Palliative Care for Chronic Pain

Palliative Care the Path to Better Pain Management – National Pain Report | September 2, 2016 | By Steve Ariens, P.D. Pharmacist

Steve Ariens points out that chronic pain patients, because they have an incurable disease (pain without remediable cause), should receive pain management as palliative care.

I’ve noticed others suggesting the same idea since 2013:

The latest definition of patients needing palliative care seems to include us, except for the strange requirement that palliative care should only be provided when a person will no longer need it much longer.

WHO Definition of Palliative Care

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness,…

Pain is usually not considered a life-threatening illness, but it can certainly destroy a life.

…through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

The above is exactly what chronic pain patients want as well.

How silly that the same care deemed essential when people are leaving this life is judged unnecessary while they are still living life.

Palliative care:

  • provides relief from pain and other distressing symptoms;
  • affirms life and regards dying as a normal process;
  • intends neither to hasten or postpone death;
  • integrates the psychological and spiritual aspects of patient care;
  • offers a support system to help patients live as actively as possible until death;
  • offers a support system to help the family cope during the patients illness and in their own bereavement;
  • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
  • will enhance quality of life, and may also positively influence the course of illness;
  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

From  Steve Ariens’ article:
Palliative Care the Path to Better Pain Management – National Pain Report

We have all seen/heard where many politicians/bureaucrats have passed rules/regulations/guidelines that place a limit on amount of opiates that a prescriber can provide any individual patient.  Usually expressed in Morphine Equivalents.

This “cookie cutter medicine” concept totally ignores the patient’s individual source, intensity of pain and if the patient is a fast or ultra fast metabolizer of opiates

Because these limits are being put in place by some/many that have little/no medical background or education, IMO, they have included loopholes for chronic non-cancer pain that may enable them to get better pain management.

Our society, as a whole, has empathy for those who are suffering from terminal cancer, because they can spend their final days in excruciating pain.

Most/all of these politicians/bureaucrats have placed in these legal requirements, exemption for those who are terminal, cancer and in need of palliative care.

All of these politicians/bureaucrats who are “short on medical knowledge” seems to believe that palliative care is exclusive to terminal cancer patients.

Most/all laws have loopholes that can be utilized. In this case, this loophole could provide a prescriber a path to be able to provide better treatment to chronic pain patients by exceeding the imposed Morphine Equivalent limits and still conform to the letter of the law.

I thought it was made clear that the CDC guidelines were NOT a law, but rather a suggestion (though the DEA seems to believe it’s law).

My suggestion to chronic pain patients, whose prescribers are reducing their pain medication and using these various rules/laws/guidelines as justification.

Take a copy of the WHO palliative care guidelines along with a copy of whatever rules/law/guidelines the prescriber claims to be following and

pointing out where those patients in need of palliative care are exempt from those limits, and

ask the prescriber why they cannot be diagnosed as being in need of palliative care per the WHO guidelines.

I would suspect that all too many prescribers have only read the Morphine Equivalent limits and not bothered to read the entire text, and have established their own policy based on the general rule and not tried to find a reason within the text to allow them to provide better pain management for their patients.  

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