In 2020 people in the US seem to be more comfortable taking pain medications than they are talking about them. Chronic pain patients feel stigmatized in a way they did not before the opioid crisis. The opioid crisis and responses to it have altered pain medication management rapidly and drastically. This change has largely been driven by the CDC 2016 Guideline for Opioid Prescribing, which some see as a “cookbook” approach. Few people question the need for guidelines but even providers question the ways in which they have been applied, especially by insurance companies, medical boards, state legislatures, hospitals, etc. In the midst of the opioid crisis another class of drugs, benzodiazepines, have come under increasing scrutiny. “Benzos” have been widely prescribed for a variety of conditions. However, they are now known to be dangerous in combination with opioids as well as highly addictive in and of themselves, making withdrawal difficult and, under some circumstances, life-threatening. If, when, and how to withdraw are points for serious discussion in Pain Clinic. Medical cannabis, in states which have legalized its use, is another tool in the pain specialists' armamentarium. However, as long as it remains a Schedule I drug, stigma from either prescribing or using it as a medication in chronic pain remains likely. This may be true for providers even more than for patients. Safe and effective management of chronic pain is a complex issue for providers and patients alike. This series looks at pain management in chronic pain in 2020 from the point of view of a woman, physician, social anthropologist, and photographer.
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