Thread by @MysteryCorgi

I have just discovered that #Oregon is proposing changes to the state #opioid policy for #chronicpain patients on #medicaid.
I am incensed and I don't even live in Oregon. So let's break this down. #disability #opioidhysteria #spoonies #painpatients #opioidepidemic
Buckle up.

CW: ableism, bullshit, suicide, swearing
References:
portlandtribune.com/pt/9-news/4013…
nationalpainreport.com/chronic-pain-a…

To summarize:
-Oregon's Health Evidence Review Commission and Value-based Benefits Subcommittee (HERC and VbBS) are proposing changes to Medicaid
-The changes intend to discontinue long term opioids for chronic pain patients

-All chronic pain patients will be forced to taper their opioid use within a year NO EXCPETIONS
-Once the year is done there will be NO opioids for these patients

Instead patients will be replaced with the following ALTERNATIVE treatments:
-Cognitive Behavior Therapy (CBT)
-Mindfullness
-Pain Acceptance
-Aqua Therapy
-Chiropractic Adjustments
-Non-opioid medications like NSAIDS
-Acupuncture

Now I'm going to break down why these alternative therapies aren't going to work and why there will be blood on the hands of HERC and VbBS when some pain patients inevitably commit suicide.

Cognitive Behavior Therapy (CBT) is talk therapy that helps patients learn to identify negative thoughts and behaviors and work to develop skills through structured techniques.
For some folks, CBT works great. Others may need something different.

Even if CBT works well for a patient if they don't have a good therapist it won't be as effective and can turn patients off of seeking treatment. I've had therapists retire, I've moved. Stuff happens, and it's important to try to find a good therapist that fits.

bbc.co.uk/science/0/2359…
psychologytoday.com/us/blog/think-…
healthcentral.com/article/5-reas…

But sometimes it's easier said than done. Many patients don't have access to more than one therapist, if they are able to work with one at all.

Either way, CBT alone cannot help chronic pain patients, and is often used alongside other methods of pain management. But not every patient has access to a full medical team or the transportation or money or insurance to get such a team.
ncbi.nlm.nih.gov/pmc/articles/P…

On top of that, seeking psychotherapy as a psychiatric VS as a chronic pain patient is a totally different experience. The last time I was admitted to a psychiatric ward for a voluntary 72 hour hold, I was asked to leave about 13 hours in, because they were not equipped... >>

>> ...to deal with me. The ward's staff was not trained to deal with chronic patients. They refused to help me get water when I could not walk to the sink because "that's not our job." And then proceeded to ask me to drive myself home when I couldn't stand upright.

CBT in summary:
-can be beneficial in conjunction with other legitimate treatments
-there aren't enough studies with enough emperical data to completely support CBT as a treatment on its own

Mindfullness is one of the core parts of CBT, so as an alternative treatment it will fall under CBT.
"Pain Acceptance" aka Acceptance and Commitment Therapy (ACT) is just a specialized extension CBT.

Studies show that CBT, ACT, and Mindfullness as treatments for chronic pain, particularly #fibromyalgia show "mild to moderate improvements in mood and quality of life, but bery small changes in pain severity."
psychologytoday.com/us/blog/unlear…

sciencedirect.com/science/articl…
ncbi.nlm.nih.gov/pubmed/21683527
ncbi.nlm.nih.gov/pmc/articles/P…

So, so far HERC and VbBS are recommending that chronic pain patients "think happy thoughts" to feel better, ala some 'Cogito, ergo sum' approach to medical care.

This is dangerous for so many reasons, but I will highlight one that I think many chronic pain patients will understand: it's ableist as fuck. I've heard of and experienced a fair amount of ableism when it comes to invisible illnesses and mental health... >>

>> ...But I've never heard of any patients being asked to, I dunno, think REALLY hard until their arm stopped being broken. Maybe if cancer patients thought hard enough, they'd stop having tumors. And I'm certain that HIV+ patients have thought long and hard about not having HIV

I've deeply thought about not being depressed, not being anxious, not having PTSD. But as hard as I've thought about it, my brain hasn't corrected its chemical imbalance.

And another thing? We're too tired to think ourselves well. Being in pain day in and day out is exhausting.We need to use any energy to do basic shit like go to medical appointments or try to take care of our basic needs... >>

>> ...A trip to the bathroom can feel like a damn marathon when walking results in agony. Preparing food? Bathing? Cleaning? Maybe on a good day.

Aqua Therapy is not available to every chronic pain patient. This may be due to location or cost or any other number of variables. So unless Oregon has widespread availability for chronic pain patients to receive aqua therapy it cannot be a reasonable replacement for opioids.

acceleratephysicaltherapy.com/2014/03/23/the…
spine-health.com/wellness/exerc…

Chiropractic Adjustments. Chiropractic care is a profession that is steeped in qutite a bit of controversy. It's an alternative treatment with both scientific and ethical issues. I mean, I don't usually meet medical professionals at mall kiosks, do you?

painscience.com/articles/does-…
health.spectator.co.uk/the-evidence-s…

NSAIDs as an alternative: NO. NSAIDs are not supposed to be used long-term. NSAIDs can increase the chance of a heart attack or stroke as early as the first couple of weeks of using them, and the risk compounds and increases from there.
practicalpainmanagement.com/patient/treatm…

NSAIDs, when used long term, can cause kidney and Liver damage. So if you want your pain to be managed by NSAIDs, I hope you enjoy the potential Renal Failure. Also, if you don't already have IBS, ulcers, or acid reflux, get used to it thanks to overuse of NSAIDs.

" No medication is perfectly safe. According to the FDA, as many as 20,000 people die from NSAID use every year."
"The risk of addiction to opioids is well-publicized and makes good headlines, but in chronic pain patients it is less than 5 percent."
painnewsnetwork.org/stories/2017/5…

Over the counter NSAIDs and other pain relievers, like Acetaminophen are not always great choices for patients due to interactions with other medications. And getting a dose high enough for it to work usually requires prescriptions, at least in my experience... >>

>>...And when my body starts to tolerate the medications, I'm stuck between a rock and a hard place: resist taking pain relievers as long as possible so they hopefully keep working at lower dosages OR keep taking as prescribed and suffer as they slowly become less effective.

Acupuncture: GLORIFIED PLACEBO EFFECT. DO NOT @ ME
journals.lww.com/anesthesia-ana…
nccih.nih.gov/health/acupunc…

Pain Acceptance, again: I don't feel that I should NEED to accept the pain I experience on a daily basis. I've accepted that it's a thing that is happening to me. I have accepted the extremely tiresome and herculean task of trying to treat it and hold out for a future cure...>>

>> which I have no certainty of actually living long enough to see a cure, if there ever is one.

I once was telling a nurse about the pain I experience daily. The phrase "my normal pain" had barely escaped my lips before she stopped me and said something taht was extremely important for me to hear at a time when I had resigned myself to suffer. She said, "pain isn't normal."

PAIN IS NOT NORMAL. Simple as that. We should not accept pain. Nor should we resign ourselves to it, just for the convenience of those who do not experience it. If treating me as a human being is hard for you to grapple with, TRY TO WRAP YOUR MIND AROUND *BEING* ME.

I know it might be hard for people to take that tiny, basic step of interacting with another human on a BASIC HUMAN level. Learn empathy or get the fuck out of our way. Don't let your eugenics and ableist ideals hit you on your way out, fuckers.

And now I'm going to tag some folks I admire in the hopes to continue this conversation and spread it. @EbThen @talilalewis @Imani_Barbarin @karriehiggins @_brown_recluse_ @lisaquestions @MortuaryReport @fromsarahlex @MavenOfMayhem @yrfatfriend

I'm going to go seethe offline and try to calm down. It's difficult to be calm when my life and so many other lives are at stake.

Also @coffeespoonie