Coincidentally, the month of September is “Pain Awareness Month” and its 2nd week is also “Suicide Prevention Week”. I believe pain awareness *is* suicide prevention, so here is my yearly post about the unintended serendipity of these two awareness campaigns going on at the same time.
By now we have direct evidence that a lack of pain awareness, as demonstrated by all the politicians and healthcare “experts” enshrining the CDC “guideline” prescription opioid restrictions as law, is leading to suicides of patients with uncontrolled pain.
Can the connection become any more obvious? Continue reading
Preventing Opioid Abuse Shouldn’t Mean Ignoring Patients’ Pain – by Subhash Jain – Aug 2019
I’m surprised and delighted that this article was published in the respected “Harvard Business Review” so that it reaches the people making the rules from their seats in the executive suites of medical corporations.
From lawsuits by several states against the manufacturers of opioids to criminal prosecutions against pharmaceutical executives, much has been made about pain medications and their misuse. Unfortunately, if you just pay attention to these headlines, you’re likely to miss an important fact:
Pain medications are an important and medically necessary part of many patients’ treatment.
Hurrah, another doctor pushing back against the widespread policies of reducing long term opioid use to almost zero. Continue reading
The re-education of a physician into the school of pain – Heather Finlay-Morreale, MD | Physician | July 27, 2019
Since childhood, I have suffered from severe stabbing headaches.
Thus, my first lesson in pain management. Getting accurate, effective, pain treatment is a lengthy and difficult process.
Actually, it’s usually impossible to find truly effective pain relief, especially when the most effective medication (opioids) is being withheld. Pain treatment is still handled with the same old standbys: NSAIDs, Tylenol, and opioids.
Throughout medical school, I learned about pain receptors and pathways, but little about how to treat pain. Continue reading
The Global Burden of Musculoskeletal Pain—Where to From Here? – free full-text /PMC6301413/ – Am J Public Health. 2019 January
This article makes it clear that our chronic musculoskeletal pain is a serious burden, not just for us, but for all of society too. It itemizes reasons why chronic pain is so often regarded as a mere nuisance and isn’t taken as seriously as other health concerns.
In the 2010 Global Burden of Disease Study (GBD), which broadened the scope of musculoskeletal conditions that were included over previous rounds, low back pain imposed the highest disability burden of all specific conditions assessed, and subsequent GBD reports further reinforce the size of this burden.
Over the past decade, the GBD has produced compelling evidence of the leading contribution of musculoskeletal pain conditions to the global burden of disability, but this has not translated into global health policy initiatives. Continue reading
The two PubMed articles in this post are from the early 2000s, over 16 years ago, yet they describe the same situation we’re stuck in today, with doctors being squeezed, harrassed, and sued from both sides of the opioid controversy.
Sometimes they are successfully sued for refusing to administer necessary pain relief when a jury decides that “insufficient pain management in a dying patient constituted abuse by a physician.” (which seems obviously right to me)
Other times they are successfully sued when a doctor who “provided comfort care to terminally ill patients was accused of performing euthanasia.” (luckily, the conviction was later overturned)
I’m very glad I’m not a doctor who has to make such potentially career-ending decisions these days. Continue reading
Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids – Jama Network Open – July 2019
This JAMA study shows that 40% of doctors refuse a new patient if they are using opioids. Many refuse not just to manage their pain, but to manage any other aspect of their general health.
Findings In this survey study of Michigan primary care clinics, 79 clinics contacted (40.7%) stated that their practitioners would not accept new patients receiving opioid therapy for pain. There was no difference based on insurance type.
Meaning The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or poor management of other mental and physical comorbidities. Continue reading
The Price Tag of Living With Chronic Pain – By R. Morgan Griffin – Aug 2007
Pain was once viewed only as a symptom, the consequence of another condition. It was often ignored as doctors focused on treating its underlying medical cause.
But for almost everyone, pain is what matters. “It’s pain that brings people into the doctor’s office,” says Penney Cowan, executive director of the American Chronic Pain Association. “It’s pain that they want treated.”
“The costs are incalculable,” says Christopher L. Edwards, PhD, assistant professor of psychiatry at Duke University School of Medicine. “How do you estimate the value of lost self-worth? How do you estimate the loss of family, friends, and a sense of accomplishment?” Continue reading
How Did We Come to Abandon America’s Pain Patients? – Filter Magazine – by Alison Knopf – July 2019
This is an excellent article pointing out exactly how pain patients have been neglected and dismissed by the medical system. Kudos to Alison Knopf for her exemplary work.
Overdoses—not those involving prescription opioids, but of heroin and illicit fentanyl, often combined with benzodiazepines—continue to go up. But opioid prescribing continues to go down.
The Ethical Responsibility to Manage Pain and the Suffering It Causes – Position Statement of the American Nurses Association, Apr 2018 – Repost
I’m reposting this from last year because it’s such a good (and rare) example of a reasonable attitude toward opioids. The Nurses Association gets credit for standing up for patients a year earlier than others.
The purpose of this position statement is to provide ethical guidance and support to nurses as they fulfill their responsibility to provide optimal care to persons experiencing pain.
The national debate on the appropriate use of opioids highlights the complexities of providing optimal management of pain and the suffering it causes.
In these first sentences, the difference between nurses and doctors shine through:
Nurses are much more concerned with suffering, while doctors nit-pick about what is painful and what isn’t, who is “really” hurting and who is “catastrophizing”. Continue reading
Opioid medication discontinuation and risk of adverse opioid-related health care events. – PubMed – 2019 May
Here’s a recent study from the NIH showing that sudden tapers are a disaster for patients. If you showed them this study (link in title), with documented harm to patients, any doctor who still honestly cares for their patients would not force sudden tapers like this.
Between 2012 and 2017, the United States dramatically reduced opioid prescribing rates.
While this may be an appropriate given the opioid epidemic, there has been little research to guide the clinical practice of discontinuing patients from opioid medications and opioid death rates have continued to increase. Continue reading