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The Guardian 06/22/2016

I take opioids to treat chronic pain. Stigmatizing them will harm me.

At a recent visit to one of my doctors started out in the usual way, with a review of my current medications. I have rheumatoid arthritis, an incurable autoimmune disease, so my list of medications is fairly long.

The doctor paused when she reached Tramadol, a mild opioid I use sometimes before bed when pain threatens to steal sleep.

“You need this every night?” she asked. This caring doctor I’d trusted for years stiffened as if on alert. I could practically read on her face the March 2016 recommendations from the Centers for Disease Control and Prevention that accused doctors of creating the opioid crisis and recommending that the “vast majority of patients” with chronic pain not be treated with opioids.

I looked down and mumbled that I only took it sometimes, and that my rheumatologist had prescribed it. But I couldn’t erase her piercing look from my mind.

Chronic pain patients like me are not the cause of the opioid crisis; only 22% of those who misuse opioids are prescribed them by a doctor, and only 13% of ER visits for opiate overdoses were chronic pain patients. Most chronic pain patients are rule-followers who just want to function.

If there is a cause of addiction for patients with chronic pain, it is the desperation induced by searing pain itself, combined with isolation, lack of support, and the resulting deep depression and anger that come with seeing one’s life slip away.

Still, I take precautions. Because I never want to appear to be seeking pain meds, I minimize my pain, rarely ask for pain relief, and only to confess to a severe problem when I’m desperate. But I’ve been desperate. I have been in intense pain every day for over five years. I am no novice, and the pain is significant and real enough that I have been forced to try everything.

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