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13 Articles in Volume 18, Issue #7
A Commentary on Medical Cannabis
Are Abuse-Deterrent Opioids Appropriate for Your Pain Patient?
Behind the AHRQ Report
Challenges Facing Abuse-Deterrent Formulations
Demystifying Opioid Abuse-Deterrent Technologies
Editorial: Our Clinical Pain Neighborhood
Independent Pain Practice: A Case Example
Inside Performing Arts Medicine
Letters to the Editor: ACT Therapy; Compounded Topicals
Nerve Growth Factor and Targeting Chronic Pain
Pain Control for Athletes: What Works?
Quality Training: One Center’s Experience with Pain Assessment
The Importance of Developing Professional Relationships in Pain Practice

Letters to the Editor: ACT Therapy; Compounded Topicals

October 2018 PPM Letters to the Editor from practitioner peers and patients.

The Complexity of Acceptance and Commitment Therapy

Dear PPM,

In response to the June 2018 editorial, “The Practicality of Pain Acceptance,” which addressed Acceptance and Commitment Therapy (ACT), I have a few comments based upon my experience as a broadcast journalist, lifelong activist for human rights, and as a 30-year veteran faced with chronic, intractable central nervous system pain from a failed back surgery 30 years ago.

If such a complex issue can be stated simply, accepting and committing to a level of pain which cripples an individual to the extent of severely diminishing not only mobility but quality of life (eg, the ability to eat, sleep, work, socialize), acceptance is not the answer. A Serenity Prayer, however appropriate for acceptance of “things we cannot change,” does not apply here as the panacea for thousands of patients suffering today as the CDC and DEA have pointedly misplaced a population of thousands into “collateral damage.” The statistics citing an epidemic of opioid overdose were utilized as any statistics may be used to “support” a theory; statistics have been well known for decades to support both sides of an argument, depending upon which side of the argument the author is defending.

The law, as it stands, needs to change. All laws, if they are to help the population, evolve over time, but never without action. Whether one advocates the World Health Organization’s 2017 definition of untreated chronic, intractable pain as “tantamount to torture,” or whether one sees it as a matter of accepting and committing to debilitating, life-sucking pain, neither conclusion is viable in the current medical/political climate, particularly in light of the patient-advocate rights under fire today.

I suggest, to any practitioner who is truly educated in pain management or even concerned about the large, vocal, needlessly suffering population of patients caught in this travesty of justice, that you remember your oath to heal and do no harm, and if necessary, review our constitutional rights to the pursuit of happiness, versus a life of acceptance and commitment without even once asking to be “pain free.” One is not mutually exclusive of the other.

I remain very appreciative of this journal and its website, the views presented, including the efforts of Editor Emeritus Dr. Forest Tennant, to innovate change in this regard. Thank you.

–Nicki Marie Jack

Keyboard

The Basis for Compounded Topicals

Dear PPM,

The article in the July/August 2018 issue “Topical Analgesics for Common, Chronic Pain Conditions” by Raouf, et al, missed a major point. Most orthopedic surgeons in particular have found topical medications to be useful. What is causing tremendous problems are the so-called “compounded medications” of four to five drugs, which are whipped up and sold for enormous prices. There is little to no juried scientific basis for the use of these compounded medications. The use of them is, frankly, sometimes quite effective, but third-party payers will not usually cover them. Moreover, they are often offered to doctors’ offices through less than legal kickback schemes, making it seem that there must be enormous profits in their being dispensed. Those topical medications, it appears, are often used to pad workers’ compensation and personal injury physicians’ office bills. I think that this practice gives the basic topical medications a bad name.

–Michael Treister, MD

Dear Dr. Treister,

Thank you for your comments. You make some very valid points. In fact, it is because of variabilities among compounded topicals and lack of supportive evidence that we did not include polypharmaceutical compounded products in our review. You will see, however, that we did include single-entity topical compounded opioid products and clonidine as there is evidence to support their efficacy.

–Mena Raouf, PharmD

Last updated on: October 3, 2018
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Editorial: The Practicality of Pain Acceptance
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