At every county fair, there's a ride that looks harmless enough; painted horses circle under bright lights while soft music plays in the background.
Riders climb on, grip the pole, and move in steady loops. From the outside, it feels active, but in truth, it never goes anywhere.
Chronic pain care has built something similar, looking structured and responsible, feeling regulated and safe. Yet for many patients, it goes in circles, draining time, money, and dignity.
The 28-Day Clock
Linda fell from a ladder at age 45, shattering two sections of her spine. Five surgeries followed; she learned to walk again after each one. For years, she lived with moderate pain and managed without heavy medication.
Age changed that.
By age 71, she relied on a small, stable dose of oxycodone that had barely shifted in 25 years. Her longtime physician carefully managed it, checking her kidney every few months, with honest talks about dosage. There was no drama or escalation.
Then retirement came.
The clinic refused to continue prescribing, explaining that government rules no longer allowed opioid management there, causing Linda to find a pain clinic.
She visited five of them, paying a copay each time, before finding one that would accept her. The closest location was a 45-minute drive away. After several months, she transferred to another clinic 25 minutes away, and when it closed for renovations, she resumed the 45-minute drive.
It's a rerun every 28 days.
That's a schedule that works out to 13 visits annually, not 12. At $25 per visit, that equals $325 annually to maintain a prescription Linda has responsibly taken for decades. If a physician isn't available or the schedule changes, the copay reappears; if the clinic location changes, the copay returns.
The ride keeps turning.
Thirteen Times a Year
Mary, a cancer survivor who's endured major surgeries to her spine, joints, heart, and brain, takes two codeine tablets per day.
Two.
Yet every month, she's required to answer medical inquiries and navigate refill barriers to receive the same modest prescription.
A retired Marine, requesting anonymity, describes decades of physical strain and multiple combat deployments. When severe pain leaves him unable to rise from bed, his clinic offers little beyond over-the-counter medication. He stopped asking after repeated refusals.
A former prosecutor in her seventies takes half a tramadol at night to sleep, cutting 90 pills into 180 doses to make them last. Pharmacies sometimes release seven pills only, labeling her opioid naive despite years of documentation.
Each time, she must call her physician, clarify records, and return to the counter.
Steve, a retired ER nurse, once viewed patients requesting narcotics with suspicion. After injuring his own back, he experienced the system from the other side. When he asked for a modest adjustment after years of stability, he was warned about oversight, paperwork, and regulatory flags. Eventually, he secured a change, but not without resistance.
None of these accounts describes reckless escalation or deception; they describe patients who've remained stable for years while the system around them has grown rigid.
The Insurance Maze
Financial strain compounds the burden.
Linda and her husband pay Medicare premiums, which are deducted directly from their Social Security benefits, while supplemental coverage adds several hundred dollars per month. Deductibles range from thousands of dollars before meaningful coverage begins. Prescription tiers shift older medications upward, increasing costs for drugs that have safely worked for decades.
When Linda tried switching medications to satisfy clinic pressure, the alternative cost $300 per month at the lowest dose. She experienced swelling, skin reactions, and breathing difficulty. Only an allergy spared her from continuing a dangerous trial.
For patients living on fixed incomes, a $25 copay and a few hundred dollars in tier adjustments aren't minor inconveniences; they represent real trade-offs between medication, groceries, utilities, and stability.
The music plays on.
Fear Replaces Judgment
There's a clear pattern across these stories.
Longterm patients with steady histories now face contracts, monthly appointments, drug screens, strict refill windows, and rigid calendars. Clinics that once managed chronic pain quietly now refuse opioid treatment entirely.
Dependence means the body adapts to medication that helps with sleep, movement, and daily functioning. Addiction involves compulsive behavior despite harm. The difference shows itself in conduct.
Linda maintained a stable dose for decades; Mary takes two pills per day; the prosecutor cuts hers in half; Steve waited years before requesting a change. These aren't signs of uncontrolled use; they're signs of restraint.
Yet policy often treats dependence and addiction as indistinguishable. A 28-day schedule doesn't measure risk; it measures compliance. A copay doesn't prevent misuse; it reduces income. A pharmacy limitation that dispenses seven tablets instead of 90 doesn't solve addiction; it multiplies stress.
And the ride keeps spinning.
The Hidden Cost
The consequences extend beyond money.
Veterans connect untreated pain to rising suicide rates. Families strain under alcohol, used to dull pain that clinics refuse to treat. Seniors plan travel around refill windows, while patients fear physician retirement more than illness.
Trust fades quietly.
Many people have tried physical therapy, injections, yoga, NSAIDs, meditation, and procedures. Some endure repeated ablations and injections to demonstrate a willingness to pursue alternatives: I've received close to 16 ablations and countless injections that aren't lasting very long.
When people say they fear being entirely cut off, it reflects a sense of survival, not drama.
Nobody boards that painted horse seeking excitement.
Yet, once seated, stepping off can mean surrendering mobility, sleep, and independence.
Bright lights, steady circles, 13 times a year.
It's a never-ending ride.
I Want to Hear From You
These chronic pain columns exist because people are willing to speak honestly in a system that often punishes them for it.
Read My Chronic Pain Series here.
If you're living with chronic pain and have had to learn to stay quiet to survive care, your experience matters. Whether your story is long or short, clinical or personal, it helps expose what life inside the system actually looks like.
If you choose to share, you grant PJ Media permission to edit, publish, and use your submission without compensation. Any edits will be limited to grammar and clarity, never substance or meaning.
To submit, visit the Contact Us page and put “Dave Manney: Chronic Pain” in the subject line.
You may request anonymity or use a first name only. A few honest paragraphs about your condition, care, and how your life has been reshaped are more than enough.
Remember: Silence protects broken systems; your voice helps challenge them.
Policy choices about pain care shape real lives long after headlines fade. Linda, Mary, Steve, and countless others now live under a twenty-eight-day clock that measures compliance rather than relief, as fixed incomes absorb rising costs. PJ Media VIP keeps those consequences visible and pushes accountability where it belongs. Join PJ Media VIP here.
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