When you talk about the top pain physicians in the United States, Dr. Sean Mackey of Stanford usually makes the list.

He is the Redlich Professor and Chief of the Division of Pain Medicine at Stanford University School of Medicine. He is Director of the Stanford Systems Neuroscience and Pain Lab and has additional appointments in the Departments of Anesthesiology, Perioperative, and Pain Medicine, Neurosciences and Neurology.

He has been consistently saying over the past several years that we need a revolution to change how we think about pain—that it’s not a one size fits all issue and each patient experience is unique.

So when he took to Twitter this week to talk about a patient they had recently treated at Stanford, we felt it was strong enough to simply include in this piece.

Here is what he said:

I’d like to share this brief story about a patient who’s currently taking opioids.

We’ve been treating a patient at Stanford who has a lower extremity injury. He came to us on high-doses of opioids through fentanyl patches. His primary care doctor wanted him weaned off. He has tried every treatment imaginable.

Our pain center is multidisciplinary, so we had a team conference to discuss his particular case. He was seen be a physician, a pain psychologist, and a physical therapist. There was a lot of debate around what to do.

The team concluded after a long conference that this patient is a functioning member of society and is doing everything that’s been asked of him. Every time he’s tried weaning down (three times), he’s had to quit work.

So, the recommendation was to not change anything.

The lesson: we cannot generalize these tools (i.e. opioids) and make broad statements across everybody. For some people, opioids will lead to major problems. On the other end of the spectrum, there are people who will benefit greatly from the use of opioids for managing pain.

Given the polarized view of opioids, we hope stories like this will continue to bring awareness to this incredibly nuanced issue. As with many issues we face, this is not black and white. I am not pro-opioid or anti-opioid. I am pro-patient.”

To follow Dr. Mackey on Twitter @DrSeanMackey

To follow National Pain Report on Twitter @NatPainReport

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