MEDICAL CARE FOR CHRONIC PAIN PREDICTS HARM, PERPETUATES PAIN AND OPIOID EPIDEMICS
There has never been evidence that opioids or other medical interventions treat the non-medical condition of common (non-cancer) chronic pain
by Clark Miller
Published February 7, 2025
From ABC News, a reminder of what has been known for decades, over the course of the impairment- and vice-fueled medical/media generation of the opioid crisis and prior to that: that there never has been a body of evidence to support efficacy, let alone safety, of opioid drugs for non-cancer chronic (“centralized”) pain, an entirely non-medical, psychogenic condition.
That’s been laid out, explained, here and here and here and in numerous posts following, here, in detail here.
The original research article appeared in The Lancet –
To review, from this post published at A Critical Discourse in 2018, outlining the evidence that had been widely available and would have been part of any legitimate medical training –
We’ll see, below, that the Opioid Crisis did not emerge because correcting evidence became apparent or available only after evaluated, critically scrutinized, responsible clinical practices had already led to routine prescribing of opioid pain medications for centralized chronic pain.
Instead, it occurred in the face of those approaches being unsupported and without validation of safety or effectiveness from the beginning by all lines of available evidence and research, evidence longstanding prior to the runaway prescription of opioids. That’s an abdication of critical thought, accountability, and public responsibility that must be faced and become understood to avoid repeating.
But – How did that happen, and why are we avoiding that question?
There has never existed, not at any time, a body of research evidence to provide even preliminary support for the safe practice of prescribing opioid medications for chronic pain, or with the expectation of durable benefit for chronic pain.
See, for example:
Chou, R et al. 2015. The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 162:276–286.
From the beginning, well prior to explosion of runaway, widespread use of prescription opioids for centralized chronic pain, all lines of evidence pointed against and contraindicated their use. There was never support for their safe, effective use due to longstanding:
1) lack of research evidence for effectiveness long-term
2) evidence for the potential for hyperalgesia
Hyperalgesia – increased sensitivity to pain – induced by use of opioids (OIH) is known and described extensively, beginning late 19th century.
See, for example:
Lee, Marion et al. 2011. A Comprehensive Review of Opioid-Induced Hyperalgesia Pain. Physician 14:145-161
3) established addictive potential of opioids
The high abuse and addictive potential of opioids including those prescribed for chronic pain is long-established (1), generating a history of statutory control (2) e.g. Harrison Act (1914); Boggs Act (1951) and others.
The 1970 Controlled Substances Act (3) lists opioid drugs commonly prescribed for chronic pain as Schedule II Substances (4), highly controlled as “drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence”
4) understanding of the psychogenic nature of centralized chronic pain
Chronic pain (5) – long-lasting pain that is non-cancer, not caused by acute tissue damage or inflammation – is established by decades and multiple lines of evidence and research as psychogenic (generated by mental/emotional states) in nature and with indicated treatments that are psychological (behavioral health therapies), not biomedical.
See, for example:
Dersh, Jeffery et al. 2002. Chronic Pain and Psychopathology: Research Findings and Theoretical Considerations. Psychosomatic Medicine: 64: 773-786
[Numbers 1 – 6 in parentheses in boxes link to online sources listed at bottom of post.]
5) evidence for cognitive behavioral therapies (CBT) as the indicated treatment for chronic pain
Extensive and longstanding research (6) establishes that effective and durable CBT treatments for centralized chronic pain (long-lasting pain that is non-cancer, not due to acute tissue damage or inflammation) are psychological (behavioral health therapies), not biomedical, fundamentally targeting underlying beliefs and mood states associated with pain.
See, for example:
Cherkin, DC et al. 2017. Two-Year Follow-up of a Randomized Clinical Trial of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care for Chronic Low Back Pain. JAMA. 317(6):642–644. doi:10.1001/jama.2016.17814
For a critical review of the current evidence: Doxa Deconstructed: Chronic Pain is Not What You Think
All relevant lines of evidence existed decades prior to emergence of runaway misuse of opioids and the current crisis.
Again –
the Opioid Crisis did not emerge because correcting evidence became apparent or available only after evaluated, critically scrutinized, responsible clinical practices had already led to routine prescribing of opioid pain medications for centralized chronic pain.
Instead, it occurred in the face of those approaches being unsupported and without validation of safety or effectiveness from the beginning by all lines of available evidence and research, evidence longstanding prior to the runaway prescription of opioids.
That can only be explained by an abdication, a failure of critical thought and critical discourse and of ethical reasoning and accountability, allowing the opioid crisis to be generated by other cultural forces, forces with the cultural capital (status, authority, legitimization by the mass media) to create accepted, fake “knowledge” in the face of contradicting and invalidating evidence – made-up “knowledge” that protects status, power, interests.
Numbered links to sources
1 – The high abuse and addictive potential of opioids including those prescribed for chronic pain is long-established
2 – generating a history of statutory control
3 – The 1970 Controlled Substances Act lists opioid drugs commonly prescribed
4 – Schedule II Substances are highly controlled as “drugs with a high potential for abuse”
5 – Common chronic pain is established by the evidence as psychogenic, not physical
6 – Extensive research establishes cognitive behavioral therapy (CBT) as the indicated treatment for chronic pain
Back to our current post and new evidence on chronic pain treatment –
A team of researchers and clinicians have developed and successfully trialed an intervention program designed to guide people in coming off prescription painkillers, taper their opioid intake, and learn how to manage their pain using alternative techniques with a course that combines one-to-one and group support.
1 in 5 people came off opioids within one year
The study, titled I-WOTCH (Improving the Wellbeing of People with Opioid Treated Chronic Pain), found that the intervention program helped 1 in 5 people come off their opioids within one year, without substituting medication and without making their pain worse.
Over 600 people took part in the randomized controlled study between 2017 and 2020 who at the beginning of the trial had been regularly taking strong opioids for at least three months. The participants were recruited from GP practices from the North East of England and the Midlands.
The study compared two treatments, dividing participants randomly into two groups. One group had access to their existing GP care, plus a self-help booklet and relaxation CD; the second group had the same and also took part in an intervention program specially developed by the study team.
The intervention program included sessions on coping techniques, stress management, goal setting, mindfulness, posture and movement advice, how to manage any withdrawal symptoms, and pain control after opioids.
Participants completed questionnaires about their everyday functioning and painkiller intake at intervals throughout the trial.
After one year, 29 percent of people who took part in the intervention program, were able to fully come off their opioids completely, compared to just 7 percent who were treated with existing GP care, the self-help booklet, and CD.
There was no difference between the two groups in terms of their pain, or how pain interfered with their lives.
[emphasis added]
Professor Sam Eldabe, clinical trial co-lead and consultant in pain medicine at The James Cook University Hospital, said: “Our trial is the culmination of six years of work during which we learned that the harms from long-term opioids extend beyond the individual into their social circle. Patients taking opioids lose interest in social interaction with family and friends and gradually withdraw from society into an opioid-induced mental fog.
“Despite appreciating the social impact of the drugs, most patients utterly dread a worsening of their pain should they attempt to reduce their opioids.
“Our study shows clearly that opioids can be gradually reduced and stopped with no actual worsening of the pain. This confirms our suspicions that opioids have very little long-term impact on persistent pain.”
[emphasis added]
That fear along with the typically iatrogenic instillation of false, self-defeating beliefs that common chronic pain signals physical pathology, fragility, vulnerability to additional or re-injury pose strong barriers to engaging in the most effective combination of therapies: cognitive behavioral therapy to dispel the ungrournded fears, motivational therapies to activate the physical behaviors feared, and increased exercise and physical activities that even more powerfully, experientially deactivate the psychogenic pain.
Although the study included group and individual sessions in the intervention group, therapy sessions provided by qualified therapists were not included.
Positive outcomes would have been predicted, with high confidence, to evidence higher success rates with qualified mental health professionals providing CBT, motivational, and other therapies.
Colin’s story
Colin Tysall, 81 from Coventry, was prescribed painkillers, including opioids to treat chronic back pain, as a result of working as an aircraft radiologist for 30 years.
“I was an industrial radiologist and wore my back out x-raying aircraft parts and handling heavy castings for jet engines. The castings could weigh up to 200lbs and even though we would move some of the castings around in stillages, it was still a strain. We were having to move these castings around very carefully, with no lifting equipment.”
Colin started experiencing sciatic pain down both of his legs and found that he had three slipped discs in his back. He describes the devastating impact of painkiller dependency:
“The treatment at the time was bed rest and painkillers. The tablets got stronger and stronger until eventually I was prescribed opioids,” said Colin.
“I spent so much time in bed that I lost the use of my legs and fell into a deep depression, so I was prescribed antidepressants too. I couldn’t look after my family, and at one point I tried to take my own life.
“I didn’t like being on tablets. They addled my brain, they made it difficult to think straight, my brain wasn’t functioning as it should. I would have nightmares a lot. As soon as I could come off them, I did.”
After spending 10 years visiting a hospital to treat his back and mental health, Colin turned to alternative treatments to treat his pain.
“I found that the best treatment for me was exercise. I got involved with mental health self-health groups, and I became friends with people experiencing similar problems. We would walk and talk together, which was the opposite of the guidelines at the time, but I found it helped keep my mind off the pain, and it made it easier to cope.”
After spending a couple of years tapering his medication to a lower level, Colin was eventually able to come off the tablets altogether. Recently he has found that he is no longer suffering from the pain.
Colin retrained as an associate mental health manager, and he continues to work at Coventry and Warwick universities helping to train psychiatric and nursing students.
Most recently, Colin got involved with the University of Warwick’s Clinical Trials Unit and has been helping support patients in the I-WOTCH clinical trial group support sessions as a trained I-WOTCH layperson.
[emphasis added]
Even 10 years of increasingly sickening and debilitating medical care by practitioners entirely out of scope of practice to treat the non-medical condition of chronic pain, did not prevent recovery once Colin began accessing some elements of the indicated, evidence-based psychological and psychosocial therapies and supports.
A bit behind the curve in June of 2022, CNN highlighted what’s been known about chronic pain for decades as “startling new science”.
True, it would have been awkward to report accurately that the truth about chronic pain was understood before the runaway, unsupported use of opioids was exploding through the efforts of a collusion of medical experts, institutions, professionals, Big Pharma, and American media. Not just understood but being successfully implemented, as described by sam Quinones in “Dreamland” in at least one program treating chronic pain – until insurance payers became collaborators with American Medicine.
As Quinones described, it required that America’s Medical/Insurance/Pharmaceutical complex delegitimize and demonetize the effective programs successfully treating chronic pain from a psychosocial/behavioral model in order to displace those effective approaches with billable medication prescribing and make those institutions and professionals appear helpful, important, and legitimate, with the social costs of becoming predictably and increasingly lethal.
The insights and clinical and ethical obligations championed in the piece by Dr. Haider Warraich are no less valuable, including that –
Almost everything we know about pain and how we treat it is wrong. Both patients and physicians have been taught that chronic pain is essentially acute pain prolonged. But while acute pain rises up the spinal cord to the brain, chronic pain can often descend down from the brain, often without any trigger from below.
The fallacy that treatments for acute pain will work for chronic pain has, in part, led to the opioid epidemic and prevented people from treatments that might have given more relief.
And
The chief function of pain is to direct all your energies and attention to it by inducing fear that your body is under threat. For example, when I had terrible back pain, I worried that exercise might leave me paralyzed or that my spine might snap in half. Alternative modalities help us reframe how we think about pain.
Right, that’s the critical importance of provision of cognitive behavioral therapy and motivational therapies by qualified psychotherapists, to “reframe what we think about pain” away from the decades of lethal lies that it is a medical condition with medical treatments, instead to the truth.
The longstanding body of evidence establishing common chronic pain as a non-medical condition,
outside of the scope of practice of medical providers predictably and recklessly generating lethal epidemics, has been easily available for decades.
You wouldn’t know it. Not from their reckless generation of an opioid crisis fueled by the runaway dispensing of opioids for all pain – acute, chronic, fabricated.
You wouldn’t know it by the behaviors of medical professionals and their institutions decades into the lethal crisis, with deaths mounting, over pandemic years, from their clinical practices (described in detail here in the post “INAPPROPRIATE OPIOID PRESCRIPTIONS RISE AS: PAIN DIAGNOSES DROP; USE OF EVIDENCE-BASED TREATMENT STOPS; LETHAL ODs WITH PRESCRIBED OPIOIDS TREND BACK UP”).
And you wouldn’t know it from the persistent emergence of harm-predicting distortions in media accounts of the the latest “breakthrough” and “game changer” in the treatment of pain.
It is “A Drug to Treat Pain” and “Without Opioid Effects”
as trumpeted by the New York Times.
The first new pain medication in 25 years to be approved by the F.D.A., as such a godsend and with the level of confidence for safety and relief that an F.D.A. approval should inspire.
It is, as headline readers now understand, “an alternative to opioids” and a “promising breakthrough” in the battle against the (prescribing doctor-generated) opioid crisis. It is in fact a likely “game changer“, so expect to see dramatic shifts in the trajectory of a steadily worsening opioid crisis.
The new miracle drug (which could rival methadone and buprenorphine as miracle cures) is actually “designed to eliminate the risk of addiction associated with opioids” and “designed to end opioids’ addiction and overdose risk“.
You get the picture. And to the extent that Americans do get the messaged picture, they will remain trapped in chronic pain, something the new medication suzetrigine (Journavx) does not treat, – does not, cannot treat – instead only acute pain, e.g., from surgery or injury, we’ll get to that.
For visual learners, Newsweek provides these engaging images right under the headline, illustrating that lower back and other chronic pain sufferers have reason to rejoice with approval of the new medical cure.
And by media reports there’s more, including reason to believe that the new pain medication “could eliminate addiction“, can provide “a solution” to the opioid crisis.
The problem of course is that those are all lies,
predictably, coming from America’s medical/media collusion. Not necessarily Faucian, that is, sociopathic lies, but lies generated by some combination of cowardice, carelessness, groupthink, and/or diminished capacity for critical thought.
One thing that the news pieces do well, almost uniformly, and anomalously, is to include as background a critically important, well-established distinction, explained in detail here also, and required to understand the unique and non-addictive nature of Journavx – the distinction between “peripheral” pain, like the pain from acute bodily injuries like tissue laceration, surgeries, a tooth extraction, or other damage in contrast to “centralized” pain, including almost all chronic pain and not associated with any such bodily tissue damage or inflammation.
Peripheral pain arises when pain nerve endings are affected, sending signals to the brain generating the inner experience of pain that is highly adaptive, serving as alert to immediately engage in behaviors to attend to, protect, and otherwise manage the injured tissue in ways that promotes healing. It is under normal circumstances and due to the remarkable capacity of the organism for healing, short-term, “acute” pain, adaptively generated as needed for healing, then disappearing, for obvious reasons – it is no longer needed.
Centralized pain is generated by the mind, i.e. is “psychogenic” and is not related to or adaptively needed for healing, commonly persisting, arising, and/or recurring long after medical imaging and all other measures establish that there is no injury, pathology, or physical explanation for pain as an adaptive response for the affected, healed area.
The new medication, Journavx, by shutting down adaptive, peripheral pain signals due to tissue damage, affects only peripheral pain, does not and can not treat chronic pain, which is not realted to sensory nerve endings, instead generated by the mind from distorted beliefs, thoughts, impressions, fear and other mood states in the mind – why the single, effective, evidence based treatment for chronic pain is psychotherapy.
There is no acute pain crisis or epidemic in America.
There is instead a chronic pain epidemic, due largely to the very effectively messaged, lethal lie that it is a medical condition treatable by medical professionals, trapping millions of Americans in outcomes from harmful surgeries, ineffective treatments, addictive drugs, and worse.
The new, celebrated, “game changing” drug Journavx does not touch chronic pain, cannot.
And? The preliminary clinical trial results are compromised, lacking confidence, as described here –
In phase 3 clinical trials by the drugmaker, researchers looked at how well the drug worked after surgery. Patients who had undergone either tummy tucks or bunion surgery were given either suzetrigine every 12 hours; an opioid, hydrocodone, plus Tylenol every six hours; or a placebo for 48 hours after the operations.
Some of the patients who got suzetrigine also took ibuprofen as a so-called rescue medication — that is, if they were still experiencing pain after their suzetrigine doses.
“The results we have now do not tell us a lot about how much of a rescue medication was used,” said Dr. David Rind, chief medical officer at the Institute for Clinical and Economic Review (ICER), a nonprofit group that evaluates the cost, safety and efficacy of drugs. “We don’t know if they would have had higher pain reduction if they had just taken an NSAID from the start.”
In any case, the post-surgical use of pain medication could have been provided safely all along including with opioids, if licensed medical providers prescribing them could have been trusted to ethically and with clinical competence limit the course of their use to 7 days or so and to never prescribe opioids for chronic pain. But we know how that turned out.
From the same NBC report –
In a report last month by ICER, a panel of experts rated the current data on suzetrigine as “promising but inconclusive.” By the group’s definition, that means it is moderately certain the drug would provide a small or substantial benefit to patients and a small — but not zero — chance of negative health consequences.
How much potential risk of harm is tolerable depends on the type of drug it is, Rind said. For example, it’s widely accepted that cancer drugs have harsh side effects but not enough to outweigh the potential benefit of treating an often fatal disease.
In those situations, “you are willing to accept a higher risk,” Rind said. “With a new pain reliever, it really has to be incredibly safe to be OK, and we really will not know that until it’s on the market and used by lots of people.” …
Despite remaining questions about the drug’s efficacy and long-term safety, Rind said the physicians he has spoken with are excited about the drug.
There are patterns here: in the carelessness and cluelessness of major media portrayals to a vulnerable public of potentially harmful medical misinformation; in the excitement of suggestible licensed medical professionals to begin prescribing a new medication to patients without strong evidence of effectiveness or safety; and more fundamentally of the predictable harms from provision of medical treatments, the providers entirely out of scope of practice, for conditions that are non-medical.
