Addressing the dual crises of pain and opioids

Addressing the dual crises of pain and opioids — a case for patient-centeredness – by Beth Darnall – Oct 2018

Caring for pain has become deeply intertwined with the opioid crisis. Though largely fueled by illicit opioid use, the opioid crisis has understandably spurred national and local organizations, as well as the public, to seek methods of pain treatment that carry the lowest risks. That in turn has led to policies that often emphasize limits on opioid prescribing.

We must remember, however, that opioid limits alone do not constitute a pain care plan, nor do blanket opioid limits appreciate the individual differences across patients who live with pain.

I couldn’t agree more. Those entities passing down these opioid limits are not medical professionals, but rather bureaucrats and politicians who have no idea about the medical realities of those of us living with constant pain. Their ignorance has terrible consequences: it’s warping medical treatments and spreading the lie that “opioids lead to addiction”.

Over the past 15 years, the absence of patient-centered pain care contributed to an over-focus on prescribing opioids.

Now, we are in danger of repeating the mistakes of the past by applying a one-size-fits-all regulatory “solution” that fails to address the specific needs of the individual and fails to treat their pain.

To be truly effective, our pain treatment programs and our policies should be evidence-based.

Unfortunately, these days all studies on opioids blame these medications for the systemic destructive effects of pain itself, so there has been little evidence generated to do anything usefu with opioids. See Opioids Blamed for Side-Effects of Chronic Pain.

They should be patient-centered. And, as one component of patient-centeredness, they should be accessible to those who need them

Research is the path to evidence-based care and legislative solutions.

In a major step forward, earlier this year Congress approved billions in funding for the National Institutes of Health’s (NIH) HEAL Initiative, a trans-agency medical research effort focused on developing and investigating new and low-risk ways to treat pain, in addition to addressing opioid use disorder.

Then they should study how successfully opioids treat *real* pain patients’ pain, not some artificially created prolonged acute pain in mice.

The Patient-Centered Outcomes Research Institute (PCORI) has invested millions in funding studies to determine which pain care therapies work best for different individuals, which strategies to prevent opioid use disorders are most effective and how best to deliver medication-assisted treatment to those with addiction

The research that informs our policies and practices should reflect the realities of diverse patients and everyday situations.

That may sound obvious, but traditional research has typically included carefully selected patients. Fortunately, research funders such as PCORI and NIH are supporting the inclusion of more typical, “real-world” patients in research so that the results will be more broadly applicable.

This is an encouraging trend. Perhaps scientists are starting to realize that my above described studies with mice don’t apply in the real world, and that experimentally created pain for studies does not even approximate chronic pain in the real world.

For instance, my team is conducting a PCORI-funded study on prescription opioid tapering that has few criteria that would exclude people with pain from participating. We are testing the comparative effectiveness of two common, evidence-based treatments to help manage pain during voluntary opioid reduction.

People living with pain helped to design the study and are guiding its implementation.

Our national patient advisory board, comprised diverse representation across race, ethnicity and geographic location, is also guiding the research team. With this kind of inclusive approach, we expect that our findings will apply more broadly to patients in communities around the U.S., thereby increasing adoption of our methods and patient access to care that is acceptable to them.

As research and treatment become more patient-centered, our pain treatments will become more effective because they will be responsive to individual patients’ needs and circumstances. Pain care in the U.S. will be transformed when we focus on the right treatment, for the right patient, within a system that includes patients as true, valued partners.

This is an effort I support. It’s an indication that researchers are starting to wake up to the reality of real people living with real chronic pain in the real world.

Author: Beth Darnall, PhD is a clinical professor at Stanford University School of Medicine, Department of Anesthesiology and Perioperative Medicine and is an NIH and PCORI-funded principal investigator of chronic pain treatment and patient-centered opioid reduction research. She has authored three books for patients and clinicians on behavioral medicine for chronic pain. Follow her on Twitter: @bethdarnall.

I’m so grateful that Dr. Darnall is on our side now. She’s certainly “making amends” for how she convinced the public that most of our pain was just catastrophizing.

She’s a smart lady and should have known how her ideas would be misinterpreted by the vast “general public”, which has no patience for nuance and is marinated in anti-opioid media-hype.

Most people, even medical professionals that should know better, reached the sloppy conclusion that pain is “all in our heads” and twisted Dr. Darnall’s ideas about “catastrophizing” into blaming patients for their own pain.

9 thoughts on “Addressing the dual crises of pain and opioids

  1. peter jasz

    Dr.Darnall: Beautifully spoken. And articulated.

    The ‘billions’ (of dollars) for “research” is rather curious; opiates offer up Extremely effective pain-control. It;s been used for thousands of years. Those who use it to combat (vicious) pain know its efficacy. Studies also indicate when (opiates) are used for pain, “addiction” rates are UNDER 1.0% (ONE percent). Medical Science knows this. So do researchers, physician’s, pharmaceuticals.

    Problem is, pharmaceuticals desire massive corporate profit -they’re greedy. And I’m being/ speaking nice about them. So what will, where will these billions go, and for what purpose again I wonder ?
    How about spending that money on researching flipp’in pathology -and corrective measures. Specifically regarding horrific spine-pain conditions such as Adhesive Arachnoiditis; a horrific, vicious pain condition that’s frighteningly highly prevalent but disturbingly under reported. Disturbingly so. “Failed-Back Syndrome” (how articulate and precise !), “Mechanical” pain (that’s
    a great one -used routinely by physician/surgeon’s because they don’t have a clue -or care- about the repetitive, chronic tissue injury/disease so prevalent in pain patients).

    ‘Pathology’, people: Biology, Physiology -medical ‘conditions/tissue injuries’ well-known yet its impact/severity never reported -or rather acknowledged- in medical journals.

    Put the money into cleaning up this corrupt enterprise of Pharma-Physician Association -promoting dubious drugs to people (that they know is ineffective and likely killing the patient), but are quite happy driving their Porsche’s to Country Clubs -but damn-it, it’s not enough.
    That’s where the money will be going.

    Summarizing; there is no issue/problem with opiate use for pain patients. None. Zero. Nada.
    And studies/facts to prove.
    So what will be studies again -and why ????

    If researchers believe they can out-smart ‘Mother-Nature’s’ formula’s, they’re fools.
    They’ve tried. And failed. And will continue to fail. But the money will pour in.
    Check out the Side-Effects” of natural opiates (near zero) to that of commonly prescribed anti-inflammatory, anti-convulsion (Gabapentin and similar) drugs that have both a long and disturbing list of damning side-effects known to kill people -or making them very sick (when taken as prescribed). Yet, these garbage med’s continue to be prescribed with smiling faces because physician’s are being sourly mislead into its efficacy. It’s bull-shit. Plain and simple.

    For pain patients (and understand the unrelenting ferocity and horrifying pain-conditions that exist and they experience 24/7-365. If you would/could see these suffering pain patients ‘in- person’, you’d do anything to help offer up relief. It’s so sad to see suffering folk. Opiates help relieve miserly pain. Give it to those in truly desperate need -without restriction.
    These med’s well known and accessible -if physician’s could prescribe it without fear of severe government repercussions/sanctions.
    It’s right there, we have it: Morphine/Oxycodone -and similar. It’s reasonably priced, widely available (studied/researched), and compared to so-called “alternatives” (that are highly ineffective), side effects are largely (in fact nearly entirely) benign.

    Get real people. Help the suffering (immediately and without restriction) pain patients with known, proven, affordable, safe and effective pain med’s that has been successfully used for century’s.

    Then go play your billion-dollar schemes.

    peter jasz

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      The drug-war is too big has too much momentum to do an about-face, and I think we’re going to have to extract ourselves from its hold bit by bit. I have much more hope for that now that medical professionals are finally speaking out against this atrocity.

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  2. Mavis Johnson

    A lot of people in the Psychology Industry have still not gotten here message. They went along with the nonsense she peddled in her popular books. She has not done a true turn around or explained how she was wrong. Darnell made a lot of money and got a lot of publicity because her extreme and unscientific views were popular. She even had Dr Phil repeating her nonsense on TV. Yesterday he counseled a man with multiple crushed discs, telling him he was addicted, even though he took his medication responsibly. I suspect he was experiencing pseudo addiction, since he was not sleeping.
    Dr Phil put up all of the side effects of chronic pain, and attributed them to opiates, except for constipation. Later in the show he told the poor guy, that he knew he could not stop taking opiates, he has sen his crushed discs o his imaging. Then he made a false claim about adjusting his serotonin levels to compensate for the pain medications. He blamed his lack of serotonin on the opiates, and not the pain again! This is exactly the kind of misinformation and drivel that most Americans are exposed to constantly by mass media.

    Dr Darnel cashed in! She used fear based social media marketing to sell her books!

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      Actually, I respectfully disagree – I think she passionately believed that pain didn’t need opioids. But with her continued exposure to more and more pain patients, she’s finally seeing that opioids are necessary after all.

      I really admire her for so publicly advocating for our access to medications she denigrated in the past. I think it proves our point even more when an anti-opioid champion like Dr. Darnall recognizes and validates our need for opioids.

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  3. peter jasz

    Zyp: Is that joke (your last comment, specifically):

    Actually, I respectfully disagree – I think she passionately believed that pain didn’t need opioids. But with her continued exposure to more and more pain patients, she’s finally seeing that opioids are necessary after all.

    After-all ? Se’s a stink’in professional, physician, and she: “believed ….that pain didn’t need opioids.”
    Does she not have a professional, sensible, intelligent-minded obligation to her profession, patients, the greater community -and specifically those in such damning, excruciating physical pain ?
    According to you, after she ‘learned’ about pain, she blathered something more of which she clearly knows nothing of. Why didn’t this witch inform readers (prior to her first/original naive comment/remarks) precisely the extent of her pain research/understanding ?
    If you (or anyone else) believes this kind of garbage-talk (from a supposedly educated medical professional) is acceptable -and later defended as:
    “Oh, she learned a thing or two” (while never, ever even talking to a (severe) pain patient prior, let alone suffer through such an agonizing reality) as acceptable talk/behavior, I’d question your own sensibility. And maturity.

    peter jasz

    ” …

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      I think we’re both right. Yes, she should have wised up much sooner, but changing her professional campaign against opioids shows a lot of courage.

      Yes, it’s atrocious that she pontificated against opioids for chronic pain patients without having spent enough time with them to understand exactly what she was already talking about. But she has redeemed herself in my eyes with her impassioned plea to the Oregon Health Authority to scrap their plans for forced tapers.

      Sometimes the most effective allies are former enemies.

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