Monday, November 22, 2010

America's Fear of Treating Pain Properly

There's a "prescription drug abuse summit" here in Portland today (Monday). 

I only know about it because there was a big article in the local paper about a guy who developed chronic pain after a mugging, got addicted to his pain meds and then turned to heroin when he could no longer get the prescriptions.

Don't get me wrong -- I know that some people do abuse their prescription medication. I know that some people exaggerate or lie about their conditions to get prescriptions, either to abuse the drugs themselves or to sell them. Or both, probably.

But I also think there are way too many people out there who are suffering in pain needlessly because doctors are afraid to prescribe meds that might catch the attention of the federal and state agencies who monitor these things.

My copy of Melanie Thernstrom's The Pain Chronicles (I know -- I keep talking about this book, but it is so well written and full of pertinent facts!) should arrive on Monday or Tuesday, and I had to return the copy I borrowed from the library so I don't access to the statistics she cited. 

But it was something like only 6 percent of people who reach age 30 without developing addictions to alcohol, cigarettes, illicit drugs, etc., are at risk of becoming addicted and abusing properly prescribed pain meds. It was an even smaller percentage who jump from their prescription drugs to abusing street drugs.

It's true that just about anyone who takes opioid medications for lengthy periods will develop a physical dependence and need to wean down to limit withdrawal symptoms. But that's also true of anti-depressants, Prednisone, and probably lots of other medications I'm not thinking of.

When I moved to Portland in 1999, I brought, among my other medical records, documentation of my 1995 on-the-job shoulder injury that required two surgeries and led the state of Washington to declare me permanently partially disabled with limited range of motion, limited strength and chronic pain. The first thing I was told by the doctors I tried to set up as my primary care docs was, "I don't prescribe pain medications."

OK ... I wasn't asking for any -- I was simply giving them my medical history. And it's not like they required any kind of proof or testing before prescribing my requested allergy, asthma and migraine medications! 

I was, however, a bit relieved that I had stockpiled pain meds after my second surgery. Because while I didn't take Vicodin on a daily, weekly or even monthly basis, I did have pain flares periodically and I had learned the hard way about how pain spirals out of control if it's not treated properly before it gets really bad. (The difference between my first surgery, when the nerve block failed and the surgeon gave me inadequate post-surgery pain meds, and my second surgery two years later, with a successful nerve block and a doctor who prescribed adequate strength and quantity of pain meds, was amazing. But apparently very textbook because there are lots of studies that document that process. (That first shoulder surgery was also when I learned that I would never again tolerate a doctor who didn't have good communication skills and a willingness to answer my questions fully.)

I consider myself lucky that I have a good relationship with a good doctor, who trusts me to take medication appropriately. I apparently also don't set off red flags for her, since I know she has refused to prescribe pain meds for some other patients whom she believes are using them inappropriately. 

But there are a lot of other people out there who are suffering needlessly, not because they abuse their meds but because their doctors are afraid. Writing too many narcotic prescriptions garners attention, and sometimes investigations. Licenses can be lost, and reputations are easily tarnished even if they are ultimately cleared of any wrongdoing.

I remain unconvinced that making it harder for people with pain to get pain meds (by increased monitoring of prescription medications, the goal of the "summit" here) will make a significant difference in the number of drug abusers. What it will do, and what it has done in the past, is make more people suffer. 


I don't feel like I am expressing myself here as well as I'd like. The downside to needing to post daily means that I feel pressured to get the post out quickly rather than taking an extra day or three to ponder and tweak what I'm trying to express. I do have strong feelings on the topic, mostly because I know too many people who have given up on the medical system and suffer at home. 

Have a happy Monday, everyone!



WinnyNinny PooPoo said...

I had a doctor once tell me the only medication left that helps my neuropathic pain (soma) is addicitive. No Duh! It doesn't make any difference if you have to take it anyway. The difference is if you exhibit addictive BEHAVIOR - taking too many, taking off label amounts, trying to refill too often...

steph said...

I think you said it well. :)

Joan said...

I know lots of people suffer needlessly. We need to do a better job.

I also know beyond a shadow of a doubt there are problems. We need to do a better job.

The problems are not always with the person for whom the pain medications are prescribed. I have greater concerns for the children and teens who find their parents meds and try them out. I know you are focusing on the article in today's paper - and that is not an uncommon story - but what about the 5 kids in Hillsboro who, laSt week, OD'd on a parent's stash of Oxycontin? One girl took 15 pills. They are all very fortunate they are alive.

We need to do a better job.

Addiction is a problem. We need to do a better job.

Prescription Drug addiction is the responsibility of the doctors - they can lose their license. What you experience is a person doing the best with what they understand in a tightly watched area. Doctors (and allied health professionals, like me) are ill equipped to do an adequate job of screening for addictive behavior or addiction. it's not something they were taught in any sort of depth in medical school. There are entire specialties for pain management....

We need to do a better job.

In my limited opinion on the subject, I think we do a rotten job of stepping in early to help people find ways to alleviate pain, particularly chronic pain, other than chemically (massage, acupuncture, Reiki therapy, hydro therapy, aquatic exercise, PT, etc). We also do a rotten job of educating people who live with pain on the notion that, in some instances, it takes work (and sometimes increased pain for a time) to allow exercise and other alternative means to do their job to reduce pain.

We need to do a better job.

I also am going to point out the obvious: someone who has an addiction often does not see it in themselves.

It's a complex issue...with NO simple answer and no right or wrong issue.

But I do know, we need to do a better job.

No, folks should not be required to live with chronic pain. But I also think it's not a bad thing to create awareness of the addictive nature, of the pathway to heroin addiction, of the increasing use of Rx drugs in this new generation of teens, or to make it a bit difficult to obtain substances that have those potential consequences.

That's what the article said to me: We NEED to do a better job.

Aviva said...

@WNPP: Exactly!

@Steph: Aw, thanks! I appreciate it!

@Joan: Wow -- that would make an excellent stump speech if only you were running for office. :-) I agree we all need to do a better job. Personally, I don't expect to ever be pain-free, although I don't think I'll ever stop longing for it. I think that dangerous meds should probably be locked up in the home, the same way guns ought to be. And I, for one, probably need to do better on that, although luckily my kid is too young to be intentionally getting into it. As for the kids who got into a parent's properly prescribed meds? How is that different from getting into the liquor cabinet and drinking themselves into a coma? Teenagers do stupid, crazy things. I don't think having 15+ tablets in the house is an unsafe amount, and I think knowing the dosage is as important as the number of tablets. (In the O, they said the guy was getting 180 oxycodone a month from his neuro. Was that the 5 mg oxycodone pills *I* get? Or was it the 80mg oxycodone pills I read about when that pain clinic in Vancouver got shut down? (I don't take 180 of my pills a month, either, although that's the quantity I get when I get a refill.) There's also plenty of other medications besides narcotic that can be dangerous to little kids as well as the experimenting teens (the latter, I believe, will get what they want somewhere if they want it badly enough and I don't think the parents should have to suffer by not having appropriately prescribed meds to protect the teens from themselves), so it's not a problem solely with narcotic pain meds.

FWIW, the people who end up in pain clinics often have just as poor training from medical school and even their practices as the rest of the medical folks. Chronic pain has been around forever, but is really just started to be properly researched and studied.

A key for getting people interested in doing non chemical pain relief requires insurance coverage, which rarely seems to cover things like Reiki, massage, etc. And even when they do, like with PT, they rarely cover as many sessions for as long a period as people need. Like you said, we (and the system) need to do better. If it's not obvious from the way I'm writing -- with a killer headache and exhaustion -- I think I'm aggressively agreeing with you. I know sometimes I sound like I'm arguing when I'm actually agreeing ... :-)