If you are someone whose pelvic and/or endometriosis pain has not been adequately, effectively and appropriately treated, please consider signing this Petition and sending a loud, strong, and staunch message to "pelvic pain specialist" Dr. Sawsan As-Sanie affiliated with The University of Michigan.  Let her know that her hypocrisy is shameful and that her non-evidence-based anti-opioid pain medication views and practices, which she is disseminating on a large scale through publications in top medical journals, are causing severe and significant harm to patients who are suffering from untreated severe pain due to pelvic pain conditions such as endometriosis.  Please consider signing this Petition and engaging in any of the below-suggested advocacy activities because we deserve better: we deserve pain relief; we deserve a quality of life that isn't dictated by pain and suffering; we deserve to not have to suffer gaslighting and medical trauma about our pain; etc.   We deserve answers and accountability about Dr. As-Sanie's hypocrisy about the treatment of pelvic and endometriosis pain that is causing harm to so many of us with these conditions.  

1) REQUESTING ALL INDIVIDUALS WITH PELVIC PAIN, ENDOMETRIOSIS, ETC BOYCOTT DR. SAWSAN AS-SANIE WHO IS AFFILIATED WITH THE UNIVERSITY OF MICHIGAN

2) SEND FEEDBACK TO JAMA ABOUT DR. AS-SANIE'S HYPOCRISY ABOUT TREATING PELVIC AND ENDOMETRIOSIS PAIN AS DETAILED BELOW: jamams@jamanetwork.org or call 1-312-464-4444 (Editorial Office)

3) SEND FEEDBACK TO DR. AS-SANIE ABOUT HER HYPOCRISY ABOUT TREATING PELVIC AND ENDOMETRIOSIS PAIN AS DETAILED BELOW: email Dr. As-Sanie at: sassanie@umich.edu

4) SEND FEEDBACK TO THE UNIVERSITY OF MICHIGAN INSTITUTE FOR HEALTHCARE POLICY & INNOVATION THAT DR. AS-SANIE IS AFFILIATED WITH: email them at: ihpifeedback@umich.edu

Here is a my Letter to the Editor that I wrote in response to Dr. As-Sanie's recently-published article in JAMA where she stated that opioids are not recommended for treating endometriosis-associated pain, despite the fact that endometriosis is rated as one of the top 20 most painful conditions in the world and that opioids are the most effective analgesic medication-there are no equivalents to them.  They are the most effective analgesics for nociceptive pain as well, which is a significant component of endometriosis-associated pain.  

In “Endometriosis: A Review,” Authors As-Sanie et al argue:  “Due to risk of dependency, opioids are not recommended” for treating endometriosis-associated pain.  However, As-Sanie et al do not provide any evidence supporting their assertion that opioids entail a “risk of dependency,” what that risk might be, if there are methods to de-risk, etc. 

Additionally, As-Sanie was an author and investigator on the SPIRIT 1 and 2 trials of relugolix for endometriosis-associated pain; this study is cited as Reference 51 in the JAMA Endometriosis Review.

Per SPIRIT 1 and 2, including information contained in the Supplementary appendix, a “menu” of 7 opioid and/or opioid combination analgesics were offered to patients in this trial as rescue analgesia (PDF p. 321), with the authors (including As-Sanie) asserting the following: “...some patients require treatment with opioid drugs” (p. 62); “For patients who may need the Tier 2 analgesic medication [the opioid analgesic medication], a prescription should also be written for this prior to the start of the Run-In Period.  This is to ensure that patients do not endure unnecessary pain during the conduct of the study (p. 62); and “To avoid experiencing extended periods of uncontrolled pain, patients who require the Tier 2 medication should get a prescription…and initiate treatment…as soon as feasible” (PDF p. 240).

Interestingly enough, this Supplementary material also notes: “Patients should be counseled on the safe use of opioids” (p. 63).  This seems to disprove As-Sanie’s assertion in this JAMA Review that “opioids are not recommended due to risk of dependency,” as apparently opioid analgesics were able to be used “safe[ly]” in the SPIRIT 1 and 2 trials, but not in any other context.  Also, there is no information in the SPIRIT I and 2 trial protocol indicating that participants were advised of a “risk of dependency” with regards to the opioid analgesic rescue medications.

Thus, it is very interesting, curious, discordant, concerning, and questionable as to why As-Sanie expresses so much concern about the “risk of opioid dependency” in this JAMA Review but did not appear to have this concern during the SPIRIT I and 2 trials.