What Happened to the Untreated Chronic Pain Crisis? – Pain Medicine News – Mar 2018 – By Joe H. Browder, MD
Though “Addiction has been part of the human condition as long as recorded history“, policymakers are reacting as though it were a new phenomenon arising from the use of prescription opioids.
Their clueless and cruel stupidity is depriving pain patients of the most effective treatments, namely opioid medication.
Simply stated, nothing has happened to the untreated chronic pain crisis. The same percentage of patients from the population still suffer from chronic, unrelenting pain.
The only difference is this: We now know that one treatment option, when taken to the extreme, is not the simplistic solution that we had hoped for and were led to believe.
In retrospect, simplistic is a nice adjective along with delusional, foolish or academically corrupt to describe the belief that any human condition can be alleviated with a known addictive substance.
Addiction has been part of the human condition as long as recorded history.
There is growing consensus that the same percentage of the population has been addicted to some agents for at least several centuries.
The overreliance on opioids for the treatment of chronic pain just substituted one psychoactive medication for others. It is interesting that as the opioid crisis has become more pronounced, there is less awareness of cocaine or methamphetamine addiction.
One new part of this equation is the development of a physician, pharmaceutical and insurance complex, with each achieving a different goal with opioid use but toward the same end
Now there is a massive rebound against the use of prescription opioids for chronic pain.
In the process of righting the wrongs, a number of chronic pain patients who had regained function with the appropriate treatment of their disease state with opioids are now caught in the tidal wave and losing either their opioids or their function.
This loss of function has restored, in at least some of these patients, turning to street drugs, which have become ever more potent and dangerous
All interested parties should now agree that the opioid genie is out of the bottle and can’t be eliminated from society
Well-intended prescribing guidelines and laws restricting the use of prescription opioids are inflicting real harm to patients everywhere.
The groups trying to alleviate this problem include lawmakers, who generally are poorly informed and trying to satisfy the needs of their constituents.
There is a very loud constituency advocating for the reduction in addiction and overdose deaths.
And this “loud constituency” ignorantly insists on broad prohibitions with no consideration or concern for the Negative outcomes of unbalanced opioid policy
Lawmakers will attempt to pass laws that alleviate these problems, but inevitably, any law is so broadly written that it will cause harm to a patient whose chronic pain is being appropriately treated.
Insurance companies have also been reluctant to cover alternative treatments, such as physical and psychological therapies, for prolonged periods of time, which these patients need.
And here’s the problem for insurance companies: alternative treatments must be repeated regularly for the rest of a pain patient’s life.
To cover such continual costs, premiums must rise.
One of the major problems with pain management, however, is that no technique has been shown to provide long-term pain control. Opioid medications; neuroadjunctive medications, such as gabapentin and dual-action antidepressants; traditional physical therapy, the above-mentioned procedures; and alternative treatments have not been proven to provide long-term pain control.
We’re at a point at which prescription drugs are being replaced by illegal drugs.
This is further complicated by the fact that sophisticated pill presses can produce illegal pills that look like brand-name medications but can actually contain any number of psychoactive medications.
The analogs of fentanyl are most dangerous; they can be up to 100,000 times as potent as opioids, milligram to milligram. The statistics are now likely to be corrupted because law enforcement members do not know what medications they are finding on overdosed patients, and only expensive toxicology reports can tell for sure.
The number of prescription medications actually peaked in 2012.
However, the number of overdoses, overdose deaths and neonatal abstinence syndrome cases continues to grow.
When will policymakers finally notice the growing discrepancy between opioid prescriptions and opioid overdoses?
Even the government is starting to hear about this erroneous assumption: See CDC Over-Counting Rx Opioid Overdose Deaths.
Because of the current fluctuation of the situation, the statistics that are being used are likely to be irrelevant to the current situation.
One statistic that is assumed as fact is that more than a three-day prescription for pain medication will cause patients to become addicts.
That is highly unlikely.
A vast number of patients have been given post-op medications without becoming addicted.
The treatment of chronic pain will require well-trained providers who are versed in a multidisciplinary approach, and a little bit of everything will be helpful.
Author: Dr. Browder is senior partner at Pain Consultants of East Tennessee (PCET), in Knoxville. He has practiced pain medicine since the early 1990s, and founded PCET in 1998. He is triple board certified in pain medicine: as a diplomate of the American Board of Anesthesiology with added qualifications in pain medicine, a diplomate and fellow of the American Board of Pain Medicine, and a diplomate of the American Board of Interventional Pain Physicians. He is also a fellow of Interventional Pain Practice from the World Institute of Pain. PCET is an American Pain Society Clinical Center of Excellence, and can be found online at www.painconsultants.com.