Medicare to Decide Your Pain Care; Speak Now to be Heard!


In an unprecedented move recently documented in a Pain News Network Article, CMS (Centers for Medicare and Medicaid) are moving to ‘firmly’ adopt the CDC’s opioid prescribing guidelines, effectively freezing out any chronic pain patient who is not suffering from cancer-related pain.  The new daily limits, which are anticipated to become gospel in 2018, will limit Morphine Equivalent Dosing (MED) to 90 mg/day.  Some sources report dosing as LOW as 60 MED!  This isn’t a lot of pain relief, folks.

Do you want your insurer to decide how much pain medicine you receive, or your doctor?  Chronic pain patients, speak out.  We will not be discriminated against!

Please read “Medicare Planning to Adopt CDC Opioid Guidelines,” (c) Pain News Network 2/3/17.  The article is by Pat Anson, editor.  The link:

Comment period ENDS MARCH 3rd.  Comments should be emailed ASAP to

My Comments on Medicare Planning to Adopt CDC Opioid Guidelines


I recently learned–with horror–of the CMS’s intention to adopt the CDC’s guidelines on opioid prescribing.  As a person living in chronic pain (and one who lost his father to suicide due to his inability to conquer his own chronic pain) I feel I have some experience in this matter.  I went through a rigid step process; must utilize a pre-specified pharmacy to fill my opioid prescriptions; must agree to on-the-spot urine tests; have never “run out” of medication or “lost” an opioid prescription; nor have I ever taken more than prescribed.  Neither have my disabled friends.  I suffer from debilitating, degenerative arthritis of the knees, hips and spine; have had five right knee surgeries; have peripheral neuropathy; and complex myofascial pain syndromes–to name just a few diagnoses.  Complicating matters are years of child abuse and a rape in my late teens, which only exacerbates my pain symptoms, despite years of counseling, anti-anxiety and anti-depressant medications.  Opioid medication is only a small piece of my treatment.  I also undergo multiple interventions from steroid injections to radio frequency lesioning to ablate nerve endings, temporarily stopping the transmission of pain signals.

Arbitrarily limiting the daily opioid intake of a chronic pain patient is not the answer to the Opioid Crisis.  It is always the last treatment of choice, and dosing must be decided on a case-by-case basis.  While a 90 mg MED may be too much to control the pain of a 90 pound person with moderate-to-severe arthritis, it is most likely not enough to adequately treat the pain of a 200 lb. man who can’t get out of bed without excruciating pain.  Limits must be looked at individually, and by experts in the medical field who are familiar with the patient, not by insurance company CEO’s who are trying to earn more than their average $10 million annual compensation.  I, myself, spend half my Social Security Disability Income on health insurance, split between a $112 Medicare premium, and the $833 I pay per month for my Blue Cross Medigap plan.  I am enraged that someone other than my physicians has even the intention of deciding how much pain medication I am allocated on a daily basis.  And I am not alone in this ideology.

Setting limits to pain relief in this manner will create new problems:  patients who have been legally obtaining their pain medication and taking it as prescribed will be forced to look outside the system for a replacement.  A patient who never in their wildest dreams would think of using an illicit drug to control their pain will do exactly that.  Others may turn to the abuse of alcohol; few will take more serious actions, including suicide.  Living in chronic pain is isolating, exhausting, often humiliating, and of course, painful.  Please do not make those who have suffered long enough suffer further by setting unrealistic limits on pain relief that will affect millions of Americans.

Big Brother, CMS Takes Your Pain Relief Away


In an unprecedented move recently documented in a Pain News Network Article, CMS (Centers for Medicare and Medicaid) are moving to ‘firmly’ adopt the CDC’s opioid prescribing guidelines, effectively freezing out any chronic pain patient who is not suffering from cancer-related pain.  The new daily limits, which are anticipated to become gospel in 2018, will limit Morphine Equivalent Dosing (MED) to 90 mg/day.  For the average chronic pain patient, this isn’t a lot of pain medication.  My MED ‘score’ is 150.  See where you are here:

Pain patients will also face further, obscene scrutiny by your insurer and pharmacy.

Please read “Medicare Planning to Adopt CDC Opioid Guidelines,” (c) Pain News Network 2/3/17.  The article is by Pat Anson, editor.  The link:

The time to be outraged and act is now.  Comments should be emailed ASAP to

I’m actually speechless…

Meanwhile in America:
(in case you were not paying attention…)
The Senate voted 51 to 48:
1. To end coverage for preexisting conditions, veterans benefits, and aid to rural hospitals.
2. To remove discrimination protection for women in healthcare.
3. Against the provision allowing children to remain on their parent’s insurance till the age of 26.
4. To cut off funding for the Child Health Insurance Program (CHIP).
5. Against ACA contraceptive coverage and maternity care provision.
6. To direct committees to send budget legislation to de-fund and repeal the Affordable Care Act.
For those who get health insurance through work, no pre-existing conditions. Lifetime caps for coverage are back for everyone.
Real and disastrous actions are being taken that will affect more than just the 20-30 million people who will lose their health care coverage and the 3 million people who will lose their jobs.
Despite their assertions of this being an action to “repeal and replace,” no viable alternative plan has been proposed.
As of this moment, no replacement exists.
On a personal note, remember the Bastille?


Thank You, Cory Booker, D-NJ – Sanity Speaks


WASHINGTON, DC – U.S. Sen. Cory Booker (D-NJ) issued the following statement:

“In the dead of night, Senate Republicans voted to continue their effort to repeal the Affordable Care Act, pulling the rug out from millions of Americans who gained access to quality health coverage thanks to the changes ushered in by this law.

“With no replacement plan of any kind in place, a repeal of the Affordable Care Act will mean that millions of Americans –hardworking families, their children, the elderly, the poor, those with disabilities, the underserved–will lose their health coverage and have nowhere to turn. That’s why everyone from experts and groups representing doctors, nurses, patient advocates to small business associations and elected officials on both sides of the aisle have spoken out about the disastrous consequences of a repeal without an immediate replacement.

“This effort to the repeal the Affordable Care Act is reckless, dangerous, and cruel. We should be building on the gains made under the Affordable Care Act and improving the law, not turning back the clock to a time when too many families had to choose between going to the doctor and paying their bills. I will continue to fight with everything I have to protect the millions of Americans whose lives now hang in the balance.”

It’s my birthday and I’ll whine if I want to


Dear US Senate: How dare you move to repeal Obamacare without even contemplating a reasonable facsimile.  This governing by Ivory Tower needs to stop — and stop before our next President — and I use the term loosely, is inaugurated next week (which, by the way, I’ve declared a National Day of Mourning).  We, particularly those served by the Affordable Care Act (ACA), the disabled and handicapped population, and any other American with a conscious for that matter, should be outraged.  Call or email your senator.  Simply because a Democrat put a law into place does not mean the Republican majority has to repeal it.  Senate, you’re acting like a bunch of spoiled, white, upper-middle-class white boys and girls…stuck in the 7th grade.  How dare you give insurance companies back the power to discriminate based on pre-existing conditions.  Make insurance unattainable to millions.  Let people suffer and die for no reason.  All the while insurance company executives continue to earn millions in yearly compensation.  Be outraged.  Take action.  Call and email your senators and insist they support fair and equitable insurance coverage for everyone — not only the spoiled few.

Senate Contacts:

From CNN on Latest Obamacare Enrollments:

Holiday Depression & Lost Identities


Holidays, particularly Thanksgiving and Christmas, are often difficult for many.  Family gatherings are known for bringing up painful memories – from those who never meshed well in close quarters – to heated discussions which arise over allocation of meal preparation duties – to old sibling rivalries that come to life once again.  And then there’s the infamous “Drunk Uncle” that’s become a beloved Saturday Night Live character.

When one reaches “that certain age” when parents, aunts and uncles have long passed, these holidays can easily become even more painful and complicated to navigate.  Old traditions are suddenly gone, as are the places and people we remember – fondly or not.  Those with chronic illnesses face additional challenges: the inability to participate in many normal activities, to finding ourselves alone, as friends – who’ve “disappeared” somewhere along our path to diagnose(s) are no longer present, painfully triggering our inability to feel whole or connected.  Even if I was invited to the round of events and holiday parties of years past, I would find it difficult to meet new people.  The “what do you do” question that’s regularly posed gets quickly dismissed when one responds “I’m disabled.”  Or, “I used to be a …”  My partner, in an effort to be helpful, usually responds for me, quickly stating “He’s retired.”  Even though it’s been more than 10 years since I’ve been able to work, I still cringe at the question, and even the “retired” response evokes a level of anxiety that only those chronically ill or disabled can truly appreciate.

After the New Year is rung in by Times Square revelers, one imagines that holiday angst would dissipate as quickly as it arrived.  Perhaps in a perfect world, certainly not in a year in which the entire country is uneasy, waiting for a new President to be sworn in.  A President, who in the kindest of terms, is a bit reactive, unevolved and inexperienced in the world of international politics.  Meryl Streep said it best during her Golden Globe Lifetime Achievement speech last evening, during which she defended the fair treatment of everyone, how violence only brings more violence, the importance of cross-cultural efforts to demonstrate human existence through the art of film, and that we all have a role in protecting the media, as they are truly the purveyors of a truth that will not be forthcoming from our new administration.  If you have a moment, I suggest you Google Ms. Streep’s speech.  I’m sure You Tube ( and other sites will have posted it in its entirety.  I wish you all a healthy, productive and positive 2017.

Blue Cross Places Further Controls on Pain Medicine Prescriptions


With little fanfare nor dialogue with its policy holders, earlier this week Blue Cross announced further controls and limitations on its coverage of prescription pain medicines. While done under the guise of “safety,” (i.e., addiction), the state’s largest insurer is placing additional hurdles in front of the thousands of Massachusetts residents who require opioid medication as part of their overall pain management therapy. (The cynical public relations executive still lurking within me does believe safety may have played a role in these new restrictions, however, I also smell a rat: thousands upon thousands of dollars saved each year on coverage of prescription pain medications, such as those containing the active ingredient hydrocodone or oxycodone.) There is a risk of addiction; there is also the risk that those patients whose diagnoses merit the use of an opioid-based pain medicine are denied access to safe, affordable medication in a timely manner. Many clinicians will balk at the additional, time-consuming paperwork Blue Cross will require to satisfy its new narcotic prescription strategy.

Unfortunately, chronic pain patients were not exempted; rightly, however, those battling cancer and/or other terminal illnesses will not be forced to abide by these new rules, which include coverage of 2, 15-day prescriptions monthly before Blue Cross, in its own words, “intervenes.” Below is a link to a recent Boston Globe article explaining the insurer’s new guidelines. Don’t get me wrong. I do believe there should be a control in place over the prescribing of this class of medication, but this should happen at the physician level – those clinicians who understand each patient’s pain condition(s) and who are qualified to make the risk/benefit analysis that should be made prior to the prescribing of any medication, regardless of drug class.

Transcranial Stimulation (TMS) to Fight Pain, Depression?


From today’s WedMD.  First understood to reduce patients’ depression, researchers are now exploring its applicability to reduce pain — in conditions such as Fibromyalgia. In this new therapy, electrical current is used to generate a powerful, magnetic field, similar in strength to those magnets used in Magnetic Resonance Imaging (MRIs).

Transcranial Stimulation (TMS) is currently being offered by two Boston-based healthcare institutions, Massachusetts General Hospital (MGH) and Beth Israel Deaconess Medical Center.

The Pain Medicine Debate: Why Are Patients Being Shut Out?


Often pain medicine (opiates) are rightfully indicated in the treatment of long-term, non-cancer chronic pain.  I agree there are valid concerns — from the fear of over-prescribing and addiction to potential “diversion” — but why haven’t more patients been included in this important conversation?  This is a last-hope therapy for many, and those who truly require pain medicine risk being shut out.  A good, timely read from The Washington Post.