I completely agree with painman. It's as though the opioid hawks feel the wind is finally at their back, and out of nowhere have swept in for the kill.

For those who don't get around to following Neurochic's suggestion to go onto the RSDSA site - or who might not spot the appropriate links, here’s the link to the RSDSA Action Alert that went out Thursday.

And here are links to the Gawd-awful PROP petition to the FDA and the response of the RSDSA. The last paragraph of which tells the tale: by changing the approved labeling, any use of prescription opioids BEYOND 90 DAYS will become “off-label” and therefore not covered by Medicare and most health insurance plans!

Having said this, it occurred to me that a key element in setting up the current situation has been the discrediting on the "pain community” as shills for pharmaceutical and medical device manufacturers. See, e.g., American Pain Foundation Shuts Down as Senators Launch Investigation of Prescription Narcotics, Charles Ornstein and Tracy Weber, ProPublica, May 8, 2012; as well as the authors’ earlier, The Champion of Painkillers, December 23, 2011.

So, to the rescue comes the Department of Psychiatry of the University of Washington, et al, the folks who have all-but-outlawed - by statute - the use of opioids for any and all non-metastatic chronic pain in the State of Washington, and the nation's leading proponents for an unproven therapy for CRPS that happens to employ mental health professionals by the bucket and around the clock: Cognitive Behavioral Therapy (CBT). [Link is to Wikipedia article] http://en.wikipedia.org/wiki/Cogniti...vioral_Therapy In fact, the Society of Clinical Psychology, American Psychological Association, Division 12, now specifically lists “Chronic or Persistent Pain” among an enumerated list of “Psychological Disorders and Behavioral Problems,” and includes in there the following:

Chronic Pain Conditions
• Fibromyalgia
• Chronic Low Back Pain
• Rheumatologic Pain
• Headache
• Chronic or Persistent Pain in General (including the conditions listed above)

Note well what they are saying: if a patient has non-metastatic chronic pain, that is a per se psychological/psychiatric disorder!

(Quite the contrast, I believe, to the currently recognized Dx in the DSM-IV “Mood Disorder Due to a General Medical Condition,” 293.83: we’ll have to see what survives in the upcoming DSM-V.)

And here, by way of what may be a very rude awakening, I ask everyone to check out Jennelle’s post from 08.15.09 in her update on the pain program thread, as well the subsequent comments to that thread. Hopefully, her experience does not become a prologue to our common future.

In any event, this is just a rough sketch of the what appears to be the current lay of the land. Hopefully, it won't come to fruition. But if we are to preserve our right to use modest amounts of opioids in response to one of the most painful conditions known to medicine, PLEASE write the FDA in opposition to the PROP petition, and encourage your treating pain management specialists to do the same. Thanks.

Mike