Chronic Cancer versus Non-Cancer Pain

Chronic Cancer versus Non-Cancer Pain: A Distinction without a Difference? | GeriPal – Geriatrics and Palliative Care Blog – March 2016 – by Eric Widera, MD (@ewidera)

In 1824, Jeremy Bentham published the “Book of Fallacies” in which he criticized fifty arguments used in political debate and explained the sinister interests that led politicians to use them.

One of these fallacies he describes as the “sham distinction”, now known better as a “distinction without a difference“.

This logical fallacy appeals to a distinction between two two things that ultimately cannot be explained or defended in a meaningful way.    

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From Cancer or Not, the Pain is the Same

Terminology of chronic pain: the need to “level the playing field” – Free full-text /PMC4734783/ –  Jan 2016 – John F Peppin and Michael E Schatman

This article, published in the Journal of Pain Research, makes it clear that there is NO biological/medical/physical difference between “chronic cancer pain” and “chronic noncancer pain”.

Pain medicine as a separate subspecialty is in its infancy, only fairly recently being recognized as such by the American Board of Medical Specialities. As it continues to find its way in the ever-changing world of medicine, terminology becomes an important consideration.

Terms carry tremendous impact: 

Pain Management in Patients With Hypermobility Disorders

Pain Management in Patients With Hypermobility Disorders: F… : Topics in Pain Management – Topics in Pain Management: July 2017 – Linda Stapleford Bluestein, MD – Continuing Education (CME) Activity

Learning Objectives/Outcomes: After participating in this CME/CNE activity, the provider should be better able to:

1. Describe the various types of hypermobility.
2. Identify signs and symptoms of hypermobility spectrum disorders.
3. Develop treatment plans for patients with hypermobility disorders that address their specific and unique needs.

Chronic musculoskeletal symptoms account for a vast amount of health care utilization and are a leading cause of impairment and deterioration of quality of life.  

People With Chronic Pain May Die Earlier

Why People With Chronic Pain May Die Earlier – Korin Miller – June 8, 2017

More than one in 10 Americans, or 25.3 million adults, suffer from pain every day, according to NIH data released in 2015.

Chronic pain seems to be just that—a serious pain—but new research has found that ongoing pain is associated with an increased risk of dying early.

For the analysis, which was published in Arthritis Care & Research, researchers looked at data from two large population cohorts of 50-year-olds.

They discovered that people who reported suffering from chronic pain had a nearly 30 percent increased risk of dying during the study.

It got worse as the pain became more intense:

People who said they had “quite a bit” of pain were 38 percent likely to die during the study, while those who were in “extreme” pain regularly had an 88 percent increased risk. 

Chronic pain linked to increased risk of dementia

Chronic pain linked to increased risk of dementia in study of older adults – Medical News Today – June 2017

This study gives us good reason to demand effective treatment for our pain.

Treat us for our pain now or for our dementia later.

Allowing a patient to remain in pain causes real physical and cognitive damage.

Opioid restrictions are hazardous to patients’ health

Researchers at UC San Francisco have found that older people with persistent pain show quicker declines in memory as they age and are more likely to have dementia years later, an indication that chronic pain could somehow be related to changes in the brain that contribute to dementia.

The Prison of Evidence Based Medicine

Deconstructing the evidence-based discourse in health sciences: truth, power and fascism – Int Journal of Evidence-Based Healthcare – 2006

This is an interesting critique of the ever-increasing focus on evidence-based medicine (EBM) in healthcare.

I agree that, while this seems purely scientific, the narrow focus on EBN actually undermines the human factor, which may lead to many more creative and compassionate approaches to practicing medicine.

EBM ignores all individual variation and, with what we know of genetics and biochemistry by now, this is a very UN-scientific approach. It also ignores the values and beliefs held by patients that are most critical to “healing”. 

Demonizing opioids endangers lives too

Op-ed: Demonizing opioids endangers lives, too | The Salt Lake Tribune – By Julieann Selden – Apr 2017 

Another example of the dangers of NOT using opioids to control pain.

Potential opioid benefits are glaringly absent from the campaign billboards and websites.

Extreme pathos warns Utahns to “steer clear of opioids,” suggesting Tylenol and exercise as alternatives.

The rhetoric is guilt-inducing, unrealistic to many situations, and diminishes the credibility of the campaign.  

Yes, people can die from opiate withdrawal

Yes, people can die from opiate withdrawal – Wiley Online Library -Shane Darke, Sarah Larney, Michael Farrell – Aug 2016  

It is generally thought that opiate withdrawal is unpleasant but not life-threatening, but death can, and does, occur.  The complications of withdrawal are often underestimated and monitored inadequately.

Death is an uncommon, but catastrophic, outcome of opioid withdrawal. 

So, why do so many doctors believe that simply discharging a pain patient, whether out of fear of the DEA or even for lack of compliance, causes no harm?

Opioid Quality Metric Based on Dose Alone

An Opioid Quality Metric Based on Dose Alone? 80 Professionals Respond to NCQA by Dr. Stefan Kertesz

Efforts to reduce prescribing while optimizing care for patients with pain, and expanding access to addiction treatment, are of cardinal importance.

How we advance these objectives depends partly on changing our shared understandings of what it means to deliver good care. It also depends on policies, resources and formal methods to assess if we are doing a good job.

Dr. Kertesz points out that all these new restrictions aren’t based on any studies at all. Nor are any studies planned to investigate the effect of these new policies.  

Opioids + Pain != Euphoria

Psychoactive Properties of Opioids and the Experience of Pain –  Journal of Pain and Symptom Management – February 2016

Here is a letter to the editor of a pain journal from Stephen R. Connor, PhD of the Worldwide Hospice Palliative Care Alliance.  

He points out what so many of us have noticed: if you take opioids when you’re in pain, you do not get “high” (see also Opioids, Endorphins, and Euphoria)

A frequently held view in palliative care is that when patients in pain use opioids, they do not experience the psychoactive or euphoric effects of opioids.

Furthermore, that those not in pain who use opioids do experience these euphoric effects that may lead to opioid-use disorder.