Jennifer Gunter @DrJenGunter The Gray Lady’s gynecologist (@NYTStyles), sexpert, appropriately confident, lasso of truth, I speak for no one but me. The Vagina Bible (8/27), Jensplaining. Aug. 01, 2019 2 min read

Um @AndrewYang have you actually spoken with any board certified pain medicine physicians? This statements suggests that you have not.

As a board certified pain medicine physician I would laugh at @AndrewYang’s statement on opioids, but it is a serious subject and so I am just aghast and the complete lack of understanding of the issues here.

Under this plan all patients taking opioids for metastatic cancer would have to go to a hospital for a prescription for opioids. As their doses will be limited they’ll probably need to go every 3 days. Oh yeah, most of their doctors are in clinic not the hospital, etc. etc.

You know why a lot of people are started on opioids inappropriately medically speaking? Because their insurance will pay for opioids and an MRI, but not physical therapy, pain psychology and other aspects of comprehensive pain management.

It’s often easier to get an uninficated back surgery than physical therapy! And patients think, damn, my pain is bad. It can only be fixed with something big like surgery. And then there is a 9 month placebo and pain returns etc and then you get offered a 2nd surgery.

All chronic pain is not the same. Sometimes opioids are necessary. This must be done with a clear plan of what constitutes efficacy, and a discussion of the harm because it goes far beyond addiction.

For non malignant pain we need an investment in appropriate first line therapies as comprehensive pain managements improves function and reduces suffering. Sadly, this is often the last resort of available at all.

Also, you cannot evaluate a patient with chronic pain, explain the neurobiology of chronic pain or the treatment algorithms to any patient in 15 minutes.

Example. An elderly immobile patient in severe pain from poor circulation to feet and resulting gangrene of toes. Doctors are waiting for toes to autoamputate. Every day a nurse comes to debride her toes. This all hurts a lot, gabapentin helps a little.

This patient can’t come in regularly for an opioid prescription. There is no obvious diversion risk. Vascular procedure failed to help. No other option but opioids. Fall risk discussed. Given life expectancy due to comorbidities impact on osteoporosis unlikely.

You can follow @DrJenGunter.


Tip: mention @threader_app on a Twitter thread with the keyword “compile” to get a link to it.

Enjoy Threader? Sign up.

Threader is an independent project created by only two developers. The site gets 500,000+ visits a month and our iOS Twitter client was featured as an App of the Day by Apple. Running this space is expensive and time consuming. If you find Threader useful, please consider supporting us to make it a sustainable project.