A ‘civil war’ over painkillers rips apart the medical community — and leaves patients in fear – January 17, 2017 – By Bob Tedeschi @bobtedeschi
For Thomas P. Yacoe, the word is “terrifying.”
Leah Hemberry describes it as “constant fear.
For Michael Tausig Jr., the terror is “beyond description.”
All three are patients struggling with chronic pain, but what they are describing is not physical agony but a war inside the medical community that is threatening their access to painkillers — and, by extension, their work, their relationships, and their sanity.
This is exactly how I’ve been feeling: trapped between endless pain and my government’s callous attitude and ineffective solutions. The drug war cannot solve the problem of human addiction.
Two years after the United States saw a record 27,000 deaths involving prescription opioid medications and heroin, doctors and regulators are sharply restricting access to drugs like Oxycontin and Vicodin.
But as the pendulum swings in the other direction, many patients who genuinely need drugs to manage their pain say they are being left behind,.
“There’s a civil war in the pain community,” said Dr. Daniel B. Carr, president of the American Academy of Pain Medicine. “One group believes the primary goal of pain treatment is curtailing opioid prescribing. The other group looks at the disability, the human suffering, the expense of chronic pain.
“There’s almost a McCarthyism on this, that’s silencing so many people who are simply scared,” said Dr. Sean Mackey, who oversees Stanford University’s pain management program.
It’s significant that these two particular doctors, who are at the vanguard of the movement to treat pain without opioids, are starting to realize they have created a monster of anti-opioid sentiment that’s devouring doctor and patients alike.
“The thing is, we all want black and white. We don’t do well with nuance. And this is an incredibly nuanced issue.”
This is becoming a huge problem in many aspects of modern American culture as complex issues arise. In this country, more and more politicians campaign on soundbites of simple solutions that are completely unrealistic.
Nuance does not matter to people like Tausig, 43, who has been unable to work or socialize since 2008, when the last of his five spinal reconstruction surgeries left him in constant pain.
He last got a taste of life without opioids a few years ago, when his pharmacy’s corporate parent imposed opioid-distribution limits, forcing him to find a new one.
Now, with regulators and health industry leaders continuing to bear down on opioids, and the arrival of a new president whose statements indicate that he might further restrict opioid distribution, Tausig’s worries have deepened.
The medical community’s battle over painkillers burst out into the open in late 2015, when the New England Journal of Medicine published a commentary in which two doctors argued that chronic pain patients should focus not on reducing the intensity of their pain, but on their emotional reactions to it.
This is typical of people without pain – they just cannot understand the burden of chronic pain.
The authors, Dr. Jane C. Ballantyne, the president of Physicians for Responsible Opioid Prescribing, and Dr. Mark D. Sullivan, argued patients should pursue “coping and acceptance strategies that primarily reduce the suffering associated with pain and only secondarily reduce pain intensity.”
The pair argued that patients who mainly focus on pain intensity tend to escalate their doses of opioids and worsen their quality of life.
But the comments also laid bare a fundamental problem in the debate over opioid treatments: Neither side has much evidence about the benefits or consequences of long-term use because almost no such studies exist.
Stanford’s Mackey said those risks are important to recognize. But, he said, nearly 15,000 people die a year from anti-inflammatory medications like ibuprofen.
“People aren’t talking about that,” he said.