BREAKING NEWS-SHARE WITH ALL!
Families for Intractable Pain Relief Co-Founder Kristen Ogden presented at the latest FDA Hearing Jan.30, 2018!
View Slide Presentation-link here:
Veract Intractable Pain and Palliative Care Clinic mission, goals, and operations and new protocol for medication reduction-links:
Dr.Tennant’s Latest Statement on Treating Intractable Pain:
By Forest Tennant M.D., Dr. P.H.
January – 2018
The current attempts by a number of parties to castigate and humiliate pain patients and their medical practitioners is not just pathetic and mostly false, it is dangerous to the fate and life of many IP patients. If it wasn’t so serious, some of the claims, biases and beliefs would make good comedy.
First and foremost there has been no discussion about the difference between intractable pain and chronic pain. There really is no bigger issue. The proper identification and treatment of the IP patient is not only essential for the health and well-being of the IP patient, it is a major key to the prevention of overdoses and diversion of abusable drugs. IP patients must have special care and monitoring.
The basic definition of IP is a “moderate to severe, constant pain that has no known cure and requires daily medical treatment”. Chronic pain, on the other hand is a “mild to moderate, intermittent, recurring pain that does not require daily medical treatment”. While there are millions of persons with chronic pain, only about 10% are intractable.
The cause of “intractability” is two-fold: (1) the initial injury or disease which initiated IP was severe enough to cause a pathologic transformation of the microglial cells in the spinal cord and/or brain. It is this transformation that produces neuroinflammation and the constancy of the pain. This process is known as “centralization” or “central sensitivity”; (2) to have enough injury to cause “centralization” one must have a most serious disease or condition of which the most common are: adhesive arachnoiditis, traumatic brain injury, reflex sympathetic dystrophy, post-viral encephalopathy, or a genetic disease such as Ehlers-Danlos Syndrome, porphyria, or sickle cell disease.
Medical practitioners must have minimally-restricted prescribing authority and autonomy to adequately treat IP. For example, the proper treatment of IP not only requires analgesics, opioids and non-opioid, but specific anti-inflammatory, hormonal, and corticosteroid agents that will cross the blood brain barrier and control inflamed and pathologic microglial cells. Treatment of IP has to be individually tailored and may require non-standard, off-label, or an unusual treatment regimen.
Make no mistake about it. The new treatment approach to IP is quite effective in reducing pain, controlling neuroinflammation, and allowing patients to biologically function well enough to have a good quality of life. Also be advised that the new IP approach is not just reducing pain but treating the underlying cause of pain. Consequently, a lot of expensive procedures, therapies, and opioids are no longer needed. As long as I am practicing I will continue to push forward this new approach.
DEA’S CASE AGAINST DR. FOREST TENNANT
WHERE’S THE BEEF?
- Any overdoses?
- Any malpractice suits?
- Too many patients?
- Makes too much money?
- Trades sex and money for drugs?
- No physical exams?
- No records kept?
- No justification for high dosages?
- No diagnoses?
- No consents given?
- Unprofessional hours, unsanitary clinic?
- California and CDC guidelines not followed?
- Anyone harmed or rendered non-functional?
- Drug diversion occurring?
- Medical Board has taken disciplinary action?
The answer to all of the above: No. No beef so far. But what about…
- Non-standard treatment regimens used? Yes, after all standard treatments have failed.
- High doses of opioids prescribed? Yes, if required to effectively manage a patient’s pain.
- Patients crossed a state line? Yes, if they can’t get pain care in the state where they live.
So what? Still no beef.
- Treating too many patients suffering from failed surgery, epidurals, and medical mismanagement?
- Providing comfort to patients who have only a few months to live?
Yes, sad but true.
Here’s the real “meat” of Dr. Tennant’s intractable pain practice: providing compassionate care to patients for whom all standard treatments have failed. There are rare, extremely ill persons treated in the clinic and many near the end of life. We have examined the California and CDC Guidelines and do not see any deficiencies or non-compliance issues. Dr. Tennant is hardly a “pill mill” and only about 150 patients are enrolled in the clinic. His nonprofit charitable organization, The Tennant Foundation, helps subsidize the clinic. What is the “complaint” or “beef” about the clinic? We sincerely want to know. At least some patients will die within weeks if the clinic is not available.
FAMILIES FOR INTRACTABLE PAIN RELIEF:
Freedom from pain, to the extent achievable, is the most fundamental of all human rights.
Please help Dr.Tennant and his patients–write your legislators and the DEA DOJ and let them know what you think!
Thank you for all the letters of support..feel free to copy the 20 Beefs and any other articles about the over-reach of the DEA /DOJ on innocent doctors and patients. Lives hang in the balance.
New– TWELVE MYTHS ABOUT OPIOID USE:
Written by: Ryle Holder PharmD, Dr. Scott Guess PharmD, and Dr. Forest Tennant M.D., Dr. P.H.
1. Above 100 mg of morphine equivalence opioids are ineffective. NONSENSE! They have no ceiling in most patients and may remain effective at dosages in the thousands.
2. All pain patients who take over 100 mg of morphine equivalence are diverting or selling part of their prescription allotment. NONSENSE! Most patients who have a bad enough pain problem to need this much opioid don’t usually want to part with it.
3. All patients who use the “holy trinity” of an opioid, benzodiazepine, and muscle relaxant are either selling their drugs or will shortly overdose. NONSENSE! The original “holy trinity” was a simultaneous ingestion of the combination of the short-acting drugs hydrocodone (Norco®), alprazolam (Xanax®), and carisoprodol (Soma®). A different, (e.g. long-acting drug from either of the 3 classes (opioid, benzodiazepine, muscle-relaxant) markedly lowers the risk. So does taking the drugs separately. Many severe, centralized pain patients have to take a drug from the 3 classes and do it safely and effectively. In other words, they take the drugs “as prescribed”. Additionally the “Holy Trinity”, originally called the “Houston Cocktail”, is a term coined by law enforcement; addicts tend to use mono-syllabic terms to refer to their poison of choice, “Holy Trinity” is too many syllables.
4. Centralized, intractable pain doesn’t exist. NONSENSE! Much research documents that pain from an injury or disease may cause glial cell activation and neuroinflammation which may destroy brain and spinal cord tissue. Multiple, high dose drugs may be needed to prevent tissue damage and control the immense pain that this condition may produce. As inflammation develops the overall stress on all organ systems increased dramatically and occasionally to a life-threatening level.
5. The risk of an opioid dosage over 100 mg of morphine equivalence is too great to prescribe opioids above this level. NONSENSE! If a severe, chronic pain patient can’t find control with opioid dosages below 100 mg or with other measures, the benefit of the high dose far outweighs the risks.
6. Overdoses occur even if opioids and other drugs are taken as prescribed. NONSENSE! If this even happens it is extremely rare. Overdose victims often take alcohol, marijuana, and other drugs in combination; but, opioids and the prescribing doctors are always blamed.
7. There are no “proven” benefits to long-term opioid therapy. NONSENSE! Simply talk to someone who has taken them for 10-20 years. Never has there been nor will there ever be a double-blind, placebo-controlled study to provide “evidence”. Opioids are a last resort when all else fails. Opioids in doses >100 mg have improved quality of life and prevented death in some instances.
8. Chronic, severe or intractable pain is just a nuisance that doesn’t warrant the risk of opioids. NONSENSE! Severe pain has profound detrimental effects on the cardiovascular, immune, endocrine (hormone) and neurologic systems. Pain must be controlled or pain patients may die of stroke, heart attack, adrenal failure, or infections due to a suppressed immune system.
9. Genetics has no effect on the need for a high opioid dosage. NONSENSE! Bigger and heavier people need a higher dose of medications (just add 1 drop of food coloring to a 1 gallon and 5 gallon bucket and observe). It is well documented that some genetic variations impede opioid metabolism to the active form of the drug, or increase the speed the body excretes the opioid. Both metabolic variations will require a higher dosage.
10. All pain patients can get by on standard opioid dosages under 100 mg. NONSENSE! There are persons who are outliers with all disease conditions such as heart failure, diabetes, and asthma. Same with pain. A few unfortunate individuals will always require high dosages. Remember our friend the bell curve? What if YOU were on the extreme end?
11. All patients started on opioids some time ago can just suddenly stop opioids. NONSENSE! Once a person is on high dose opioids they don’t dare suddenly stop because sudden withdrawal may cause hypertension, tachycardia, adrenal failure, and sudden heart stoppage. Some patients who have stopped too suddenly have committed suicide because they had no way to control pain. Montana reports that 38% of all suicides in the state are UNDER treated pain patients.
12. There are plenty of alternatives to opioids. NONSENSE! Common pain problems are generally mild to moderate and respond to a variety of non-opioid treatments. Unfortunately, there are some severe, intractable pain patients who can only control their pain with opioids.
Great article below from NY Post written by Jacob Sullum about Dr. Tennant’s current situation and the great work he does taking care of rare patients. Please share far and wide, and include it when you write your Senators, Congressmen, etc. Share with everyone! This has to stop, patients are suffering! Thank you Jacob Sullum!
Dr. Lynn Webster comes out in support of his friend and colleague- Dr. Tennant- Thank you Dr. Webster! -Author of The Painful Truth.
Thank you Maia Szalavitz! – Author of The Unbroken Brain
Dr. Fudin and Dr. Terri Lewis speak out #DropTheTennantCase!
Thank you Dr. Fudin and Dr. Terri Lewis!
Great Recent Articles from Pain News Network, Thank you Pat Anson and Pain News Network!
Reporter George Knapp from Channel 8 in Las Vegas has done an excellent job telling the other side of the “Opioid Crisis” -how it is affecting those with disabling pain, in the #ourpain series. Thank you George Knapp and Channel 8 I-Team!
Reason TV did a riveting interview of Dr. Tennant and his patients in July and an update on the raid of Dr. Tennant’s office. Thank you Zach Weissmueller!