From Bad to Worse for Pain Patients?

From Bad to Worse for Pain Patients? February 20, 2016

Has the pendulum swung too far against pain patients?

The answer is “Yes” according to some leading pain management experts at the annual meeting of the American Academy of Pain Medicine (AAPM) in Palm Springs.  

But are they planning to do anything specific and timely about it? Will they finally pull together and present a united front to speak out against all the addiction-focused propaganda flooding the media?

The AAPM represents 2,400 physicians and health care providers, including some who have stopped prescribing opioid pain medication because they fear prosecution or sanctions if they prescribe to patients who might abuse the drugs.  

“There are a variety of primary care doctors that are dropping out altogether (from prescribing opioids). They will not allow it.  

They’re saying everybody has to go to a pain management expert or you don’t get anything. And its abrupt,” said Bill McCarberg, MD, President of the AAPM.

“For that group of patients, you’re cutting everybody off inappropriately. There are some of those patients who probably need those medications, who do better with medications.”

opioids with abuse deterrent properties are difficult to prescribe because they are expensive and usually not covered by insurance.

“When you come back here in five years, in ten years, we’ll be having the discussion about the pendulum being over here, patients suffering.  About you getting shoulder surgery and getting nothing but acetaminophen to treat your shoulder because nobody is willing to give you more (opioids). That’s what I worry about.”

Ballantyne’s presentation

was low key and did not focus on opioid use. She spoke about improving pain curriculum in medical schools, an area where there is broad agreement that change is needed.

Then she went right back to the statement that created so much backlash from pain patients:

“When we treat chronic pain we do an awful lot more or want to achieve an awful lot more than simply reducing pain intensity:

We want to improve people’s lives.

We want to help them function better.

We want to improve their state of mind and their mood,

On those points, I couldn’t agree more. However, her assumption that these benefits can be achieved without significantly reducing pain intensity goes against the experience of many pain patients, as well as my own.

In over 30 years of slowly worsening chronic pain, I’ve learned a few things.

Improving a pain patient’s life
without reducing pain intensity

is as difficult as
improving a starving person’s life
without reducing hunger intensity

we have to pay attention to all the other factors that contribute to the disease.

Chronic pain is a complex disease that is not simply a focus on pain intensity. And that’s one thing we can really help in our teaching.”    

Deliberately provocative? It certainly pushes my button every time I hear it because I suspect it’s an excuse to deny effective pain treatment.

Other thoughts?

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