Chronic pain is further complicated because it involves suffering and ethics. The anti-opioid crowd would rather not contemplate this uncomfortable reality and treat pain as a “mere symptom” of something else or write it off as “psychogenic”.
Cancer pain treatment is aimed at patient comfort and is validated by objective disease severity. For chronic nonmalignant pain, however, comfort alone is not an adequate treatment goal, [why not?] and pain is not usually proportional to objective disease severity
Therefore, confusion about treatment goals and doubts about the reality of nonmalignant pain entangle therapeutic efforts.
We present a case history to demonstrate that this lack of proportionality fostersfears about malingering, exaggeration, and psychogenic pain among providers.
Doubt concerning the reality of patients’ unrelieved chronic nonmalignant pain has allowed concerns about addiction to dominate discussions of treatment.
We propose alternate patient-centered principles to guide efforts to relieve chronic nonmalignant pain, including
- accept all patient pain reports as valid but negotiate treatment goals early in care,
- avoid harming patients, and
- incorporate chronic opioids as one part of the treatment plan if they improve the patient’s overall health-related quality of life
Although an outright ban on opioid use in chronic nonmalignant pain is no longer ethically acceptable
Yet such a ban after an arbitrary time period (usually 3 months) is exactly what’s being proposed by some parties, like PROP.
ensuring that opioids provide overall benefit to patients requires significant time and skill.
Patients with chronic nonmalignant pain should be assessed and treated for concurrent psychiatric disorders, but those with disorders are entitled to equivalent efforts at pain relief.
The essentialquestion is not whether chronic nonmalignant pain is real or proportional to objective disease severity, but how it should be managed so that the patient’s overall quality of life is optimized.
If only our legislators, law enforcement, and doctors would see it this way!