Our Neglect of Chronic Pain

Our Neglect of Chronic Pain Has Left Many Without an Identity – Oct 2018 By Scott McKinney Ph.D.

The opioid epidemic is in the news on just about every television and radio show.

Our regulators debate, campaign, and vote on issues around controlling borders and over-regulating Physicians, yet no one is talking about the typical mom, dad, husband, or wife that deals with chronic pain issues.

As the regulatory broom sweeps our nation, normal and functioning, people are being brushed away by a straying bristle. The, now common story, of a person dealing with chronic pain goes something like this:  

They have an unfortunate accident or diagnosis. They seek medical care for the pain and the path typically leads to opioid prescriptions. Years go by, everything is managed. Of course, their tolerance to the medication being prescribed has increased, and so too, their dose.

One day, they go to what seems a typical follow-up appointment with their provider. The provider, with increasingly higher “regulatory-induced-anxiety”, informs the person that they will no longer be able to write their prescription and need to refer them to another provider.

This seems simple enough in the individual’s mind. Unfortunately, they soon learn that this was more than an anomaly; it is a growing trend.

After countless calls and Google searches they find other physicians unwilling to take over their care or indicted by the Federal Government.

Their problem just became critical. The clock has now started for a person who will run out of the medication that enabled them to function normally. Their managed pain will start to ravage the ability to function and the overall quality of their life.

Patients are being put in this exact scenario each day around us. They are forced to look for non-opioid solutions to their chronic pain issues, which may not provide the same level of functioning they once had or seek the only treatment available for those dependent on mood-altering chemicals.

They are told they either don’t need opioids or they need addiction treatment.

This what it looks like Stanford is/was doing:

I tried the Stanford Pain Management Program. Without more than a glance at me, they told me that the first thing they would do is take away my opioid pain medication “because it doesn’t work for fibromyalgia”. This was news to me because it was certainly working very well for me. The fibromyalgia diagnosis wasn’t a complete fit for my symptoms anyway, but they didn’t question that as much as I did.

They barely examined me or questioned me about my pain, yet they were certain I should stop taking opioids immediately. I began to understand that they were planning to give me treatment for my non-existent addiction and not for my incapacitating pain, about which they clearly communicated their skepticism.

I declined the program because I would not give up opioid medication without an effective pain-relieving treatment that would make them unnecessay.

I say give me an alternate pain reliever drug or treatment first and then I’ll give up my opioids. They say, give up your opioids first and then we’ll figure another way to manage your pain without them.  And if they can’t find “another way”, will they give your opioid prescription back? I doubt it.

This is becoming a regular story in the substance abuse treatment sector.

Patients dependent on opioids, without providers willing to address their needs, seek solace in a sector that will provide them care.

The problem with this is that addiction treatment centers are ill-equipped to care for these patients. Many do not meet the diagnostic criteria for substance abuse and have a primary diagnosis of chronic pain.

Like the bad parenting problem, we are not addressing the problem’s source.

If we want to begin correcting this problem we first need to recognize the population discussed. Yes, we need to hold physicians accountable when prescribing opioids for pain. But, there is also a lack of differentiation between substance abuse disorder and substance dependence.

So, who are we talking about in the first place? The updated Diagnostic and Statistical Manual of Mental Disorders (DSM-V)’s additional criteria of substance use disorder results in a series of diagnostic codes that neglects compliant, chemically dependent chronic pain patients; they have no diagnostic identifier unless they are classified as substance abusers.

NIDA sensibly uses the term addiction as “relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain”, 

But the DMS-5 has renamed “addiction” as “severe dependence” on a specific drug (or drugs).

It’s already been shown that the particular drug of abuse is mostly irrelevant because the problem with addiction is in the person, not the drug. This classification makes no sense and is most certainly not relevant to solving the crisis of addiction that’s killing people.

How can we begin to help a population that doesn’t even have a name?

This is problematic in two ways.

• One, it leaves pain and addiction professionals without the proper diagnostic label for this population.
• Secondly, medications and services without proper diagnoses are not covered by health insurers.

So, they are either misdiagnosed or are simply thrown aside in some direction.

An amendment to the DSM-V needs to be made to accommodate the criteria needed to justify chemical dependency or an additional set of ICD-10 codes for those chemically dependent that do not meet substance abuse criteria.

Author: Dr. Scott McKinney is the president of the Midwest Institute for Addiction. He has served in the United States Marine Corps as a Recon Marine and combat veteran. His passions have taken him from the world of Physical therapy and human performance to those with substance use and dependence. He continues to find opportunities to work for the betterment of others.