Chronic Pain and The Opioid Controversy: What People In Pain Need To Think About

“Uncle Sam is The Worst Drug Fiend In the World”

This was the title of a New York Times Article on March 12th, 1911.

It goes on to quote Dr. Hamilton Wright, then the Opium Commissioner, who says emphatically, “ Of all the Nations in the World, the United States consumes most habit forming drugs per capita. Opium, the most pernicious drug in the world is surrounded by far fewer safeguards than any nation in Europe.” The sub title of the article says, “ We use more of this drug than the Chinese.” He blames in part over- eager physicians, druggists, and pharmaceutical companies.

Sound familiar?

I guess some things do resist change.

In doing my research about opioid use, I found out that this is actually the third opioid epidemic in the US since 1900. In 1900 over 200,000 people in the U.S. were addicted to opium, hence the above article which I reference below. We are currently caught in the third wave; opioids are the leading cause of prescription drug deaths in this country. In 2010 Vicodin became the most prescribed drug in the U.S.

Given these statistics, the obvious answer to the question of opioid use is to ban them all together, after all if they kill that many people why take the risk? Only addicts would want to risk their lives for a painkiller, correct?

I wish it were that easy. The truth is, for many people, opioids are the best option out of a bucket load of not very good choices, and for those people banning opioids seems like a death sentence. I’ve lived with moderate to severe pain for 46 years and although I’ve never been a chronic opioid user, I have needed to take Vicodin daily for months at a time during my life. If I hadn’t had that option I honestly don’t know what I would have done; it was the only way my painful body would relax enough to sleep. I do know that before my doctor thought to give me the Vicodin I almost killed myself by falling asleep at the wheel on a California freeway. I hadn’t slept more than four hours for months due to my severe pain. Six months after I began Vicodin I stopped taking it because my pain levels decreased to a more manageable level. I can say with some certainty that Vicodin saved my life at that time.

The use and misuse of opioids is a complicated issue.

Over the past few months I’ve listened to and read countless accounts of people who have died due to using opioids, often as prescribed. I’ve heard about how other people have “cheated” the system in order to maintain their opioid use. I’ve been flabbergasted, yet again, by the influence the pharmaceutical industry has on the prescribing habits of doctors. There are high emotions on all sides of this issue, and with good reason- this is life and death we are dealing with.

So, for the purpose of moving toward healing as quickly as possible, in this blog there will be no blame. Instead, I’m going to move quickly through the problems. I will assume the following:

  1. Pharmaceutical companies play a large part in influencing the practice of medicine, as does insurance reimbursement.
  2. Medical doctors want to help their patients and when given mandates such as the 2001 Pain Management Standard naming Pain the “Fifth Vital Sign,” they can get over-eager and over-prescribe medication.
  3. Long-term efficacy of opioids is still not fully understood, and may change your nervous system in such a way that you actually “teach” your body to be reliant on them. (By the way, many pharmaceuticals do this, including medications that are taken for a life-time.)
  4. Pain medication is only one part of chronic pain treatment, which is very complex.
  5. Blaming the victim does nothing to help people in pain.
  6. Whether or not we have opioid medication, the problem of pain is not solved.
  7. The media plays a large part in influencing public opinion. (I’ve heard much more about opioid deaths than the 700 deaths every day that occur in the normal practice of medicine, which is the fourth leading cause of death in this country.)

Where does this leave us people who live with pain as their constant companion? Who may now feel demonized for using a medicine that benefits them despite the side effects it creates? This should be the foremost question in people’s minds. Right now, the answer is that we are in a really scary predicament.

Having been a consumer and a health care provider I feel the need to offer my advice for all of us going forward. Whenever you look at position papers, and institutional guidelines discussing chronic pain management they always center on the importance of integrated care, and stress how difficult it is for one provider to meet the needs of a client in chronic pain. However, when this actually happens, it is an anomaly. Even “pain clinics” often focus on surgical/pharmaceutical/ electronic stimulation (all high dollar items….) and much less on lifestyle counseling, and other more supportive but less invasive therapies.

Here is what the American Pain Society says about integrated care:

“Interdisciplinary care can be provided in acute, chronic, and cancer pain treatment facilities. Moreover, it can be provided along the spectrum from pediatric to geriatric populations. The composition of the team will vary since practice settings differ in size, complexity, resources, and patient populations (Table 1). Measurement goals will differ depending on type of pain and state of the patient’s disease. However, regardless of the population served, interdisciplinary care is patient-centered, family-centered, and stakeholder centered (ie, case manager, adjustor, employer). Treatment should be holistic, never directed toward an isolated body part or symptom. Efforts are made to achieve empowerment of the patient and his or her caregivers or significant others.”

“Although there may be circumstances were individual health care providers can provide adequate care and situations where there is a lack of available resources for truly integrated interdisciplinary care, we believe that optimal care for patients with pain is best provided within the model we have described and one worthy of aspiring toward.”

http://americanpainsociety.org/uploads/about/position-statements/interdisciplinary-white-paper.pdf

We have known for over a century about the problem of opioids, and for decades about the benefit of inter-disciplinary treatment for chronic pain but we are living in a broken record, choosing to ignore very good information and instead pointing fingers and hurting the very people we are trying to help.

It is time to stop.

We are a consumer driven society and as consumers of health care we can make different decisions in order to drive change. So, here is my call out to all of you in pain. Have frank discussions with your medical providers about your situation. Make an educated decision about whether long-term opioid use, or for that matter, any opioid use, is right for you. Then ask, and if that doesn’t work, demand, referrals to other health care providers that can be of assistance to you. (I’ll give you some ideas below.) Create a team of support. And do everything in your power to work with your pain in order to decrease the impact is has on your life. This is what you should have been counseled on and assisted with all along, but ultimately your health is your responsibility and if the medical system is failing you, which it is, you need to take action on behalf of yourself.

I’m with you all the way, and in upcoming blogs I’ll be talking about the things I’ve learned and do for myself and my body which is in constant pain.

For now, keep your chin up, and stand up tall when you talk to your doctor and ask for what you need. It is their job to help you.

Sending a hug your way…..

For more information about the current opoid problem and interdisciplinary chronic pain guidelines:

http://query.nytimes.com/mem/archive-free/pdf?res=9906E4D71331E233A25751C1A9659C946096D6CF

http://theincidentaleconomist.com/wordpress/opioid-use-and-policy-in-the-us-a-history/

http://www.kevinmd.com/blog/2016/04/the-opioid-epidemic-its-time-to-place-blame-where-it-belongs.html

http://americanpainsociety.org/uploads/about/position-statements/interdisciplinary-white-paper.pdf

Here are some ideas about providers that can help chronic pain. (Some will be insurance reimbursable and some not, so look at your pocketbook and ask questions before you commit to working with anyone.)

  • Occupational Therapist
  • Physical Therapist
  • Nutritionist
  • Osteopathic Physician
  • Chiropractic Physician
  • Personal Trainer
  • Reiki Practitioner
  • Acupuncturist
  • Psychologist
  • Vocational Counselor
  • Social Worker
  • Massage Therapist
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