Reddit mentions of Pain Assessment and Pharmacologic Management (Pasero, Pain Assessment and Pharmacologic Management)

I was mostly agreeing with you using a personal anecdote. I'm sorry if it came off as something else.

I say "mostly" due to two points that got lost with my first message. I get I might be in a minority with these, but they're worth mentioning.

1. I'm relatively well educated (Master's in engineering) and middle class (own my own home, no debt outside my mortgage, six figures in my retirement account).
   
2. I've got good days and bad days, and on bad days opioids are the only reason I can get through the day. I consider myself to have a lot of fortitude and not unreasonable with pain (I'm not a "wuss"). I am perfectly aware that I cannot be 100% pain free and have made my peace with that. But when it feels like my knee is going to explode or I'm having a protrusion with my hernia, a Norco is the only thing that will let me move around or get a few hours of sleep.
   
   I don't pretend to know as much as you practitioners, but I've bought several textbooks and clinical guides to understand pain in general. I started with https://www.amazon.com/Pain-Assessment-Pharmacologic-Management-Pasero/dp/0323056962 and picked up more books to try and understand the underlying anatomy, management and treatment options, etc. Mostly related to my particular situation, but it did give me insight into pain management in general. When it's all said and done, I find myself in disagreement with the article this post was originally about, and think a more moderate approach is called for. Patients shouldn't be able to work themselves to insane 200+ MED doses all because they claim they hurt, but "I haven't prescribed an opioid in over a decade" isn't the answer either. NSAIDs alone are attributed with up to 15,000 deaths per year. This is a complex situation and patently dismissing opioids because they have drawbacks and risks isn't the right answer either. I gave my own history as an example of someone who's a chronic pain patient on instant release opioids long term to help illustrate my point. That's all I was trying to get at with my original post. You seem to be aware of all of that, so again wasn't arguing - just offering my perspective.

My background: I am a layperson who is on pain management. My father is a pharmacist who works for a pharmacy associated with an oncologist. In order to understand my situation, he suggested I read http://www.amazon.com/Assessment-Pharmacologic-Management-Pasero-Managerment/dp/0323056962

The book cites numerous studies indicating that while NSAIDs and acetaminophen should always be the first options considered, they are frequently insufficient, and combined with the risks of long term use, properly dosed opiates frequently provide reduced patient risk. The CDC's assertion that, as the NY times guy put it "The agency said that there’s just no evidence that they work long-term to relieve pain while there’s a wealth of evidence that they cause harm." is patently false. Opiates are effective long term, with "stable pain leading to stable doses", have significantly fewer side effects, and when properly dosed, a less than 1% chance of leading to addiction.