An Epiphany

An Epiphany by Myra Christopher @LynnRWebsterMD


Myra Christopher is the PAINS Director and someone I’m proud to call a friend. She has given me permission to re-post her blog, An Epiphany, here. It was first published at

This morning I was a guest on Central Standard, a program which airs on the local Kansas City NPR station.  The program’s focus was chronic pain.  Over the weekend the host’s producer called to do a “pre-interview.”  One of the questions he asked me was about the relationship between efforts to improve chronic pain care and the opioid epidemic.  My first thought was “strap in” because you’re getting ready to be interrogated about the fact that PAINS continues to advocate for comprehensive chronic pain care, including opioids when necessary and effective, and because I have been openly critical of parts of the CDC’s Guideline for Opioid Prescribing for Chronic Pain.  Although I am agnostic about opioids, on more than one occasion, I have been the victim of what a colleague calls “hit and run journalism” and alleged to be an “agent of big pharma” because of the position I take.  I think we have overused opioids.  I do NOT believe they should be our first line of defense.  I think they are very dangerous medications; however, when prescribed and taken appropriately, they are safe and effective and can be lifesaving.  In addition, I think we don’t know nearly enough about them.  As the producer and I talked, however, I realized that this man was genuinely curious and trying to understand the complexity of chronic pain.   The strangest thing happened; in the process, I had an epiphany that I keep thinking about and I want to share.

Improper Treatment of Acute Pain Leads to Addiction

For at least five years, we have attempted to point out that there is clearly a correlation between efforts to improve chronic pain care which led to more liberal prescribing of opioids and the rise in abuse of and addiction to prescription pain medications.  However, even former CDC Director Tom Frieden, who spent much of his time post-Ebola crisis bringing the opioid crisis to the attention of the federal government and the American public, stated publicly that there is no known causal connection between these two public health issues.  One of the stated goals of PAINS’ newest initiative, No Longer Silent, is to clarify the relationship between opioid prescribing for chronic pain and the opioid epidemic – two critically important public health issues.

During my conversation with the radio producer, it struck me that the real “causal connection” here is the poor or improper treatment of acute pain.

Everyone working on either of these issues is very familiar with the story about the high school football star who wrenched his knee and was given a 30-day supply of oxycontin and died a year later of an opioid overdose or the straight A student who had her wisdom teeth extracted, became hooked on opioids, then shifted to heroin when she could no longer get her opioid prescription refilled and died of an overdose in a back alley.  These are tragic and powerful stories among many other cases related to real life situations which should never be explained away.

However, when confronted with the apocryphal story about the football player, I say, “The untimely death of anyone is tragic, especially that of a child or a young adult, but it is also tragic for people who live with chronic pain NOT to be able to access treatment they need, including medications, because we are trying to contain the opioid epidemic.”  Then I take it another step.  I say, “I know these things happen, and the teenager should probably NEVER have been given a 30-day supply of these powerful meds for a wrenched knee, but we know that for a variety of reasons this has routinely happened.  Then in three or four days, the kid’s knee feels better, but he is scheduled to take the SAT in a week or so and he just broke-up with his girlfriend. His mother is on his backside about his calculus grade, and his boss at the Dairy Queen wants him to take on more hours. AND while taking the opioids, he feels better than he has for a long time. He’s not quite so stressed. So, he keeps taking the prescription, and when it is gone, he gets very resourceful about accessing more medication or street drugs to sustain the euphoric effect of the legitimate prescription.” With proper pain management, I believe the football player’s knee pain could have been managed without exposing him to a substance use disorder, addiction or even death.

Alternatives to Long-Term Opioid Prescriptions

I’m not a clinician, but I have worked in the pain space for a long time now; so, let me stick my neck out and suggest that if opioids had been prescribed for a shorter period of time, if then over-the-counter pain meds had been recommended, if heat and ice therapy had been utilized, if he had distracted himself with music or X-box games while recovering,  if the teenager had stayed off his knee for a longer period of time – even if it meant missing a game or two – and if he had seen a physical therapist, he might be alive today.

The subtitle of the Institute of Medicine report, Relieving Pain in America, is A Blueprint for Transforming Prevention, Care, Education, and Research (emphasis added).  Those of us who served on the IOM committee that produced Relieving Pain talked about the need to prevent chronic pain from occurring by providing better care for acute pain.  However, the 360-page report gives little attention to prevention. In Chapter 2, Pain as a Public Health Problem, there are three pages focused on prevention. The section begins, “Perhaps the most important conclusion that can be drawn from a review of the enormous toll caused by pain relates to the need for prevention.  A public health approach to prevention attends to the external, often structural, factors in the social and physical environments that affect not just individuals but populations. These are the ‘upstream’ influences that shape conditions and behaviors that produce or exacerbate disease. In many instances, pain prevalence could be reduced as a consequence of normal public health initiatives aimed at preventing chronic disease….”

Upstream Influences

It was “upstream influences” that triggered my epiphany. The CDC’s locus of concern about opioid prescribing for chronic pain, in my view, has been and continues to simply be misplaced. It should be focused “upstream” on opioid prescribing for acute pain as a measure to prevent pain from transitioning from acute pain, a symptom associated with an injury, surgery, or disease, to a neurologic chronic disease! After having this “Aha!!” I went back to the CDC Guideline for Opioid Prescribing for Chronic Pain and concluded that the real problem is they are mislabeled!  Objections expressed by many individuals, including myself, and organizations about recommended limitations of dosage and duration of opioid prescriptions would dissipate if the Guideline was directed towards acute NOT chronic pain.

What do you think?

Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.

The Painful Truth @lynnrwebstermd Lynn R. Webster

Find me here:

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Copyright 2017, Lynn Webster, MD



  1. Suzi Montgomery on March 13, 2017 at 7:24 pm

    I think we often forget to look upstream… and judgement and decisions ensue that are based on limited peripheral vision. Christopher’s epiphany to shift the locus of concern seems logical and holistic.

  2. Angel on March 18, 2017 at 5:01 pm

    Acute vs chronic, recreational use vs necessary medical treatment, these are separate issues that have been lumped together and are causing absolute misery suffering and death.
    As I type this tears roll down my face, my first time out of bed in 6 weeks and made it to the kitchen table. My pain is so consuming like a fire it feeds on my body & soul eating my energy my hope my future until there’s nothing left but these ashes of my existence. For 23 years I was given my life back by opioid medication, due to the closing of my pain clinic the climate of fear from my other providers, I’ve been bed ridden for months my job gone my life over. All that’s left for me is suffering I hope this wrong thinking on opioids changes before more lose everything as I have.

  3. Christina on March 22, 2017 at 10:35 am

    Angels comment in precisely on point! I am 37 yo and have been suffering with severe and chronic pain for over 16 years now. I reluctantly had back surgery (I which I had put off for SEVERAL years) and that made my pain even more severe, and of course as life would have it that is not my only area of pain. I literally spend most of my day laying down and like Angel I rarely get out. I’m able to get out so rarely that I’m deficient in vitamin D. When I do go out the pain is beyond exhausting! They don’t understand that even with our pain meds WE’RE STILL IN PAIN!!! We are not abusing them, they’re even testing us…they have actual proof! I can’t work, I can’t cook, I can’t clean, I can’t have relations with my husband….I, like many, can go on and on about what I can’t do and all we want to do is be able to say is I CAN!! Taking away the medication that barely makes our lives manageable ensures that we’ll never beable to say those 2 words! The ones who need to be the deciding voice are those of us who know what it’s like to still feel pain when we’re trying to sleep. The only thing that has helped me to keep my depression from getting any worse, because of an absolute refusal of a pitty party has been knowing and saying there’s always somebody out there worse.

  4. Kara on March 23, 2017 at 9:51 pm


    I believe you are absolutely right.

    My acute/chronically occurring pain began when I was 11 years old. It started with severe endometriosis that would keep me from school and all other life activities for 3 to 12 days out of the month.

    When it began I prayed a lot. I honestly believed if only my faith was strong enough that God would make me better. Well, I am sure prayer helped some but it certainly did not abalate thr misplaced endometrial tissue from my organs.

    My age 13 I had my 1st of many surgeries. It failed to give any relief.

    The pain was so severe I’d throw up hourly, I would cry until I passed out from being exhausted, and always beg for death. Suicide. Just the thought of it was often the ONLY way I could find relief.

    My point? I was NOT given high doses of strong opioids right off the bat. My parents taught me breathing and distraction techniques. I used Anaprox and Midol. However, as the disease progressed I’d have to go to the emergency room every month for a shot to get through the worst hours. Sometimes I’d be hospitalized for 2 or 3 days.

    Once released I would be given a prescription of hydrocodone. The prescription would be enough for a few days.

    I can clearly recall being in bed, heating pad, music or tv for distraction, and warm cups of tea. The pain would be calm but I’d call for my mom.

    Mom? I need a “doctor pill”. My mom would say but you seem ok. You’re not crying or vomiting. She would tell me the prescription is a privilege not a right and with it comes a great responsibility. She’d explain to me that I had to cope with the fear of pain. I had to control it and not let it control me.

    She explained that I was reacting the the fear of another attack which was normal but that it had only been a few hours since my last dose and that I had to wait the full six hours because if I did not then I could develop a dependence on the doctor’s pills and that she didn’t go through 42 hours of back labor to raise a child to become an addict.

    My mom simply did not accept addictive behavior rather it was too much tv, food, candy, or whatever.

    She always explained to her kids that nothing in life can be good when it is abused.

    Now, this may sound heartless to some but my mom was wise and loving. She suffered from chronic pain with endometriosis having been her introduction to acute/chronic pain as well.

    You see? We can teach our young to be cognizant of the world around them without making millions of chronic pain patients suffer.

    Cutting people off from their opioids is not going to solve a single thing and in fact it is already making matters worse.

    Fast forward and adding several other illnesses/diseases like Trigeminal Neuralgia, Interstitial Cystitis, Degenerative Disc Disease, chronic kidney stones (not diet related), chronic migraines, Shingles, Post Herpatic Neuralgia (herpetic?? Sp??), Sciatica, and others I was eventually placed on chronic opioid therapy. And thank god for it!!

    Once I was placed on chronic opioid therapy I started my own house painting business, I went to college, I managed to stop scaring potential boyfriends away, I had a social life, and basically… for the first time since I was 11 years old … felt like life was worth living. That some pain would always be a part of my life but now I had a way to manage the majority of it.

    The meds also allowed me to take up downhill skiing, whitewater rafting, fishing, sailing, weight lifting, and areobics. All 100% not possible without the 550 to 650 MME dose I had been successfully taken for years!

    I have been on even higher doses but as soon as I did not need them I asked to be lowered!!

    I know MY body and I know what type and how much I need to function. And I know 100 MME is only going to lead me to an early end rather than a good, happy, and quality life like I deserve.

  5. Kara on March 23, 2017 at 9:55 pm

    *wishing* there was an edit button. Sorry for the typos! I should have reviewed before posting. Darn auto correct! Lol!

    *Abalate should be ablate.

    * By age 13

    And so forth.

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