Morning everyone!

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. 

As you may know, I do a lot of reading and love to share what’s interesting about what I’m learning. Recently I did a deep dive on pain and found two books and a mini-series that fascinated me. Today I want to highlight some of those findings. 

The first book, The Song of our Scars by Haider Warraich, is about chronic pain. The second book, The Empire of Pain by Patrick Radden Keefe, is about the search to cure pain. Both are fascinating reads. I also just finished the Hulu mini-series Dopesick with amazing performances by Michael Keaton and Kaitlyn Dever. A must-watch if you are interested in addictions. 


The Song of Our Scars 


This book was written by a cardiologist out of Harvard, Dr. Haider Warraich. His deep dive into chronic pain started back in medical school. The details of his own personal experience with chronic pain make this book an interesting read.   


Dopesick Mini-Series 


Dopesick tells the shocking true story of America’s opioid epidemic. If you haven’t seen it, you need to check it out. It centers around Purdue Pharmaceuticals and a drug they marketed called Oxycontin. Oxycontin was responsible for a lot of deaths, and a lot of pain, and a lot of suffering for so many people. 

This story swept through our country starting in Southwest Virginia (very close to my home in East Tennessee). It began in coal mining country, a place where there is a lot of chronic pain and drug abuse. After watching this show, you will be very wary about how doctors and Big Pharma treat chronic pain. 


The Empire of Pain 


This book is about searching for cures for pain. It tells the story of how we got where we are with pain medicine (the biggest reason being the marketing by drug companies to both patients and doctors). 

As I have said before, unless it’s a routine check up (i.e., cold, anxiety, depression, etc.), most people come to see the doctor because they’re tired or hurting. What patients need to know is that acute pain has to be distinguished from chronic pain, because the two are different clinical entities. 

Note: Acute pain may lead to chronic pain and become different things entirely. This book goes deep into the psychological components of chronic pain. 

Chronic pain must be approached differently. You can’t really treat it with opiates anymore because the chances of patients having problems with it are too high. We had over 100,000 deaths this past year from opiates. 

Note: It’s incredible what’s happening with fentanyl and heroin right now. We’re losing a lot of great young people to this epidemic. It’s horrible! 


Dopesick and Marketing Drugs 


When they came out with Oxycontin, it was supposed to be better than other pain medications like Vicodin and Lortab (Hydrocodone). They made Oxycontin so that it was long acting. 

Note: Long acting meaning they put a special coating on the outside that made it supposedly last for 12 hours. The truth was that it was nothing more than good old fashioned Oxycodone, which caused so many deaths and addictions. In fact, this created a whole new category of medicine called Addiction Medicine.

I remember this! Reps would come to my office and say that Oxycontin was less than 1% addictive, when it was really 100% addictive. We were told a total lie. Why do drug companies advertise direct to consumer? Even advertising directly to doctors can be good and bad! It’s good for the information, and bad because they can make claims that might not be true. They were making claims that were not true with Oxycontin. 

Note: Direct to consumer advertising for drug companies is only legal in two countries: the United States and New Zealand. 

The FDA gets involved as well. Sometimes they pass things that later have to be recalled. In the case with Oxycontin, it was even more suspicious because one of the heads of the FDA (responsible for giving the “OK” to the claim that Oxycontin was less habit forming than other opiates), ended up working for Purdue Pharmaceuticals two years later. We need to be better about curbing the type of relationship that can happen between the FDA, Big Pharma and the government. 


Acute Pain vs. Chronic Pain 


You have to realize that chronic pain has to be approached from a multi disciplinary standpoint. You can’t just feed someone a pill because they are in pain. A lot of times you have to accept pain as a part of life and not be afraid of it. 

It is now well known that NSAIDS are more effective for pain after one year than opiates are. If you are on opiates for longer than a month or two you are not taking them for pain. You are taking them for the euphoria. You don’t take opiates for the pain at that point because they don’t work for the pain. And if you stop taking them, you can have withdrawals which can be worse than the pain.

It seems as if life has conditioned us to believe we can’t have pain. That we need to take a pill and can get rid of it, ASAP. The TRUTH is there are other ways to get rid of pain, such as:

  • getting yourself in good shape
  • being active overall 
  • NOT focusing on the pain
  • eating a clean diet
  • decreasing stress
  • getting better sleep
  • better posture
  • better body mechanics. 

Other options…

  • psychological treatment 
  • physical therapy
  • acupuncture 
  • supplements such as Curcumin (one of my favorites); LDN (Low-Dose Naltrexone); CBD
  • medical marijuana (in those states that permit it) 

Some people are able to get on Suboxone which can help them function. A lot of times, I think doctors keep patients on Suboxone for longer than necessary, but some people do need it longer term. 

Talking to pain doctors about this is interesting. There are a lot of people who claim they could not function in their daily lives without Suboxone and who would probably be on the streets taking illegal drugs without it. Whether it works for the pain or just keeps them off illegal drugs is a question. 

I’ve really enjoyed these two books and the mini-series. The pain story in our country is a complex one. If you are in acute pain it’s important that you don’t let it become chronic pain. Be wise. Depending on a pill to take care of you can be dangerous.