Chronic Pain, CBT, and suicide

Chronic Pain, CBT, and Suicide

I recently read an article written by Psychology Today that stated “opioids are not useful for chronic pain”. Where this psychologist got his information from I have no clue. He says the CDC has “studied the data for years” yet didn’t quote or reference this data in his article. Yet based on this stupid article, my life and well being are in jeopardy. I am so angered by this article that calls for CBT (cognitive behavior therapy) as a treatment to cope with pain. The problem lies in many factors. CBT doesn’t work for everyone for every condition. It certainly didn’t work for me when I tried it many years ago for my depression. It was too complicated and I didn’t have the patience to sift through a packet of 30 or so pages of the treatment homework. I wanted relief, like most patients/clients do, NOW. Second, coping with pain doesn’t mean that it goes away. And in the mist of a flare up, do you really THINK I am going to go through a packet of 30 odd pages to find relief? Thirdly, not all therapists are trained in cognitive behavior therapy. There is only ONE psychologist that I know in the Boston area that is specialized in pain, let alone trying to find a CBT therapist. You have to seriously try and find out if they do this specialized therapy. But there lies the rub that if you are suicidal, like I am, you could be denied this treatment.

I understand there are many deaths from overdoses due to opioid medications and that is a sad fact that I am not trying to minimize. But denying these life saving drugs to patients and telling them to go to therapy to cope is negligent and harmful as well as may lead to MORE suicides. New York state recently is denying up to 10,000 patients pain medication/treatment because the doctor treating them is indicted for charges that I don’t know about. My friend is one of his patients and she is screwed because a pediatrician has stated that anyone that gives pain meds to these patients will be drummed up on charges. Three patients have died by suicide since this has happened. And that is only the ones we know about.

In my response to the article, which I publicly made at my own risk, I asked, how many deaths do you want? Try suicides. I have been afraid of admitting being a chronic pain patient because I am frightened that the DEA will charge through my door, though I do not abuse, sell, or misuse my medication. I barely take the 4 pills a day that I am allowed to take because sometimes I just am not in that much pain that day. Other days, I am taking it around the clock to ease my pain. And guess what, it works for my pain in combination with the other meds that I take.

The preface of this whole article was the death of Prince. But it still has not been discovered, least to my knowledge as of yet, that what he was taking was prescribed or illicit. If anything, Fentynal is a dangerous drug when used with other opioids. I had a friend’s neighbor die of an overdose with this medication. There were other circumstances surrounding her death, such as seeing other providers who had no clue she was taking other pain medications. Now there are network of pharmacies that are cracking down on this practice. I only use one pharmacy for ALL my meds because of convenience. I also see one provider for my medication in their respective specialties. I don’t see my PCP’s NP for my psych meds nor do I see my psychiatrist for my blood pressure meds. That is just silly.

This article had me so upset that I was almost to the point of being suicidally paranoid. I was developing a delusion that my pain meds were going to be taken away from me and if that ever is the case, the doctor will have to sign my death certificate. I will die by suicide and I don’t need medications to complete it. I am in therapy. It is more psychodynamic than another specialized modality. It is what keeps me sane at times. But the threat of losing my pain medication is real. If I am ever forced to stop my medication and be subjected to therapy other than what I am already in, I will kill myself. The pain is just too great, too torturous. And I won’t have a piece of paper telling me to cope with the pain when a pill can do just fine.

Article Review: Working with Suicidal Clients

Article Review: Working with Suicidal Clients

I have to say that this article was not what I expected. It was an overview to the special issue the journal Cognitive and Behavioral Practice was having. The authors of the article described briefly what each article was about, which left me looking for more articles to add to my collection. But the take away message was that suicidal clients are to be treated as individuals and not as a “one size fits all” treatment modality.

Cognitive therapy has been moving up in the suicide chain as being helpful to suicide clients (Jobes, 2015 presentation AAS). DBT is also as it has helped a lot of clients with borderline personality disorder.

I found it interesting that there was a safety planning section. I googled it to try and learn more and there was a website for it. I downloaded the form as well as the training manual. It might come in useful in my therapy. I didn’t need the article to get to the form. It is similar to many other planning tools used by cognitive therapists. The thing I don’t like about it is that it is a sheet of paper that can get lost or misplaced. It also has the potential of not being used if the client is not near the paper when a crisis is at hand (e.g., at school versus at home). The author for the brief article has stated that therapists are slowly moving away from “no harm” contracts and moving toward safety planning. The reason being that “no harm” contracts have not been shown to be effective and may increase the likelihood of suicide. Also, simply making a promise not to kill yourself doesn’t really hold up well legally.

Ellis, T.E. and Goldston, David B. Working with Suicidal Clients: Not Business as Usual. Cognitive and Behavioral Practice (2012) 19: 205-208