Kevin James, ex-Registered Nurse

My name is Kevin and I am a 58-year-old ex-Registered Nurse who has had chronic pain for 13 years. My diagnosed condition is right-sided osteoarthritis and lumbar facet disease, with right-leg sciatica, neuropathy right-foot, and constant nerve pain in the right-lumbar region.

I was misdiagnosed until 2012, and since then I have trialled multiple strategies, as part of an overall pain management plan, including the following

1. Appropriate use of opioid pain medications.
2. Medical cannabis CBD] since October 2018.
3. Stretching, graded exercise, and modified Pilates daily.
4. Heat packs and physiotherapy during flare ups.
5. Distraction techniques such as music and photography.
6. Meditation, mindfulness and pacing strategies.
7. Cognitive behavioural therapy.
8. Acceptance and commitment therapy.
9. Professional psychological support when required.
10. Other “engagement” strategies, including weekly Community work.

Of all the above options, the most important aspect has been the effective use of low dose opioid therapy, which was prescribed in mid-2016, following unsuccessful trials of anti-psychotics, anti-epileptics and gabapentinoids, which had demonstrably far worse side effects than my use of low dose opioids until the current time.

I had been using a total dose of 200mg Palexia SR daily since 2016 [OR 60MME], which at the time allowed me to mobilise again and begin graded exercises. As a result of changes to the Federal TGA Opioid Prescribing Guidelines, my slow-release opioid medication was tapered by 25% in mid-2019, even though I displayed no symptoms of addiction at the time, or what is now referred to as “Opioid Use Disorder.”

Despite being advised I would experience “no long-term side effects from tapering”, I developed a condition known as Post-Acute Withdrawal Syndrome [PAWS], which greatly impacted my mental and physical health for the next 18 months, and kept me largely bedridden.

Is it possible some Dr’s cannot distinguish between the destructive addictive “behaviours” certain people display, and those of a chronic pain patient requiring their usual dose of pain-relievers?

Fortunately, my GP restored my daily Palexia SR dose back to 200mg 4-6 weeks later, however the damage was done, and I am now, nearly 3 years later, still having ongoing issues as a result of being tapered too rapidly.

If a patient is stable on long term opioid therapy AND showing no signs of addiction or other adverse events, WHY have Medical Authorities in Australia chosen to adopt policies of force-tapering chronic pain patients off their mobility-restoring opioids?

IN FACT, I ask why would new and even harsher “one-size-fits-all” Draft Guidelines for Involuntary Deprescribing Opioids be developed for implementation in 2022?

In my personal experience, I have achieved far better quality of life outcomes through more flexible patient-centred strategies, and I believe all responsible chronic pain patients should be able to use ANY and ALL reasonable options in their pain toolkit, as every individual is different, and every individual has a right to safe and effective pain management.

“Chronic pain patients deserve access to every tool in the pain management toolbox, including opioids. There is NO ‘one-size-fits-all’ in pain management.”

Kevin James