Will accurately portraying life with chronic pain be a piece of Cake?

Lemon Cake Inspired By Thiebaut by DarisArt

My friends living with chronic pain and fibromyalgia are all a buzz about a new film called Cake.

According to Variety.com, the movie tells the story of Claire Simmons (played by Jennifer Aniston) who struggles with both chronic pain and a painkiller addiction.  It addresses the issues of suicide, grief and separation with a "darkly amusing" combination of humor and drama.

The story begins with the suicide of Nina, a member of the chronic pain support group that Claire attends.  After her death, Claire gets obsessed with Nina and starts an affair with Nina's husband (Sam Worthington.)  The story features Claire's support group leader (Felicity Huffman), housekeeper and physical therapist, as well as her husband.

Another article at Variety.com focuses on the fact that Jennifer Aniston doesn't wear make-up for this role.   According to the film's director Daniel Barnz, this is to show that Claire doesn't take care of herself.

A lot of my friends are sure are excited about someone with chronic pain being the main character of a movie.  The hope is that this character will somehow validate all our pain experiences to the doubters and disbelievers in our lives. I haven't seen this movie yet.  Neither have any of my chronic friends.  But we'll get our chance when the movie opens wide today in the USA (after a limited release in December 2014.) 

I do have some thoughts about all the press this movie is getting and all of the comments it has generated over on the Variety.com website.

First, I am concerned that Variety review says this movie is "...falling back on one of the hoariest and most overused of movie cliches..." and "...this manipulatively layered “Cake” probably won’t rise to the occasion..."  Ouch!

Second, while I guess being an actress and forgoing make-up for a role is some kind of Hollywood accomplishment, I think the explanation for why Claire doesn't wear make-up -- because she doesn't take care of herself -- is a little one-dimensional.  After all, I live with chronic pain and don't wear make-up, not because I don't take care of myself, but because I choose to forgo makeup and use my energy for other things I think are more important, like cooking or going to a doctor's appointment.  Which begs the question: does this movie really explain what it is like to live with chronic pain or does it just stereotype this condition?

Third, I am really concerned about how the story paints the picture of  Claire, the painkiller addicted chronic pain patient, because the fact is addiction is not common among chronic pain patients.  According to an evidence-based review of all available prior studies published in the medical journal Pain Medicine in 2008:

"...chronic opioid analgesic therapy exposure will lead to abuse/addiction in a small percentage of chronic pain patients..."  

Specifically, the risk for abuse and/or addiction was found to be on average about 3.27%.  They found that the greatest predictor of pain medication abuse or addiction was a current or past history of alcohol and/or illicit drug use, abuse or addiction.  Their recommendation? Pre-screening patients for these problems before prescribing opioid analgesic therapy.

Given all the changes that happened in 2014 with tightening access to narcotic pain medications, I'm afraid Cake is just going to be a visual aid for the public, feeding misconceptions about painkiller abuse.

Even healthcare professional have misconceptions about the proper use of narcotic pain medications to treat chronic pain.  Just this week, a prominent doctor in the field of fibromyalgia and chronic fatigue proclaimed, "You'll be pain free, because you'll be dead. Taking opioids for chronic, non-cancer pain increases your risk of death by 72%, according to a recent study in the journal Pain..."

I read a summary of that journal article and found it full of contradictory information.  For example, some researchers think that it's only the patients who obtain their narcotic pain medications from "nonmedical sources," like Claire in Cake, that overdose and wind up in the ER.  Then there is this quote (which I edited just a tiny bit for clarity):

"Safe and effective treatment of opioid-sensitive pain is possible... It requires deep pharmacological knowledge, experience, resources, considerable patience, and mental energy from a group of helpers who are able to take care of the whole bio-psycho-social conundrum of the chronic pain patient."  

That sounds exactly like what happens in my pain management doctor's office.  Hmm, too bad Claire didn't come and see my doctor.

But then again, someone treating their chronic pain appropriately with narcotic pain medications probably isn't the most interesting or provocative subject for a major motion picture, is it?  Hollywood loves misfits, even chronically ill ones.

Watch the trailer for Cake.


My most heartfelt advice for those who live with chronic pain and decide to go see Cake?  Don't get your hopes up thinking it will appropriately portray or advocate for the needs of people living with chronic pain.  Oh, and take it with a whole shaker of salt!

Until next time...

What's Wrong with Health Care: What It Took to Get My Painkiller Presciption Filled

Pretty please, just fill my prescription...    

Last time, I wrote about my troubles getting my prescription for morphine filled at my regular pharmacy: What's Wrong with Healthcare: Getting a Pain Pill Prescription Filled.  Today I'm back with an update.

They Just Said No

Remember how I couldn't get my morphine prescription filled at my regular pharmacy for over 3 months?  When last I wrote, I had just called another location of my old pharmacy, which was CVS by the way, and they told me they had my pain medication in stock.  I was cautiously optimistic that I was finally getting my medication.  

Well, I went there the next evening and guess what?  They DIDN'T have it!

Fed up, tired and frustrated, I took my prescription to a different chain pharmacy the next day and my prescription filling experience was completely different.

Filling a Painkiller Prescription, Redux

As I walked up to the prescription drop-off counter at this other chain pharmacy, the first thing I noticed was a sign explaining that some narcotic painkiller prescriptions could not be filled the same day because the medications would need to be ordered. 'Fair enough,' I said to myself.

I presented my prescription at the drop-off counter. The staff checked and they didn't have the medication in stock. So they 1) kept my prescription and 2) told me they would order the pain medicine for me. I was informed that the medicine should come in on Wednesday and 3) they would text me (my preference) when my prescription was ready for pick-up.

Since I hadn't used this pharmacy in quite a while, I needed to present my insurance card and my photo ID. "No problem," I told the pharmacy tech. As I waited for my information to be verified in their system, I could see the pharmacist completing the paperwork necessary to order my medication.

Wednesday afternoon rolled around. I hadn't gotten a call, so I decided to call them. I was told it was going to take one more day to get my prescription filled. Annoying, but I could wait one more day.

Sure enough, the next day, I got a text message letting me know my prescription was ready for pick up.

Bye-Bye CVS, Hello Better Customer Service

Despite the wait, this was a huge improvement over how I was being treated at CVS. Interacting with the staff at CVS left me feeling frustrated and like some kind of undeserving, second-class patient. This other pharmacy made me feel welcomed, important and worthy of their time and attention.

So I decided enough is enough, and transfered all my active prescriptions from CVS to this other chain.

On the day my new pharmacy called to get my prescriptions transfered, a pharmacist from CVS called and asked me to call them back. 'Too little, too late,' I thought and I didn't bother calling them.  I also didn't return their call when their corporate customer service department called me a few weeks later in response to the complaint I filed on their website.

The bottom line:  I'm done dealing with CVS, especially when I can get better customer service somewhere else.

The Curious Case of Painkillers "Lost" at CVS

By the way, I did some research and I think I know why CVS wasn't filling my prescription.

It seems there is a U.S. Drug Enforcement Agency (DEA) and California Board of Pharmacy probe into the "alleged loss of painkillers" at four CVS stores in Northern California. According to the L.A. Times, over 37,000 oxycodone hydrocodone combination drug pills, mostly generic Vicodin, went missing from these stores in 2013.  The article also states that earlier this year, CVS corporate told their Southern California stores to get their records in order because they were coming to audit them.

Now my prescription wasn't for oxycodone a hydrocodone combination drug (like Vicodin or Tylenol with codeine), it was for morphine. The key difference between these medications is that morphine is a Schedule II drug and therefore is locked up in a safe, whereas oxycodone hydrocodone combination drugs aren't, which makes it easier for the pharmacy staff to swipe it off the shelf if they are so inclined.

But clearly, all these problems with painkillers at CVS stores seems to have made them less inclined to fill patients' prescriptions for any kind of narcotic pain medication, which doesn't seem like good customer service or professional business practice to me.  Why should I be denied my pain medication because some CVS pharmacy staff members can't be trusted to handle these medications?

And About CVS's "Painkiller Rules"

I also decided to call my local office of the DEA, because I was told by several different people at CVS, both in the pharmacy and on the telephone with someone in their corporate customer service department, that:

1) The DEA won't allow CVS to answer telephone inquiries about whether they have certain pain medications in stock. (This also applies to CVS stores calling each other on behalf of a patient to see if another store does have the medication in stock.)
2) The DEA won't allow CVS to call me when they have my pain medicine in stock.
3) The DEA won't let CVS hold my prescription while they order the medication for me. (I was told that I needed to go into the pharmacy in-person with my prescription in hand in order to find out if they have my medication in stock.)

Well, guess what? The officer I spoke with at the DEA said that their agency doesn't have any regulations like these for pharmacies.

So what's the real truth here?

I was once told by a pharmacy staff member that the reason CVS doesn't answer telephone inquires about whether they have narcotic pain medications in stock is because they are worried about being robbed. How ironic is it then that the "robbers" they need to worry about are their own employees, not some thugs off the street?!?

I Think Patients In Pain Deserve Better Treatment

What more can I say? A person (like me!) with a prescription for a narcotic pain medication in their hand deserves the same exact customer service experience as someone with a prescription for any other medication behind the pharmacy counter. Yes, I am aware that the rules for dispensing painkillers are different. But as long as it is legal to prescribe them and legal to dispense them, patients living with pain deserve to get their prescriptions for pain medications filled without all the extra judgments, hassles and hoops to jump through courtesy of the pharmacy staff.

Leave me a comment and let me know what you think.

Help Stop the Global Crisis of Undertreated Pain

I just discovered a new documentary titled Life Before Death which discusses the global crisis of undertreated pain and wanted to share it with you all today. 

Please take a moment to view the trailer below.  Then head over to www.treatthepain.com to become part of a global effort to bring more pain relief to the world.  Plus you can help by liking Treat the Pain on Facebook, following them on Twitter or clicking the Do Something tab on their website.





I find this topic incredible relevant to me right now. As I have mentioned, I am looking for a new pain management doctor and I am legitimately worried about my continued access to opioid pain medications, medications that are making a real difference in the way I manage my fibromylagia pain. 

Before I started seeing my last doctor, I was never offered opioid pain medicine to manage my pain.  For 7 years I lived with severe pain on a daily basis and had to figure out ways to "grin and bear it," primarily through self management techniques.

I am grateful that opioid pain medication is now a part of my overall pain management strategy.  That said, it is only one piece of the puzzle and it certainly does not take my pain away, only reduces it.  No, I still need to keep employing all the other strategies at my disposable to manage my pain on a daily basis.  It is just a bit easier to do so when I have pain medications as part of my arsenal.

My situation is not unique.  Unfortunately, this is a hard, cold reality for many of us who are living with chronic pain:  we all are living with more pain than we should.  I would love to see that change in my lifetime.

Related articles

• Bits and Pieces: Overwhelmed with Health Care at Day 12 (ohmyachesandpains.info)
• Baffled by a Fibromyalgia Flare-up That Came Out of Nowhere? (ohmyachesandpains.info)
• In the Face of Pain: My Interveiw with Maggie Buckley (part two) (ohmyachesandpains.info)

Bits and Pieces: Overwhelmed with Health Care at Day 12

This new year is only 12 days old and I am already getting overwhelmed by all the health care tasks on my plate.  Good grief!

On Monday I shared about the flare-up that has followed me into this new year.  Well, I went for a medical procedure Monday that only made it worse, yet again. 

I had no idea how much pain I was going to be in.  It hurt so much that I asked the doctor to stop what she was doing at the halfway point and convinced her to reschedule the second half for another day.  Thank goodness Robert drove me to this appointment, as I was in too much pain to drive myself home. 

While the pain caused by the procedure subsided in a few hours, being in that much pain reactivated my hip and low back pain and I have been miserable all week.  Thank goodness for my flare-up kit.  It's making a real difference in easing my pain and helping get through this ordeal.

Tuesday's BIG appointment with my hepatologist went really well.  I got a nice surprise too.  Seems that my viral load went down, from 24 million to just under 10 million.  I attribute the drop to the drug metformin, which I asked my endocrinologist to add to my diabetes care plan.  You can read more about the anti-Hep C effect metformin has here. 

At that appointment I passed another milestone: right now the paperwork needed to start Hepatitis C treatment is getting completed.  I anticipate that I will begin treatment in February.  But before then, my schedule is packed with additional medical appointments and things I need to get squared away before I go to battle. 

First of all, I need to get an eye exam before treatment.  With some nudging, the eye clinic staff was able to squeeze me into an appointment at the end of the month.  Over the past several weeks, I've also persistently pursued and obtained an appointment with a cardiac arrhythmia specialist for next week.  I am relieved that I will have a doctor on my team who can troubleshoot any potential heart-related complications from Hep C treatment. 

And at my dental cleaning yesterday, the hygienist found a cavity that I am choosing to get filled right away too. 

I wanted to see my pain management specialist too before my life becomes all about Hep C treatment, but I learned yesterday that she has moved to Fresno.  What a shock and disappointment that was!  After the shock wore off, I found myself a little miffed that she hadn't notified me of this huge change or attempted to facilitate the transfer of my care to a colleague. 

It seems like, once again, I have been dumped!  Aargh!

I found her completely by accident, a happy and fortunate accident.  Finding a replacement is going to be really hard--she was the only doctor I saw that was willing to consider all pain medication options for me, including narcotics.  What she prescribed for me is working so well during this current flare-up.  I need a new pain management doctor who will continue to provide me with this real and much needed pain relief.

Despite all the craziness, I haven't completely lost my cool.  In fact, I kind of feel lucky to have so many distractions keeping me from getting worried and stressed about the start of Hep C treatment just a few short weeks away. 

Isn't it funny how the Universe works sometimes...

In the Face of Pain: My Interview with Maggie Buckley (part three)

Maggie:  The nature of pain care in our country right now is undergoing a big change, unfortunately, and some approaches are being restricted for good cause and some approaches are being limited for no real good reason or because of politics.

In Washington State for example, the State legislature has regulated opioid use, stating who can receive these medication, who can prescribe them, under what conditions and setting an upper limit on dosage and number of pills prescribed.  So that doesn't help any of us with chronic pain because now legislators, not doctors, are dictating what health care decisions are going to be made.

Selena: Laws like that come from a mindset that I don't understand.  I don't get why you don't adequately treat people who are in pain and you pass laws that withhold a pain treatment option that might help.

Maggie: Well, opioid pain medication is often vilified because it is morphine-based, so people think it must have something to do with illicit drugs.  So despite the actual statistics, it is the people with the personal stories about how they have lost a loved one, someone who is not living with chronic pain, to misuse or abuse of prescription pain care medication that are swaying public opinion.

The majority of people who overdose on opioids do not have their own prescriptions for these medications.  They have acquired somebody else's medication.  The suspicion then falls to the person with the prescription: Are they selling it? Did they give it to somebody?  The person who has passed away can't be questioned as to where they got the medication.  And in our culture, it is wrong to vilify the dead person; it's wrong to say that they died through actions of their own.

So grieving families tend to blame those of us who have chronic pain and have prescriptions for any "dangerous" medications.  They are not cognizant of the full picture.  That's why awareness needs to be raised. That's why we need more advocates out there explaining that there are more people in this country who have overdose deaths from acetaminophen than from prescription opioids.

It's another examples of how a little information in the wrong hands going a long way.

Selena:  I can also see how withholding opioid medications might mean that some people are using over-the-counter pain medications to excess or inappropriately because it's not really helping them manage their pain.

Maggie: Yes, so if consumers aren't educated and know what the pain treatment options are, they are going to be focused on taking a pill.  And if they are just focused on pills, and their doctor isn't giving them a prescription or not giving them enough of a prescription, then they are going to go some place else to find some other substance.  Whether it's an over-the-counter drug, street drugs, marijuana or alcohol, if someone is in pain they are going to be looking for relief.

As a person with pain, I am sure you understand and agree with me that the one thing we all want hope.  We want to know that in this moment, right now, when we have so much pain and we don't want to go on like this, what keeps us going on is that we have hope that we don't always have to be in pain.  We have hope that there is something out there that is going to help us.

Selena:  I guess I have gotten to a point where I don't hope I won't have pain, just that I will be able to manage the pain I do have.

Maggie:  That is pretty much how I think too.  For me, the pain is never going to go away. I've never known anything but pain.  I have experienced pain since childhood and I just want it to be managed enough so I can participate in life.

Selena:  Yes, exactly.
     

Related articles

• In the Face of Pain: My Interveiw with Maggie Buckley (part one) (ohmyachesandpains.info)
• In the Face of Pain: My Interveiw with Maggie Buckley (part two) (ohmyachesandpains.info)

Question of the Week: Got Pain Meds?

Image via Wikipedia
I've been living with chronic pain from chronic myofascial pain syndrome, osteoarthritis in my neck and low back, fibromyalgia, carpal tunnel syndrome and thoracic outlet syndrome for the past seven year.

Early this month, I was given my first prescription for a narcotic pain medication to help me manage the moderately severe pain, on average 7 out of 10, that I deal with on a daily basis.

I'm not exactly sure why it took so long for any of my doctors to decide to give this type of pain treatment a try. I have tried a lot of other medication for pain and have not gotten any significant relief. In fact, it has been at least a year since I have been offered the opportunity to try anything new. The list of what I have tried is very comprehensive and includes: antidepressant medications like Cymbalta and Lexapro, anti-seizure medications like Neurontin and Lyrica, non-steroidal anti-inflammatory medications like Mobic and Motrin and novel drugs like Tramadol and Nabilone.

I do know that since I have sleep apnea, my doctor was initially concerned about a narcotic pain medication suppressing my ability to breathe. A conversation with my sleep specialist cleared up this concern, since I am a faithful CPAP user and my sleep apnea is being adequately treated.

I also am aware that there is a marker reluctance in the medical community to use narcotic medications in general and in the specific case of fibromyalgia. It is my understanding that doctors are concerned their patients might become addicted to their pain medications. After doing some research of my own, I have found many credible sources that state the risk of a pain patient becoming addicted to narcotic pain medications is actually quite small. You can read more at Health.com and WebMD on this subject.

My doctor has asked me to sign a contract with her and submit to random drug testing before she prescribed this new medication for me. I have no problem complying with this conditions. In fact, I have made the decision to take a narcotic pain medication with great care and forethought, as I do with all the medications I take. I have great concerns about medication side-effects and adverse effects. I am willing to do what it takes to safeguard my well-being, include discontinuing any medication that is not benefiting me.

Now that I have reached this new treatment milestone, I am wonder what your thoughts are on this subject.

Do you take pain medications? Have you been prescribed a narcotic pain reliever? Do you wish that your doctor would prescribe one for you? Do you feel comfortable talking to your doctor about this treatment option?

I'm looking forward to reading your responses, which you can leave here or on the Oh My Aches and Pains! Facebook page.

PS While you are here, you might like to enter my Blooming Beauty contest for a chance to win a limited edition Mary Kay Lashes Love It! bundle.

Related articles

• Fibromyalgia and Narcotics (thefightlikeagirlclub.com)
• Chronic Pain: OTC or Prescription Medicine? (webmd.com)
• Hope For Fibromyalgia-Medication (Follow-Up) (hibernationnow.wordpress.com)