Pain
And Prejudice: Challenges And Solutions
To
observe that people with chronic pain in America are treated like second class
citizens is a simple truth. And sadly human errors seem
to significantly contribute to a hostile environment for people with
pain.
Why do we have 110 million people with chronic pain?
The possible reasons for such a large number
of people with chronic pain are multifactorial include the following and perhaps
other influences.
1.
Aging
population
2.
Industrial
injuries
3.
Traffic
accidents
4.
War injuries
5.
Self-inflicted
violence (survivors of suicide attempts, annual attempts 1 million).
6.
Surgical
complications
7.
Improved
diagnosis of Fibromyalgia.
8.
Sports
injuries.
9.
Longer
survival of patients with Cancer and malignant disorders.
10. Longer longevity with increased in number of people
with arthritis and other disorders.
The challenges encountered by some 110
million people with chronic pain (1)include the following:
§ Archaic, unscientific classification of controlled
substances. Yes it is true that our current classification system is not rooted
in scientific principles (2) and it is a vestige from early 1920s.
§ Shortage of doctors willing to treat pain because of persecution
of pain doctors and restrictive regulations making easy access for pain
treatment difficult. For instance in the past 10 years some 20,000 pain doctors
have been punished by our laws that criminalized medicine (3).
§ Promotion of false claims of prescribed pain
medications causing epidemics of heroin addiction and od deaths. For instance
regularly CDC publications
wrongly
disseminate scientifically questionable information by representing statistical
associations as if they were causative.
There
seems to be no scientific evidence to suggest a causal link between treatment
with opiates for chronic pain and the increase in overall overdose deaths. The
increase in total number of overdose deaths seem to be multifactorial and
associated with increasing numbers of suicides, popularity of over-the-counter
pain medications and other psychosocial factors.
§ Popular media broadcasting dramatic personal stories of
death and heroin addiction based upon false CDC claims.
§ Burdensome attendance and travel regulations for pain
patients in need of methadone (daily visits restrictive travel). For many with
chronic pain methadone is an inexpensive and effective remedy yet methadone
treatment is restricted to clinic's with medically unnecessary requirements.
§ Gross underestimation of adverse impact of chronic pain
(premature death, brain atrophy, depression, social decline). By now we have
considerable medical literature of serious long-term complications of untreated
chronic pain beyond already known adverse
psychosocial and quality of life
impact. Chronic pain seems to make almost all coexisting conditions worse. MRI
evidence of gray tissue atrophy in prefrontal cortex and other crucial brain
regions is compelling.
Equally
alarming is the relatively recent evidence of shortened lifespan and premature
death in some vulnerable patient populations (4,5,6).
There are many effective solutions to
provide adequate care for pain patients without increasing crime. However not
much can be done unless we face a painful reality:
Living with chronic pain in America is to
suffer more pain because of man-made prejudicial laws.
To improve care for people with chronic
pain should start with dissemination of accurate scientifically sound information.
This of course must include correcting
misleading advertisements geared toward scaring the public about the down side
of potential relief and artificially creating a conflict between people with chronic
pain and people interested in combating
substance addiction.
It is reasonable to have effective and safe
treatments for both pain relief and addiction. The current tension
Is
unnecessary and correctable. The following may serve as our premise.
§ The predominant focus of treatment for chronic pain
should be relief from pain with appropriate attention to potential side effects
including overuse.
§ The predominant focus of treatment for substance
addiction should be relief from addiction.
§ The predominant focus of treatment for people with
chronic pain and history of addiction should be relief from pain with
appropriate attention to potential overuse.
§ We must end criminalization of medicine and persecution
of physicians treating pain.
§ Artificial medically unjustified regulatory limits
restricting physicians from prescribing medications such as methadone and
buprenorphine should be eliminated.
§ False alarms with misleading information about
prescribed pain medications causing epidemics of heroine addiction and od
deaths must end.
§ CDC and other governmental agencies must aggressively address
the ravages from chronic pain, addiction and mental illness without scare
tactics at the expense of people with mental illness. It would be very
desirable for CDC to utilize as much energy time and commercials to highlight
the true epidemics of mental illness and suicide (suicide rates have been
increasing and now rank as one of the major causes of death with 40,000 annual
suicides).
These are all practical solutions within our grasp. More importantly
millions of Americans with chronic pain and illness deserve better than what
they have been getting from us for a long time.
References
1. Relieving pain in America. Institute of
Medicine report. June 2011.
2 . Salerian AJ Addictive potency of
substances. Journal of psychology and clinical psychiatry. June 2015.
3 . Libby R
Criminalization of medicine
4.
http://www.cdc.gov/vitalsigns/painkilleroverdoses
5. Kakko J Svanborg DK Kreek MJ Helig M , One year retention and social
function after buprenorphine assisted relapse prevention trial. The Lancet volume 361 issue 9358 February 2003
pages 662 – 668.
6
. Apkarian V et al chronic back pain is
associated with decreased prefrontal and brain matter density loss. Department
of physiology and Institute of neuroscience Northwestern University Feinberg
School Of Medicine 2004.
7.
Salerian A J, Case studies of 17 Patients. Journal of case reports and
studies.( 2015 ) 2 (5): 506
8.
Salerian A J, Discontinuation Of Opiate Treatment: A Retrospective Review of 49
patients. Journal of Psychology And Clinical Psychiatry. 2015, 2 (4): 00083
9.
Salerian
A J, Opiates: Benefits And Overuse Potential. Pharmacy and Pharmacology
International Journal 2015 volume 2 issue 3
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