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Oct-09-2011 23:47printcomments

'Undertreatment of Pain' vs. Prescription Drug Addiction and Death

"To know what is right and not do it is the worst cowardice" Confucius

Pills as bullets

(MYRTLE BEACH, S.C.) - Why is Congress, the FDA, the FTC and the DEA allowing the American Pain Foundation to be kept fat and well financed by pharma in marketing the bogus "undertreatment of pain" in the U.S. while we fight an epidemic of prescription drug addiction and death? Recently the below was printed regarding the consumption of narcotics in epidemic proportion throughout the world -- very interesting read -- Addiction Journal

Consumption of Opiates and under treatment ?

October 2, 2011

The United States makes up only 4.6 percent of the world’s population, but consumes 80 percent of its opioids — and 99 percent of the world’s hydrocodone, the opiate that is in Vicodin.

Full story here… other $ide $tates –

Amid heightened awareness that many patients with cancer and other chronic diseases suffer from undertreated pain, the Food and Drug Administration (FDA) approved Purdue Pharma’s controlled-release pain reliever OxyContin in 1995.

One of the "other side" is the American Pain Foundation. 

I have long been curious about Purdue Pharma, maker of OxyContin's lobbying group - the American Pain Foundation (APF).  It is a very well funded and a vocal organization headed by Scott M. Fishman, MD, Chairman and President.  The APF issues press releases on a regular basis regarding the "undertreatment of Pain" in America.  Why does Congress, the Federal Drug Administration (FDA), the Federal Trade Commission (FTC) and the Drug Enforcement Agency (DEA) allow this type of unscrupulous marketing to be used in an effort to push narcotics?  It is no surprise to anyone that we are fighting an epidemic of addictions and deaths -- particularly as it relates to OxyContin, but Purdue Pharma is a big financial supporter of the American Pain Foundation.  (See below)

  • Visionary
  • (greater than $1 million)
  • Endo Pharmaceuticals, Inc.
  • Champion
  • ($100,000 to $499,999)
  • King Pharmaceuticals
  • McNeil – PPC, Inc.
  • Medtronic
  • Medtronic Foundation
  • Pfizer Inc.
  • Purdue Pharma L.P.
  • Patron
  • ($50,000 to $99,999)
  • Cephalon, Inc.
  • Forest Laboratories, Inc.
  • Neuromodulation Therapy Access Coalition

Also, directly off the APF propaganda pages

-- "The problem of undertreated pain is well established. Members of the APF Board of Directors were part of the recent congressionally-mandated IOM review of Pain in America that reported 116 million Americans are in chronic pain. That is more than the number of people who have diabetes, cancer, and heart disease combined. This is estimated to cost $635 billion dollars each year, which substantially contributes to excessive health care costs."

Excessive health care costs? No -- excessive health care costs are in the treatment of addiction when doctors prescribe narcotics such as OxyContin and "hook" their patients on a form of Heroin leaving the patient to deal with addiction and horrific withdrawal when they try to stop taking the FDA approved Heroin (OxyContin) -- and severe addiction at that.

"The breadth of the organization is as broad as pain itself. It includes people with acute pain, pain at the end of life and cancer survivors, children with sickle cell disease, soldiers who have lost legs to land mines, and people with mysterious pain disorders that no one can understand, among many others painful conditions." Tell me Dr. Fishman does this include the marketing of narcotics for something you and Purdue Pharma referred to as "pregnancy pain" or how about "military pain"? Listening yet Congress, FDA, FTC, DEA -- want to ask the APF what in the world is a medical definition for "military pain"? Why would any expectant mother need to take a drug such as OxyContin for "pregnancy pain." You let them get away with it. And maybe now would be a good time for someone in government to question why any child between the ages of 6 to 16 would be used in clinical trials of OxyContin? Think it's criminal? I do.

More from Dr. Fishman - "The problem with prescription drug abuse cannot be overstated. It’s an enormous problem that is consuming medicine and policy makers. Our goal is to help make sure prescription drug abuse is addressed, while access to appropriate care for people suffering in pain is not unduly hindered. The drugs that treat pain are essential for society and we don’t want to lose that valuable arsenal. We strongly advocate for safety and effectiveness of all pain treatments." The company that keeps you well financed -- Purdue Pharma lied about the dangers of OxyContin and we are now immersed in prescription drug abuse because of the criminal marketing of OxyContin. Anyone in Congress, the FDA, the FTC or the DEA curious yet as to why the lobbying tactics of the APF are so well funded?:

Four days ago, I emailed the APF and asked them two questions -- one being where were their conferences held in 2011 -- and one being who are the "expert" physicians they use as speakers to advocate for the "undertreatment of pain" in America. I was informed that I would receive a reply as a "media person" within 24 hours. It is now way past 72 hours and still no reply from the APF. Listening yet Congress, FDA, FTC and DEA?

Gil Kerlikowske, the national drug czar, says the current culture of writing narcotic prescriptions for moderate pain, which began about a decade ago, needs to be changed and doctors need to be retrained.

Many pain specialists say narcotic pain relievers should only be used by patients with terminal illnesses, when addiction is not a concern.

So Dr. Fishman here's a question for you -- How can the the APF market for the "undertreatment of pain" in America when we consume 80–90% of the narcotics produced? Maybe I should be asking Congress, the FDA, the FTC and the DEA this question since you may be busy "explaining yourself" to JAMA (Journal of the American Medical Association) and your discrepancy with your financial disclosures as relates to APF. Anyone listening in Congress, FDA, FTC or DEA now?

JAMA.Published onlineSeptember 20, 2011.doi: 10.1001/jama.2011.1398

Incomplete Financial Disclosures in Letter to the Editor

  1. Scott M. Fishman, MD

[+] Author Affiliations

  1. Author Affiliation: Department of Anesthesiology, University of California, Davis (

To the Editor: I was requested to add 2 financial disclosures related to a letter to the editor1 published in JAMA. I previously disclosed that I authored the Federation of State Medical Board book Responsible Opioid Prescribing and received no royalties. Additionally, I am disclosing that I am president and chair of the board of directors of the American Pain Foundation (a nonprofit foundation that receives some of its support from manufacturers of prescription opioids) for which I received no compensation. However, one time per year I am reimbursed for out-of-pocket expenses for coach airfare and cab fare for an annual board meeting. I have participated in numerous ACCME-certified continuing medical education activities yearly for which I received market rate honoraria. These programs were organized by academic health systems and/or medical professional organizations and some may have been funded by commercial sources related to opioid prescribing. I have not accepted any funds directly from any commercial sponsors. These disclosures were not originally reported because I did not believe that travel reimbursement and/or CME honoraria from academic health systems or health professional organizations for speaking at ACCME-certified programs required disclosure. I regret any inconvenience this may have caused and appreciate the opportunity to provide an explanation. A correction and related letter appear online, and the original letter to the editor has been corrected online.

Editor's Note: The additional declarations of potential financial conflicts of interest by Dr Fishman, as requested and required by JAMA, highlight our continued commitment to this issue.

Published Online: September 20, 2011. doi:10.1001/jama.2011.1398

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Fishman reported having authored the Federation of State Medical Board book Responsible Opioid Prescribing and receiving no royalties; being president and chair of the board of directors of the American Pain Foundation (a nonprofit foundation that receives support from manufacturers of prescription opioids) for which he receives no compensation but is reimbursed for out-of-pocket expenses for coach airfare and cab fare once per year for a board meeting; and having participated in numerous ACCME-certified continuing medical education activities yearly that are organized by academic health systems and/or medical professional organizations for which he received market rate honoraria, some of which were funded by commercial sources related to opioid prescribing although no funds were accepted directly from any commercial sponsors.

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Financial disclosures?  I think it goes beyond that -- where is the money going funneled to the American Pain Foundation by big pharma?  Do I have your attention now Congress, FDA, FTC and DEA?  I believe you owe something to the American people in keeping them safe as you deal with prescription drug deaths and addictions -- but then do you really buy the "undertreatment of pain" in America in light of the statistics and what you have been witness to in the last decade plus?  President Obama's drug czar doesn't buy it and frankly neither do I.

LP -- I am so proud to be a part of your life and for the love and dialogue we share in being so supportive of each other. Yes the word "perfect" definitely applies in so many ways.  You are truly my gift from above.

_________________________________ Reporter Marianne Skolek, is an Activist for Victims of OxyContin and Purdue Pharma throughout the United States and Canada. In July 2007, she testified against Purdue Pharma in Federal Court in Virginia at the sentencing of their three CEO's - Michael Friedman, Howard Udell and Paul Goldenheim - who pleaded guilty to charges of marketing OxyContin as less likely to be addictive or abused to physicians and patients. She also testified against Purdue Pharma at a Judiciary Hearing of the U.S. Senate in July 2007. Marianne works with government agencies and private attorneys in having a voice for her daughter Jill, who died in 2002 after being prescribed OxyContin, as well as the voice for scores of victims of OxyContin. She has been involved in her work for the past 8-1/2 years and is currently working on a book that exposes Purdue Pharma for their continued criminal marketing of OxyContin.

Marianne is a nurse having graduated in 1991 as president of her graduating class. She also has a Paralegal certification. Marianne served on a Community Service Board for the Courier News, a Gannet newspaper in NJ writing articles predominantly regarding AIDS patients and their emotional issues. She was awarded a Community Service Award in 1993 by the Hunterdon County, NJ HIV/AIDS Task Force in recognition of and appreciation for the donated time, energy and love in facilitating a Support Group for persons with HIV/AIDS.

Marianne Skolek
National Activist for Victims of OxyContin and
Purdue Pharma - a criminally convicted pharmaceutical company
Staff Writer,

Comments Leave a comment on this story.

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Scott K March 27, 2012 10:17 pm (Pacific time)

I have muscular dystrophy and have compression fractuered my back in 5 places, also my left shoulder joint was removed. When the back compression fractured happened I disected the right corotid artery, causing it to becme occlude 20 years down the road I fell timber for 27 years, of which the last 13 with the back fractures. tell me an alternative to opiates, I can't smoke weed makes me feel like I am having a stroke. Tell me a better way to treat this pain that gets so bad I grit my teeth till they break, I have lost the 2 lower rear molars and the forth front tooth from the right. Undertreatment is a fact. However the long acting drugs are not the answer for me either better to give me something that acts quickly and I will suffer 7 or 8 pain without taking anything.

Jonathan October 19, 2011 8:05 am (Pacific time)

Marianne- Thanks for your response. I would agree with your critique of the Pain Foundation if it were supported by facts. However, through a quick search of Pain Foundation website I found a comprehensive guide to pain treatment. The guide outlines a variety of pain management options such as medication options, surgical options, alternative treatments, etc. They are advocating for treatments that alleviate "the source of the pain." They also worked with the Institute of Medicine (IOM) to release a major report on the problem of pain. This report will help support funding for research on pain and shows physicians that pain is a serious problem. Another important point is that, for many people like my brother who has a severe spinal cord injury, there is no known "cure" for the source of the pain. Surgery is extremely risky for this group of people, it's expensive, and it is known to make pain conditions worse. Many of these people have tried the full "gamut" of alternative treatments. What should they do? Here is the guide:

Jonathan October 19, 2011 7:49 am (Pacific time)

Dave - my brother has tried many alternative treatments such as trigger point injections, electrostimulators, chiropractors etc.etc. etc.....!! Your reply was unappreciative of the effort that my brother has put into finding help for his pain. My family has put in tens of thousands of dollars into alternative treatments only to be (mostly) disappointed. Furthermore, chiropractic adjustments after his injuries may have worsened his condition. I support the development of alternatives to "modern medecine." However, alternatives are often inadequate/inneffective and many people go to conventional treatment (such as opioids) out of desperation when alternatives do not alleviate the problem. It is exhausting and traumatic for people suffering in severe pain to be promised relief by an alternative treatment and then disappointed by its failure to relieve the pain...

Marianne Skolek October 14, 2011 11:47 am (Pacific time)

Jonathan -- I do think "outside the box" and have never said that legitimate pain patients should be denied good medical care by competent physicians to alleviate their pain. I am "in the box" when I say pain lobbying groups that advocate pain treatment for any and all physical pain is not appropriate when the source of the pain is not dealt with. I think we're in the same box now.

Marianne Skolek

dave October 14, 2011 11:41 am (Pacific time)

Jonathanperhapswouldbe doing better if doctors took pain more seriously. He might have been given better diagnostic testing and more effective treatments then opioids if doctors received adequate training inpaincare.You mentioned he took someof the hundreds of treatments available forpain- nomentionof - you made no mention of ultrasound, low level lasers, dry needling, chiropractic biophysics or the pettibon approachor applied kinesiology or wave mobilization, alexander technique or bioidentical hormone replacement or homeopathictrigger pointinjections, reconnective healing- to name a few. If it was me-and i did suffer a chronic pain condition iwould continue tosearch for treatments that have more permanenet benefit then opioids-and regrettably doctors are not willingtolearn what is available forpai to help people who need it

Jonathan Maddison October 14, 2011 8:19 am (Pacific time)

My 28 year old brother has severe chronic pain in his neck, shoulders, and wrists. For 12 year he has tried surgery, acupuncture, meditation, physical therapy, chiropractors, antidepressants, etc. He has been to dozens and dozens of specialists in the struggle to find help for his severe chronic pain. Chronic pain is tragic, serious, and even kills (some kill themselves to end the suffering)! While opioids are not a solution to pain, they have helped my brother manage his pain. He would love to reduce his pain another way, without all of the horrible side effects of opioids. However, opioids are one of the few options that help manage his severe chronic pain. This article does not do justice to the struggle of people in pain. The undertreatment of pain is sadly a major issue in the U.S. and around the world. Millions of people in the U.S. suffer. Many are disabled from the pain. Please try to think outside of your frame. Addiction and abuse is a huge issue, but don't let it blind you from issues like chronic pain.

dave October 11, 2011 12:17 pm (Pacific time)

They say if the only tool you have is a hammer youll treat everything like a nail. Modern medicine-due to its longstanding prejudice toward people in pain has failed to make diverse and effective treatments available for people in pain-hence the overreliance on opioids which are suboptimal comfort-oriented care. Cure is a four letter word to modern medicine when it comes to pain-even the IOM report on pain clearly states they dont believe in cures for pain. Its up to people to "occupy" pain care as the medical profession has done a particularly poor job of helping people in pain-and has helped to foster unhealthy dependence on dangerous medications which are of little value in the first place.

david b October 11, 2011 11:13 am (Pacific time)

Our overdependence on opioids is iatrogenic- it reflects the inadequacy of modern medicine to come up with safe and effective alternatives for opioids-which have been in use for 3500 years. Of course the health care industry will try to displace blame for the moral laziness toward people in pain. But the simple truth is the average physician is still uneducated in pain care and offers too little of what is available to help people in pain.. Even the APF and AAPM fails to list many of the treatments that can be used to help people in pain. Perhaps they are unfamiliar with the range of treatments available to help people in pain.

M. Dennis Paul, Ph.D. October 10, 2011 12:55 am (Pacific time)

Marianne... I certainly understand your concerns, however, there is not a blanket answer to this that mandates use of narcotics only for terminal patients. I have to address this from personal experience. I have had RSD along with multiple entrapments for over 20 years. Not wanting to use narcotics, I tried everything else available to no avail. NSAIDS and aspirin have virtually no positive effects on me. Biofeedback, stims, accupressure and accupuncture, nerve blocks, therapy and more all had minimal to zero positive effect. I have tried every new non-narcotic formulation that has come down the pike and I have used anti-depressants, beta blockers, barbiturates,anti-seizure meds and more. The only way I managed to get through my days, for 17 years, was with the use of hypnosis... which eventually ceased to bring relief (I have been a hypnotherapist for nearly 30 years). When I say that I got through my days, it is important to note that those days and years were extremely difficult and I lost 10 years of what I consider real productivity. The constant searing pain and discomfort along with lack of sleep contributed greatly to the ends of 3 marriages. Financially, it has ruined me. A few years back, I finally gave in and went to see a group of pain specialists. In truth, they were amazed I was still alive. Since then, I have been using a variety of narcotics (we switch periodically to avoid diminished effect)and I have finally found enough relief to start rebuilding my life. It is not an ideal situation but one which greatly improves my ability to function. I have spent many years conversing with other individuals with RSD (which is one of the most painful conditions known)and many do not respond to narcotics. Many respond to virtually nothing and a very high percentage of those commit suicide within the first 3 years. I am thankful that these specialists work with me as they do. I am thankful that I do respond to narcotics (not all, but several). I will add, though, that even my specialists dislike prescribing Oxycontin.. for many of the reasons you have exposed in your worthy efforts. None of my PCP's over the years would work with me on this pain other than to recommend all the failed alternatives. Every single one voiced fears of being accused of over prescribing narcotics.. in spite of every single one of them saying it would be my best option. It is simply not, for many of us, an option to wait until we are dying to get some relief.

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