Despite Opioid Disaster, Feds Continue to Ignore Alternative Pain Treatments

Posted · 27 Comments
Pain pt

Last week the U.S. government released the new CDC opioid prescribing guidelines, closely followed by the National Pain Strategy.  Like an addict coming off of a 20 year bender, the federal government has finally woken up to the fact that much life has been wasted and something different has to be done.

The CDC opioid prescribing guidelines advise prescribing opioids as seldom as possible, in as small a dose as possible, for as short a time as possible.  The guidelines advise that opioids for acute care be limited to 3-7 days.  Though these recommendations are highly controversial, the reality, acknowledged in the recommendations, is that millions of Americans, many using the medications for pain as prescribed, have become addicted and 169,000 have died.  At the same time, there is no evidence that opioids are an effective treatment for chronic, non-cancer pain.

To my mind, this is all good.  Where the recommendations fall short is in advising doctors and patients what to do instead.  Vague references are made to physically therapy and psychotherapy, without adequately addressing the fact that these therapies, while often effective for chronic pain, are either out of the financial reach or out of the geographical reach of most pain patients.  More than 93 million Americans live in mental health shortage areas, where there is less than one mental health provider per 10,000 people.  Physical therapist shortages are growing too, with the American Physical Therapy Association predicting a shortage of 40,000 therapists by 2020.  Even where physical therapy is available, insurance companies have been allowed to severely restrict the number of visits they will cover and to impose high co-pays.

Dozens of experts contributed to the National Pain Strategy, which was five years in development.  Yet there was not a single acupuncturist, chiropractor, massage therapist, exercise physiologist, physical therapist, nutritionist or naturopath on the panel.  As a result, despite the enormous potential of these therapies to heal pain, they were completely ignored in the proposed plan.  Instead, an intensive five year effort to find better pain treatments was recommended, as well as finding ways to “incentivize” doctors to provide better pain treatment.

This is an outrage.  Please join with me in demanding that President Obama and Congress pass legislation that requires that doctors be educated in alternative pain treatments and that insurance covers them at a level that allows affordable access for pain patients and a sustainable income for health care providers.  Please sign my petition on change.org here:  Pain Treatment Parity Act Petition

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27 Responses to "Despite Opioid Disaster, Feds Continue to Ignore Alternative Pain Treatments"
  1. pissed off says:

    I’m sorry but I am unable to walk and have an extremely painful blood disorder. Massage will cause me to have chronic DVT and PE,S and anyone touching me I just want to about die these meds put a bandaid for me until I walked in those who have LEGITIMATE LIFELONG PAIN worry about drug addicts and stricter control who is prescibed too. Not everyone is in the same category!

  2. LisBeth Stephens says:

    Please stop government and insurance companies from dictating health care. So many are dying because of not accepting alternative treatments!

    • Benjilei mena says:

      I am a chronic pain sufferer and I use very little pain meds to continue to fight for a quality of life I want to live not what I’m forced to live the small amount of meds I use allow me to exercise several times a week and swim several hours a week which in turn helps with lowering pain levels but without them I can’t push through the pain to do the stretching and light weights along with swimming and I end up in massive pain when I can’t exercise so I need my pain meds to push through the pain of exercising and that’s what helps me continue to live what life I have left

    • Mary says:

      Stop dictating to those who honestly need and use opioids in order to have some quality of life. When you try every thing you can and now government is dictating to doctors , Honest doctors who fear of losing their license who now are cutting back on what they will prescribe . Therefore leaving us with constant pain and loss of quality of life. Yes tried everything possible for my situation! For years people and unethical doctors abused the use of opioids . So now those of us who honestly need them we are told you can’t have the amount that managed your pain for the last 14 years! People die because they misuse not when you use the medication responsibly ! Addiction and misuse is by choice. So now we suffer? Just not right! The government was aware because I have been watching the programs and documentries on the Store Front Prescrition Doctor offices set up for profit and profile of the people misusing and selling their prescription on the TV for a long time. Why didn’t they go after them? Abuse is by choice! Pain is not by choice!

  3. How can the government dictate what people with chronic pain can and cannot take? Leave the damn decisions to the doctor and their patients!!!! This is not a dictatorship country!!!!!!!!

    • Doris says:

      Amen

    • Doris says:

      Amen I have multiple sclerosis and fibromyalgia I need my pain medication I should not have to suffer because of the other people’s stupidity there’s been a drug problem in the United States for many years and will continue to be whether it’s opiates or something else so I should not have to suffer when I need it for pain because of somebody else’s mistake the government has no right to force me to suffer like a communist country government needs to stay out of the doctor’s office

  4. b...graffeo says:

    Im so tired of these do gooders NOT understanding that Many Many of us live in daily chronic pain from illnesses that have no cure and progress over time….some of us have overlapping illnesses that are debilitating…..we dont ask for these illness and it is so very ridiculously unfair that those of us that SUFFER on a daily basis are being denied the pain relief we require to just get up….It has been proven over and over again that when you have a chronic pain illness that has NO alternative….WE cannot become ADDICTED …..Addiction happens when opiates are being ABUSED by people who are using them for recreational purposes only…..people who have no pain..
    ….For those of you who dont live every day of your life in chronic pain…..GOOD FOR YOU….for the rest of us that are trully suffering in agonizing pain each day…..i think i can speak for others in saying..
    …we hope YOU never have to experience the horrible PAIN we go through each and every single day…..The problem lies with the true abusers that take the opiates for their pleasure…and sell them….this is ridiculous that the united states government REFUSES to address the true problem of which bogus drs are handing out scripts to the TRUE ABUSERS…who are hurting the rest of us who need the pain relief….

  5. Patricia Britt says:

    People that suffer everyday with pain are the ones that are hurting we live everyday wondering if we can get something for the pain and drs don’t care or otherwise the government don’t give a damn how we feel in pain all the time hurting everyday i wish they would walk in our shoes and go through what we do and maybe they might understand what we deal with on a daily bases.

  6. Jenny Huett says:

    We should be able to see a therapist I have depression and they can’t help me they tell me until I get it under control my pain will not get under control. Never had take any meds till 4 years ago when got hurt,I have asked for other treatment and told work comp want cover it. We have tried so many different pain meds and so own lortabs at 4 times a day been own them 3 years to point not working. Then own nerve meds 4 times a day. Dr at pain clinic all he wants to-do is pain meds or nerve blocks can’t take those either.

  7. Penny Walters says:

    Physical therapy only exacerbates my level of fibromyalgia, and it is not a mental health condition. It is a defect in the processing system of the CNS. Until researchers figure out how to fix the underlying problem, these alternatives will not work. At the same time, opioids are also not a good answer. I cannot tolerate the schedule 2 (3?) drugs and the med I do take makes me just barely functional. So far the government AND the alternative treatment proponents are ignoring the real issue. And I pay the price. And I am just one of many, many in this situation.

  8. cindy riggs says:

    I agree to disagree.. .I live with chronic pain an I don’t want the goverment telling me what I’m allowed to take for the pain….they don’t live in my body to know the struggles I live with from day to day….

  9. Tiona says:

    Norcos are the only thing that works for me. I’ve been on 1 10/325 at night for 5 years now I still only take one at night so I can sleep with out pain. People only take more than need because they like the high. I only take it so I can sleep with out pain.

  10. Kimberly says:

    This is ridiculous. Although therapies should be used for chronic pain, they should be used in conjunction with pain medication! We are talking about pain patients, not drug addicts here and it’s ridiculous to think opioids don’t have their place in long term care. I am a pain patients that has taken pain medication for the better part of a decade and I absolutely do not abuse it. For the government to step in and say much doctor and I are incapable of making decision on how to handle my medical care is outright insulting. The main symptom of my chronic, incurable disease is SEVERE pain. Massages aren’t going to help that. I get really sick of healthy people who can not sympathize with my condition telling me how to treat myself. It’s utter misery. Suicide rates for pain patients are going to sky rocket if this plan is enacted. If I have to take I pill so I can get out of bed and take care of myself and my family, so be it!

  11. Misty says:

    Umm why not tell the president that taking optics away from patients is not a good thing, love how you don’t research anything as far as your suicide ratings for people in pain or the fact dependence and addiction are different. Do you not think that we have tried it all? If it worked we would be doing it. I can’t do alternative therapy as you want because it could paralyze me. When are you people going to get Smart and leave us alone and do something useful..

  12. Barb says:

    What exactly is it you would recommend to a patient, whom for several years has been living with Irretractable Long Term Chronic Pain.
    After having exhausted all Financial resources, losing their home to pay for all of these other natural modalities that did very little for that patients intense, 24/7 intolerable pain. After following the medical protocol as outlined prior to having Spinal Surgery with Plates, Screws that broke when the Orthopedic Surgeon was inserting them, causing even more issues in the long term. After 7 more years of PT and Massage, now on full social Security disability for Life due to the severity of their 1st injury, as well as the botched Surgery causing Failed Spinal Fusion & resulting in overlapping Autoimmune diseases due to the Metal poisoning.
    After all the years of suffering to never have regained any quality of life. The only thing that kept this person from committing Suicide die to the intolerable pain, the inability to support them self, the depression that set in after all of this, which by the way is very common when a life is no longer filled with living a fulfilling, meaningful, productive life. Unable to Support a Family & Tragically enduring more Surgeries that render the person with Permanant Nerve damage as the Broken Screws, Metal hardware and Cages were removed due to the severity of pain. All of the protocols in place once again followed with PT, Changes in Diet Pyscho therapy, Aqua Therapy, Support Groups and all other means to reduce pain do not help anymore. The continuation of seeking help with Tens Units, Braces and pain reducing implants in the spine no longer work. The only option left is to manage the symptoms as it is the only options left. With the guidance and help from the leading specialist on managing pain through the Pain management center, which by the way is a 3 hour drive from the rural town this patient lives in, must d3pend on what friends and family members have stuck around. The pain specialist and staff spends a few hours doing a thorough assessment which took 3 hours to complete, finally this Doctor whom also has a dual degree as he is a anesthesiolgist as well. They come up with a plan for palliative care, as the patient can no longer tolerate the level of pain. It is decided the patient would start out on a low dose of long acting pain reliever. 1 30 mg tablet 2 X a day. Along with the 5mg of a short acting pain reliever 3x a day if needed. Gabapentic for the nerve pain shooting down the legs, causing many nights lacking sleep. Oh and the Morris at 800 mg to reduce the inflammation. Afterall the anti inflammatory that had been being used was pulled from the shelves bc it was causing patients to bleed out from the stomach lining after long term use ( 2 years worth).
    There is a patient & Doctor Contract put into place as a compliancy contract. If you abused your medication,failed to give a urine sample at anytime requested, sold or diverted any of the prescribed medications then you would no longer be treated as a patient & faced prosecution.
    You were expected to show up every month on the 28th day as scheduled to review your medical needs, follow up care etc. The problem remains with the 6 hours of transportation each moth. Meantime You comply and being feeling better than you had in many years. Finally a slice of life is given back to you. What a great feeling to have piece of mind for the 1st time in so long. After a few months and all is still going smooth, though you still have pain, you find it tolerable and begin to participate in life, building self confidence back up. Joining in on family activities. Now you start contemplating if you might be able to return to work! Wow You really are doing so much better! Others are even noticing. Your friends are back and family. You have a small PT job helping out at the nursing home as a volunteer. One day you wretch your back when you sneezed and g to the ER as your Family Doctors office recommends.

    When you get there however you are treated like a street bump. Why in God’s name am I being ignored? Never does it cross your mind that as you were giving g you medical history between every wince of searing pain answering questions honestly. Givin full disclosure of the medications you are on when suddenly you have in these people’s eyes become a Drug Addiction! Oh yeah, when 4 hours pass and a doctor finally come in. Avoiding eye contact as he goes over your medical history, your medications are brought up. You are asked if you only came in today to score some more drugs because perhaps you’ve already used up your months soupy? Hmm is that what you are doing great DRUG SEEKING is written in your chart! Although you did not ask for anything g other than perhaps an x-ray as you felt that fam8lar searing hot umber band pop. Right around the area above where your surgical scars are still quite tender and ragged looking good scars lay. Dumbfounded, totally embarrassed by this Doctor, feeling the humiliation you have never dealt with prior, you are told an orderly will be around to take you to crawly soon and then maybe we will talk about something for pain to get you through the next few hours. Eventually 3 or 4 more hours go by and an orderly does come, off to x-ray we go! Quite a painful experience to say the least as you cannot sit yourself up and require assistance. A sigh of disdain escapes the techs breath as she is imposed upon to sitting you up. It ends up two of them are requires ldix1962@gmail.com afterall to transfer you from the Guerny to the table. Yu are told to lay perfect fully still n don’t breathe! Finally the a Chinese is about to take the x-ray and you let out your breath because you couldn’t hold it long enough while you had judrlt gone into another spasm from your back right down to your whole lecture leg, unbearable pain and yet you are being chastised for breathing!!! Wow what a useless being group feel like, at this point you swear no matter what you want breathe again until told to.
    Finally 9 hours later you are back in the ER and you skip the k8nd nurse for a blanket. She gets one and wraps you up, making sure you are comfortable. She takes your vitals again and ask if you always have such high blood pressure, no you answer. She makes a comment and looks at the chart and skills if the Doctor had ordered anything for pain before he left. Yep, shift changeoccured while you were over in X-ray.
    Oh dear the gal says, on a scale of 1 to 10, with one being hardly any pain or discomfort and 10 being the worst you’ve ever had where would you say you relate to the scale? You’ve been there so long, you’ve missed your regular dosage of LT medication and didn’t take a breakthrough in about 10 hours. Well, I guess I would have to say this is pretty bad and I feel worse than I did b4 my 1st surgery. So yeah I’m at my limit already and I can’t take it any longer. So I’d say 10. This nice person was very understanding and comforting for the first decent person I have yet o speak to since arrivin. She says let me see about getting you a shot for your pain. Perhaps it was an oversight on the Doctors part due to the shift ending and all. She goes to check, she also soaks to the other Doctor on call. He is quite busy now. A couple of ambulances had reeled patients In and the ER is very busy. Finally in about a hour and after tears you’ve been reduced to as you are in full on spasm, cringing and praying for atleast some Tylenol. The other Doctor comes in, very apologetic as he sees now what kind of shape you are in, he HD actually read your chart prior to entering. He tells you the nurse I bring in a shot of Daud in at 2mg and that along with a muscle relaxer is going to put you at ease. He ask I’d I have someone to take me home since I arrived by ambulance many hours ago. I explain I can call someone to pick me up. Ahh the nurse is back and she immediately gives me a shot in the IV she had started prior to leaving the 1st time. And a Lil Dixie cup of water with a muscle relaxer. I immediately become panicky as I explain to the doctor about my pain Mgt contract! Now I’m terrified I’ve violate that and will no longer have the pain Mgt that has Ben helping me for a few months now. Lucky the ER Doc is very understanding and let’s me know he had previously entered my info into the computer and assures me I am all covered and my pain Doc will be understanding when he reads the report. Afterall a ruptured disk above the old fusion site which by the way was a total failure! I’m sure you are in a great deal of pain. And honestly, I wish you had been treated for your pain right away. Talk about a night and day difference in the hours before until that last hour. The Doctor also explained that anew GPS is opening in town, perhaps you may want to consider switching as she is very well known for her trying in the treatment of Chronic Pain such as yours. The Pain Mgt. Doctor you have can contact Dr…… and get you set up with his referral and bring her up to date as to yor condition and the treatment protocol you’ve been taking. He asked if the meds I had were still as effective as when I first started. I let him know that even though I had never been on medication for any substantial amount of time. The It doesn’t feel as though it is as effective,however I don’t want to take anything more than what I have been for fear of becoming an addiction. To my amazement this fellow explained to me, what I had already been assured of by the Pain Mgt Doc. The Psychologist an my GPA that it is very few plLT Intractable Chronic Pain Patients become addicted in the sense of true addiction. Naturally you will become Dependent physically, but no more so than a Diabetic is for insulin. Imagine that. At that point I was pleased with the outco.e of my last 2 out of 12 hours at the ER. I was in very little pain, just uncomfortable. I was discharged as my friends arrived to pick me up. Though I was in need of my walker which they brought with them, I was pleased to go home, and also pleased that the outcome and advice given was more than reassuring. Also the transfer to the new PC went with out a hitch and I was doing very well. Eventually my medication was titrated to a higher dose than what I was taking at the time of my story. However I went on to join the Americans with Disabilities organization. As well s the National Pain Mgt Assn. And then assisted 2 other women with starting an online support group for others who. We’re living like myself, in pain but not letting the pain define who I am! A little of research and after being a LT Chronic pain Patient now for almost 25 years. I am still very much in pain, though it is managable and I have maintained having a life I look forward to each and every day.
    Our online support group has grown by leaps and bounds. We have an information. Clearinghouse where others can learn how to live with some quality to their lives. Sadly for a few members whom could not find pain Mgt or understanding GP’s as they feared repercussion from the DEA and the FDA. Unfortunately they were driven to suicide. Now that should be a crime against humanity that they were not treated as they should have been. It angers me to no end that good people are sufferring more now than ever for the individuals are not getting the category they desperately need. There has not been one single addict in our group of over 500 pain patients. We a respect the ability and right to have our pain treated properly. Even if that means living life with opioids. It took years of bad apples to ruin It for the rest of us! Now the futures for all of us are looking good rather bleak due to the new laws that were approved by the CDC’S involvement. Governments have not the right to make d3cisions for am entire group for atleast 500 ppl I have come to know & Love. And yes I do still have the same Doctors as I have written of. I completely understand the plight of both sides for the count. I do hope eventually that Pain Mgt In our ountry will be comprised of integrated medicine with east n western modalities as an option and covered by our insurances. We just may be facing the largest shortage of any types of medical professionals.. My nurse just happens to be at the same Hospital doing what she does as an administrator now.

    • Ken says:

      Now that is a story. I have chronic back pain and sciatic nerve pain due to multiple disc problems in L3 thru S1 along with A 4 Inch titanium plate and 6 screws in C3-C5. I still work but need NSAIDS, Pain meds non and narcotic to stay on my feet thru a ten hour work day. Muscle relaxers and sometimes anxiety meds to sleep at night? But I’m the lucky one in my house. My wife has MAJOR long term pain due to Chronic pancreatitis and expert Dr.s that treated her as a science project while they removed her pancreas, spleen, duodenum and parts of her stomach and lower intestines. Although the surgeries saved her life after a critical bout and coma in 2010 she has been left unable to eat and on TPN for two years as she could not maintain a weight above 100 lbs? Chronically ill and disabled now the Dr.s blame her digestive problems on pain meds. They blame her and lie and tell her she is the only one with problems. They lied and lied and lied! And now no one wants to see her because her case is too complicated and she is an “expensive ” patient on their rating scale and need “too much” time in her appts? She would already be dead if not for the fact she was a nurse? She probably would have been suicidal if not for her Pain management Dr? And over 40 hospital and ER visits in 6 years and every hospital has her labeled as a med seaker. Half the time when she goes she takes more of her own meds that the Dr’s will give her…..SHE’S NOT A DRUG SEEKER!!!! And imagine how it looks to have a Husband and Wife BOTH with chronic pain and on Pain meds? We are both in separate PM programs to protect the doctors and to not look like drug seekers. We want nothing more than to be OFF ALL THE MEDS but without them she is bedridden and I cant do PT and/or work on a daily basis. She lost her career and is disabled and I lost my business and had to take a lesser and more demanding job just to have health insurance and not enough money to pay regular bills and way behind on the mortgage wondering when the paperwork is going to be nailed on the door demanding us to get out???? Narcotics are NOT a great answer but until Insurance Companies start PAYING for the alternatives it is the only way we can stay functional, semi productive useful members of society. Without the PAIN MED I would be disabled and a liability to my fellow human beings!!!! Without options for alternative treatments We cannot afford these meds keep me working, doing daily PT to help my condition from getting worse and keeping me going to work every day!!! Without PAIN MEDS my wife would need 24/7 care and would probably not want to live anymore!!! So because there are Doctors abusing the system and patients abusing the system millions go without the meds that give them the little bit of hope and functionality to be Human Beings??? The SYSTEM is BROKEN and the Government cannot write a law, recommendation or change protocol to “FIX” it!!!!! I totally agree and sympathize with all of you! Our voice NEEDS to be heard!!!!

  13. Joy says:

    If you don’t suffer from chronic pain than I can guarentee that you do not know for sure just how to treat it! I suffer from extreme pain all the time and I know that the pain I feel everyday is true. I have and continue to go for as long as possible without pain meds of any kind but when I need them I should not have to jump through hoops and pay Drs every penny my husbands make.

  14. Eric says:

    I suffer from severe chronic nerve pain from left arm paralysis, back pain, arthritis, and pain from cancer Surgery. I understand that there is a problem with opiod prescription addiction. That being said.. I’ve been on an opioid medication plan for 12yrs now, and it has given me my life back. before that my life was a horrible nightmare! I suffered horrific pain for 2yrs and became a guinea pig while doctors tried to figure out alternative medication.. None worked! I Always hated taking pain pills but the medication has given me my life back and i hav a productive and active life. I am so tired of hearing that people who are on pain medication have an addiction problem, that we are addicts. Not everyone abuses there medication and now i fear us people with chronic pain will suffer horribly! It is about a quality of life not so much quantity. I have come to grips that maybe i won’t live long being on medication the rest of my life, but LIFE isn’t guaranteed anyway! I wld rather live til 65-75 than 80-85 suffering in my bed crying every day. That’s no way to live.

  15. Victoria Sinclair says:

    Wow, I know that everyone has their own stories and their own feelings about chronic unrelenting pain. I have had Fibro myalgia, Arthritis, Lupus, horrible back pain, severe Migraines etc. I was diagnosed around 1989 or 1990, I worked a full time job, raised 2 children on my own even though I was seriously ill. I refused to take anything stronger than Tylenol. They not only tore my stomach up since I took a lot, like maybe 8- 10 a day so I could function. Now that I’m disabled due to all those already mentioned health problems I am still in chromic unrelenting pain 24/7. I take pain meds now just to have some kind of life without this disabling pain. I will not give them up. I am not adicted in anyway shape or form, I get regular exams and blood work. I’m just trying to say that we are not all druggies in an alley trying to buy more. It is unfair to put us all in the same basket. We are normal folks just trying to make it thru the day in the midst of so much pain. I have tried everything else, injections, PT, counseling etc. The pain is still a very present ordeal in my life. I hate it so I won’t stop now so please think about us when you are trying to make such serious changes in our life saving meds. Please!!!

  16. Vivian Savage says:

    The politicization of the mishandling of opioid medications has left non-addict legitimate chronic pain patients in fear of what their options will be. I am fortunate to have private insurance that covers alternative therapies, but unfortunately for those who are so chronicly disabled that they are reliant on disability and Medicaid, these services are not covered. What options do they have? It was irresponsible to implement these changes without this being a major consideration.

  17. Amy says:

    It is totally ridiculous that the federal government is getting filthy rich off of drugs and cancer patients. There is a cure for cancer but the government will not release it because they could not get rich off of cancer patients. Our young teenagers are getting hooked on these pain pills because majority of the people getting large quantities are in return selling these pills for $5 to $10 a pill. I hope the government and the people selling these pills can live with their conscious

  18. Jo says:

    I have had fibromyalgia for years and without my pain meds i can barely get out of bed. I do not abuse my medication!! To decide for us what we can and cant have is a decision that should be made with your doctor. I have no one to take care of me would you fools like to pay my bills? I do believe that if you take the medication that improves my life on a daily basis suicide would probably be my answer to the pain. You believe to many people have died on opioids wait till you take what keeps us alive away from us. There are many things that need fixed in the united states go do something about them and leave us honest people that take their medication responsibly alone. I want some quality of life and these medications help me. I wish you could stand in the shoes of any of the people that have written on this page for just a day then maybe you could understand until then dont take my life away from me.

  19. Kelly Howell says:

    I have many overlapping medial issues including autoimmune diseases that are extremely debilitating. Not all of us are addicts and just need relief to function normally. It’s extremely exhausting physically mentally and emotionally dealing with the extreme pain everyday. What gives the government or the CDC the right to decide to make us suffer?

  20. Kelly Howell says:

    Also I was in the medical field before I had to go out on disability and I have seen way too many times where people who were cut off ended up on street drugs. I would never but if they pull this stunt this country is going to see a pandemic of street drug overdoses that’s going to be overwhelming. This is ridiculous.

  21. Stacey Fields says:

    Where did you get the info for this story because the numbers of deaths from opiates is a joke! Many of us need these medications to even get out of bed. The government should keep their noses out of our healthcare! I know at least 3 people who were refused pain care after major surgery it is INHUMANE

  22. Norma says:

    I was on all kinds of meds for arthritis in my spine and neck. I did not over use my scripts, I only took them at bed time to help with my sleep. In February I was diagnosed with fatty liver disease. I quit taking all of them except naproxin only when I absolutely have to have it. I just try to manage the pain mentally or I go to a pain management clinic which helps for awhile.

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