Where is the patient in the discussion of the opioid epidemic?

Where is the patient in the discussion of the opioid epidemic? – KevinMD | Blake Kelly, MD | April 13, 2017

This pain management doctor knows us; he understands exactly why pain patients need opioids. He points out that opioids are used as the last (and only) resort for pain patients that have tried absolutely everything else.

The opioid epidemic has been declared loud and clear in the media over the past several years.  

Doctors have been demonized, and patients have been stereotyped.  The statistics are alarming.  

However, I have yet to see anything published that focuses on the patient who lives with chronic pain.  There is very little understanding for these individuals.

Dr. Kelly has seen and understands the desperation of pain patients who must face the latest cruel and arbitrary opioid restrictions. He understands that only opioids stand between us and a very small and limited life.

Let me be more specific.   Society reacts empathetically towards the person who has pain related to cancer or a severe medical condition, such as a burn.  

But what about the patient with less tangible pain?  

We assume that these individuals are drug seekers that haven’t taken care of themselves, so they are must be responsible for their pain.  

Many people think, “If they would just exercise correctly or lose weight, they wouldn’t be in the shape they are in, right?”

Insurance companies have turned their backs on this group of patients by declining coverage for medications and many basic forms of treatment.  The doctors who treat these patients come under increasing scrutiny as well and risk being labeled as “pill pushers.”

I would like to provide a perspective from someone who is in the trenches with these patients on a daily basis.  I am a physician who has practiced pain management for the past ten years.  

My goal in writing this article is to shed light on the opioid epidemic, from a pain management physician’s perspective, and to put a face on the patient who has chronic pain that is unrelated to cancer, also known as non-cancer pain (NCP).

Let’s review some of the staggering statistics of the chronic pain epidemic in America.  Chronic pain affects nearly 1 in 3 Americans.  More Americans suffer from chronic pain than diabetes, heart disease, and cancer combined!

Sadly, some will commit suicide because they have given up and their coping mechanisms have been exhausted.

I would like to focus on the patients that come to a clinic like mine.  These are the patients that have tried to do everything in their power to have their pain problem cured.  

They have seen their primary care physician or a provider in the emergency department or urgent care.  They have been to the chiropractor or visited the physical therapist.  They have had a myriad of procedures or perhaps even spine surgery in hopes to avoid having to rely on medication to cope with their pain.

what about the patient who is in agony despite seeing the right doctors, or having the recommended procedures or surgeries?  

There must be something wrong with such a person.   

They must have secondary gain of some sort.  They must prefer to make only 60 percent of their previous income as a disabled workman’s compensation patient.  They must prefer to take numerous medications every day and have very restricted lifestyles.  Because a spinal injection or a surgical procedure is the price to pay to continue to get their narcotic prescription, they do what they must do, right?

In my experience with patients and colleagues across the country, the patient who suffers from chronic, noncancer pain has tried to do everything in their power to find relief.  

Medication is usually a last resort.

These patients have tried to do anything they can to lessen their medication and improve their quality of life.  They are fearful to go to the emergency department, seek out a new physician, or discuss their real medical problems with anyone for fear they will be seen as a “drug seeker.”  They struggle with self-worth because they are no longer a “productive member of society.”  They would readily abandon habit forming medication for any other treatment that would give them similar relief.

There is the crux of the problem!  The medical community doesn’t offer them healthier alternatives.  If we had the cure, they wouldn’t be in our offices.  If we had safer, non-addictive medication, they would be on it.  Doctors wouldn’t prescribe anything that could “do harm.”  

But until the day comes, they must rely on the only option they are offered and can afford.  Unfortunately, opioid-based medication is prescribed reluctantly and as a last resort by their treating physician as the only measure that provides relief from suffering and improves quality of life.  

The patient will continue to cope, hope, and believe that the future holds something more for them so they can live the life they believed they were born to live.

Blake Kelly, MD is president, Oklahoma Pain Center.

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One thought on “Where is the patient in the discussion of the opioid epidemic?

  1. DMarie

    THANKYOU, THANKYOU, THANKYOU, Dr Kelly! Thankyou for letting others know what its like for patients living with chronic, intractable, pain! And unfortunately, that outlook is currently only for very FEW EXTREMELY LUCKY patients who have a caring, ethical physician, such as yourself caring for them. However, that’s NOT the case for the vast majority of patients who are losing their fight against progressive, debilitating diseases every day. Many of whom have been simply discontinued from their medications regardless of being stable & maintaining a reasonable level of functioning. For SO many patients living with these debilitating conditions, having their opioid medications taken away is the equivalent of having their lives taken away-because in effect, that’s exactly what happens!! They are no longer on a opioid medication, but they also just lost any quality of life they had! And perhaps worst of all, instead of being understood for our desperate desire to retain what quality of life we have/had, we are viewed soley as yet another person who must be addicted to opioids!! We ALL only have one life to live here on this earth & being forced to live in a miserable state of constant pain, with no end in sight, is why many individuals exhaust their coping skills and end up either transitioning to black market drugs or suicide out of pure desperation for relief! Individuals can only stand the maddening effects of constant pain for so long before it overcomes them!
    Again, thankyou for voicing the incredible struggles & stigmas that those with invisible chronic illnesses are being forced to endure!

    Liked by 2 people

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