients have been happy, mobile and stable on their opioid dose for many years (without ANY observable addiction behaviours or negative issues to report), and are now being coerced or, in some cases, forcibly tapered from their much-needed pain killers.

WHY? I strongly believe, after talking to so many people who have been impacted, that Doctors and Pain Specialists have become inflexible and ardent disciples of the new 100% ‘bio-psycho-social’ approach. This is currently being promoted for ALL chronic pain patients with chronic non-cancer pain, despite their previous history and proven stability on these pain medications.

I’ve been contacted by many desperate people on Facebook and elsewhere in recent times, many of whom live in rural areas, and they just can’t find a Doctor at their local surgery to do this 2nd Review.

 They then have to travel many hours into a major town or city to get this approval process finalised. As we all know, it sometimes takes months to get a referral to see a Pain Specialist, and in the meantime I am hearing about unfortunate people who have run out of their regular opioid medication (OR the Pain Specialist conducting this 2nd Review will NOT approve the continuation of opioids), leading to abandonment, dangerous and life-threatening withdrawal symptoms, and a complete loss of quality of life.

Those in major centres are somewhat more fortunate. However, these adverse outcomes are not isolated incidents and are increasing in frequency as the hard-line on legal, prescription opioids continues. This is despite that even though responsible chronic pain patients, who have NO history of substance abuse, are the least likely to abuse their pain killers.

Finally, Medical Gaslighting is nowhere more apparent, than in the new mantra or theoretical medical opinion, being force-fed to patients on long-term, successful opioid therapy, whereby they are told during reviews that they have opioid hyperalgesia, and therefore must be tapered (known as ‘de-prescribing’), no exceptions allowed.

As I understand it, opioid hyperalgesia is considered to be a theoretical condition, and to date only tested in rats, yet it is now the rationale or “be all and end all” for removing people from opioids. Hyperalgesia may be indistinguishable from tolerance and other physical dependence issues, therefore I use the following two References to explain best:

1.       “Hyperalgesia is used in two different contexts in pain medicine. In one context, hyperalgesia refers to the excessive pain often induced by neuropathies or certain chemicals.

Another context is the unfounded assertion that some patients who chronically take high-dose opioids develop increased pain with increased doses, or increased sensitivity to noxious stimuli. This is based on studies of laboratory animals, and of people given intrathecal opioids or studied under other unusual conditions. I am unaware of any studies supporting the existence of this phenomenon in clinical practice with respect to patients chronically on oral or transdermal opioids.”

See reference here: https://www.hcplive.com/view/opiophobia_consequences

2.       “There is little question that it exists. The animal models can reliably detect it and, if you look closely enough, you might be able to detect it in human subjects. However, in the clinical setting it RARELY, if ever, has a sufficiently robust effect to become a significant issue…”

See reference here: https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/misuse-hyperalgesia-limit-care?fbclid=IwAR0ukjndrNwBGPMB2aQz9JKukWGr0rOOJsYxNIIYzrUWpB_Gw0NG75tuCjU

IN SUMMARY, medical gaslighting has become quite prevalent in Australia, and particularly due to incorrect applications of the amended TGA legislation and hypothetical medical ‘syndromes’ being applied to chronic pain patients’ diagnoses. “In my opinion this seems to be influenced by medical professional’s own backgrounds, personal biases and training received…NOT based on their inherent ethical duty to Do No Harm.”

Kevin R James

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Author: Kevin R James

Chronic Pan Patient Advocate and Writer. Medically Retired RN [B.Nurs.]

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