Pain Treatment not Stigma
There are a lot of misconceptions surrounding the treatment of Chronic Pain. Some are sad and some are just ironic. For example, the Government declared #opioidawareness week, during the end September, which is also chronic pain awareness month. How can we all help to remove the misconceptions surrounding this issue?
I am someone who suffers from the chronic, pervasive pain which comes from Rheumatoid Arthritis, Osteoarthritis and Degenerative Disk Disease. The problem in the world of chronic pain is not the over simplified rhetoric which one sees in the media.
Regardless of what lawmakers seeking headlines, the media looking for a scoop, and/or people with a financial bias say. I would argue that there is not an Opioid Crisis in America, there is a Treatment Crisis.
I realize that’s a pretty strong claim, but consider that the Kansas State Board of Healing Arts defines “inappropriate treatment” as a serious problem in the United States, but what is “inappropriate treatment?”
Inappropriate treatment of pain includes nontreatment, undertreatment, overtreatment, and ineffective treatment. All persons who are experiencing pain should expect the prompt and appropriate assessment of pain and function and the initiation of pain management, while retaining the right to refuse treatment. (Joint policy statement of the Kansas Board of Healing Arts — Sept 2016)
Today, there are hundreds of thousands to millions of people, in the US, who suffer from chronic, severe, debilitating pain and are either undertreated or simply not treated and are required to live with their pain. The potential hit to the market place in costs from lost work, medical care, etc, are in the trillions of dollars and worse, in some cases people have become suicidal because there is no relief available to them. Thankfully my own doctor is carefully using opioids, as one of the tools in my treatment plan to provide relief to the degree where I can be involved my own life again.
There is one simple point, which I am trying to make. People suffering from chronic pain are not drug addicts. They should not be automatically treated like “drug seekers.” They are patients in need of treatment.
Right now in today’s sensationalistic media environment, where the only thing that is being sought is the next headline, patients don’t have a voice. No one wants to hear that opioids are what makes life livable to so many. No one wants to hear that less than ¼ of 1% of chronic pain patients, who are properly treated and have no history of addictive behavior, ever become addicted.
To paraphrase a friend (http://www.thehurtblogger.com) The path to addiction is not the same path as someone suffering terrible pain, and to equate the two shows a decided lack of understanding. In fact, it’s almost willful ignorance. I have never taken heroin and I never will. That being said, I do think more research should be put into the use of Marijuana or Cannabis for the treatment of Autoimmune Rheumatoid Diseases.
What people apparently don’t understand is the difference between dependence and addiction. A patient who’s suffering, only wants that suffering to end. Someone who’s abusing, regardless of their reasons, only wants their next fix.
The first thing we need is a common language of pain. Anyone who’s been treated for pain has been asked, “if your pain was on a scale of 1–10, what is your pain number?” The problem is deciding what each number actually means? Patients may ask themselves whether or not they’re not going to be taken seriously if they say they’re at a 4, but having to live day in and day out at a 4 on the pain scale may be too much to bear. I know many people who are at 6–7 when they don’t have opioid analgesic pain management, but under treatment they might be at a 3 or a 4, so which number do they use when seeing their doctor?
Based on my own experience, I think the answer is using one of the many tools out there such as PROMIS (Patient Recorded Outcome Measurement System), RAPID3 Results, or some other commonly understood objective rating system. To do it consistently, and to ensure that that data is being given to one’s doctor every time there is an appointment. For example, ArthritisPower http://arthritispower.creakyjoints.org/ uses PROMIS data to track patients with auto-immune inflammatory arthritis. Patients who regularly report their data can print a report which their doctor can use to evaluate treating to target and how successful the patient has been. By doing this, the patient demonstrates consistency. He/She is able to have a voice by sharing what the treatment results are and a common language of pain is being used, reducing or eliminating confusion.
In addition, the economics of pain management make no sense. For example, once my insurance deductible is paid off, my drugs don’t cost me anything. Yet, if I wanted to consider flotation therapy, it would be $75 per treatment out of pocket. If I wanted to consider acupuncture, cognitive behavioral therapy or any of the other potential methods out there which have shown some positive results, I have to be willing to pay some heavy out of pocket expenses. There has to be a means to encourage patients to try alternatives to drugs, while still giving a path to relief.
Finally, you might say that I haven’t truly addressed the instances of addiction. After all the government says it’s a problem, don’t they…? Unfortunately, the government doesn’t appear to be looking at its own numbers and when they do, they automatically lump patients into the same statistical model as drug addicts.
With all the noise in the media, for example, one would think that drug deaths were in the top 5 causes of death in the United States. The problem is that they’re not. According to the Centers for Disease Control (CDC) http://www.cdc.gov/nchs/fastats/deaths.htm The top 10 causes of death in the US are:
- Heart disease — 614,348
- Cancer — 591,699
3. Chronic lower respiratory diseases — 147,101
4. Accidents — 136,053
5. Stroke — 133,103
6. Alzheimer’s Disease — 93,541
7. Diabetes — 76,488
8. Influenza and pneumonia — 55,227
9. Nephritis (kidney disease) — 48,146
10. Suicide — 42,773
However, just as was stated earlier patients are not drug addicts, so why do the statistics lump them together? HealthCentral.com did a study on the question of “Can a chronic pain patient become addicted to Opioid Drugs? http://www.healthcentral.com/chronic-pain/coping-279488-5.html/?ap=420 What they found was that “in a review of 24,000 patients who were medically prescribed opioids, only seven could be found who got into trouble with them.” Assuming that “trouble w”as addiction, that would make an addiction rate of .03%.
However, one can’t rely on a single study. So, let’s example a study conducted by pubmed.gov, which is a part of the National Institutes for Pain. https://www.ncbi.nlm.nih.gov/pubmed/18489635 In this study, it was found in 24 studies of 2,507 chronic pain patients (CPPs) that had a calculated addiction rate of 3.27%, using opioids, or as they called it “Chronic Opioid Analgesic Therapy (COAT).” However, “within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%.” (emphasis added)
“The media generally does not report the issues around opioid use with accuracy, neutrality, and critical thinking. When have they reported anything recently using any of these qualities? “The tide has shifted from demonizing pain medication to demonizing people with pain, continuing the suffering of millions with untreated or undertreated pain,” says Yvette Colon, PhD, MSW.
If you’re a medical professional, please don’t automatically see a “drug seeker” when someone complains of pain. If you’re someone suffering from Chronic Pain, join your voice with ours at Creaky Joints, ArthritisPower, or many of the other patient advocacy groups that are out there.
Keep fighting because we’re patients not addicts! #patientsnotaddicts
