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11 Articles in Volume 18, Issue #8
Challenges & Opportunities for Pain Management In Veterans
Chronic Pain and Psychopathology in the Veteran and Disadvantaged Populations
ESIs: Worth the Benefits?
Letters to the Editor: Recovery Centers Reject MAT, Cannabis for Chronic Headaches, Central Pain
Medication Management in the Aging
Pain Management in the Elderly
Pharmacists as Essential Team Members in Pain Management
Photobiomodulation for the Treatment of Fibromyalgia
Plantar Fasciitis: Diagnosis and Management
Slipping Rib Syndrome: A Case Report
What types of risk screening tests are available to clinicians prescribing opioid therapy?

Letters to the Editor: Recovery Centers Reject MAT, Cannabis for Chronic Headaches, Central Pain

November 2018 PPM Letters to the Editor from practitioner peers and patients
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Letters to the Editor: Recovery Centers Reject MAT, Cannabis for Chronic Headaches, Central Pain

MAT: Rejected by Most Recovery Centers

A recent NPR segment highlighted that medication-assisted treatment (MAT) is not always accepted in recovery houses for those fighting opioid addiction. We asked PPM Editorial Advisors for their take:

“I think you will find that most educated individuals in this field will say the same thing: treatment must be individualized. There are obviously certain patients that fall into some categories, such as repeat legal offenders, but most guidelines all point to pharmacotherapy (the term that we should use to replace MAT) as the way to go, with the top choices for addiction treatment being: buprenorphine, methadone, and vivitrol. The problem with the opioid epidemic is one thing: treatment. There is an incredible stigma against the addiction patient in all fields of life, but we need to treat those that want help.” –Frank A. Kunkel, MD


“The practice of medicine is extremely biased toward its namesake; medicine. So, of course, there are drugs to get off of drugs. And there are studies designed to show how beneficial the drugs to treat drug use are. In 2014, I became quite ill with gastroparesis. I’ll spare the details but I discussed it on a blog (

Board certification in pain management helps because I’m not afraid of pain, but it often surpassed my threshold. I’m so glad I was prescribed Fentanyl patches because they helped to reduce my ER visits and hospitalization over a couple of years. I also tried every healthcare approach I could think of to get well, such as acupuncture, homeopathy, nutritional medicine, and osteopathy (OMT). I was on 19 medications. My second attempt at OMT worked. Fortunately, I was referred to a highly skilled practitioner who used a specific technique.

I was able to get off most of the medications and desperately wanted to get off Fentanyl, but even at the lowest dose patch, I got what I referred to as the heebie geebies at about 73 hours after applying the 72-hour patch. I asked for help and so my osteopath consulted with a pain specialist who suggested OxyContin. I filled the prescription, went home, sat down and stared at the bottle for at least 10 minutes. Then I flushed the MAT down the toilet and went through 3 days of severe discomfort knowing I would soon be free of that terrible drug that helped me so much when I needed it.

Two years later, in December 2017, I had a relapse. Four months later, I went off Fentanyl again, cold turkey. The second time was easier because I knew what to expect. I did not sleep for 3 days and I couldn’t sit still so I did something productive — I cleaned out cabinets. My wife joked I should go through withdrawal more often. It was good to see her laugh as being my caretaker was taking its toll. Grant you withdrawal is not easy, nor for everyone, but there are a lot of people who no longer need the drugs they are on and another expensive and addicting drug is not the only answer.

That’s my experience as a patient in this matter. The experience was quite the reminder that doctors can be patients too. I made it past age 60 without any serious health issues, but sooner or later something happens to all of us. I hope not to have to remind myself a third time that I can withdraw without help. But if I relapse again, then go back into remission I will stop any painkiller the day I stop vomiting, again. One day longer than necessary on Fentanyl is too long.” –Daniel L. Kirsch, PhD, DAAIPM


“I have stopped referring pain patients to drug rehabilitation programs, especially if they endorse the Narcotics Anonymous model of treatment (ie, no opioid-based pain medicines, period). Further, I have found that many centers inform patients that pain medicine doctors are equivalent to the evil empire. It is an unreasonable approach, especially if the patient is well selected and monitored carefully. If the patient is not well controlled, I recommend an individual approach based on the pain physician and pain psychologist working together. After 30 years of practice, I still feel that opioid-based pain medicine can be a valuable tool in the pain manager’s toolbox. I address this issue in my new book (‘It Hurts’) and hope you will give it a look.” -Kern Olson, PhD

What’s your take? Email


Chronic Headaches: Cannabis and Other Treatments

Dear PPM,

I have had a chronic headache for four years, including signs of a benign growth in the clival region of the sphenoid. Treatment has included cannabis, which is not ideal for day-to-day function, and a combination of tramadol and gabapentin, which do not seem to be great for pain control.

I’d like to discuss alternatives. How do I get off these medications, and get my life back? I experience side effects from the headache, including lack of focus, fatigue, occasional loss of appetite, weight gain (which I believe is due to the gabapentin), lack of sex drive, and double vision (again, gabapentin). I look forward to starting a dialogue with someone who knows about pain. My current doctors seem to think the answer is more pills. –Andrew Hollis, New Zealand

Dear Mr. Hollis,

Daily headaches are common; the benign growth could be a factor, but usually benign growths are not the main cause of the headaches. We encourage all of the non-medication approaches, whichever are appropriate in your situation. These include exercise, physical therapy, psychotherapy, meditation, biofeedback, acupuncture, and massage. I have written several articles in this journal that discuss these approaches, such as: Deconstructing the Art of Headache Management and Migraine Therapy: What’s Old, What’s New (both published in June 2017).

Last updated on: November 7, 2018
Continue Reading:
Letters to the Editor: 90 MME/day Ceiling; Ehlers-Danlos; Redefining Pain