A Pain Doctor’s Dilemma

From the first paragraph of chapter one: At the turn of this century, the Congress of the United States designated it as the Decade of Pain Awareness. It is undeniable and a statistical fact that controlled substance prescriptions for pain have increased many folds since the beginning of the 21st century. More and more patients are open enough to discuss about their pain with their doctors. The general and family practitioners are still the primary providers that deal with most of the patients with chronic pain. Even though there are more physicians specialized in pain management, their number is still comparatively small while the number of patients with chronic pain is increasing every day.

From chapter two: The understanding of addiction and pseudo-addiction has come a long way, and there is still a lot of work ahead of us for the treatments of patients with chronic and intractable pain, including terminology and biologic concepts.

Studies consistently show that chronic pain is tragically undertreated in the U.S. and around the world. In June of 2012, an Institute of Medicine report called undertreated pain a “ a public health crisis “ that affects 116 million Americans, and costs the economy about a half-trillion dollars per year in medical bills and lost productivity. The same month, three pain-related articles in the Lancet focusing on post0operative, cancer-related and non-cancer related pain, respectively, found considerable under-treatment in all three areas.

From chapter three: In the current atmosphere of suspicion, lack of sympathy, politic al witch-hunting, scapegoating, and disrespect, pain patients have very little medical protection or rights. The sheer mention of chronic pain reminds me of leprosy years past; very few people want to get anywhere near you.

From the closing summary: As a trained pain doctor, you owe it to your patients to help control their pain and take steps to help them function with some quality of life and dignity. If the only way to accomplish those goals is to prescribe controlled substances when other modalities failed or not available, you should not hesitate to do so. If it becomes apparent to you that a patient wishes to choose a course of treatment that is not consistent with appropriate medical care, you must not yield to the patients’ desire.

Many people agree but afraid to express their opinion that the government has been waging an aggressive, intemperate, unjustified and over-powering war on the pain doctors. Even doctors face predicaments and some can’t agree on how to help their pain patients. Very sadly, I am seeing a “ civil war “ developing timidly in the pain community. It reminds me of a McCarthyism that is silencing so many people who are simply scared.

The fact is neither side has much evidence about the benefits or consequences of long-term use of opioids because almost no such studies exist. The risks of long-term opioid therapy are important to be recognized and more education is needed. How about thousands and thousands of people who die every year from anti-inflammatory, non-steroidal medications like ibuprofen? Nobody seems to be talking about that.