Pain patients suffer when medical community fights about opioid epidemic

"Everyone wants the number of opioid overdoses to fall. But patients ... don’t want to be made to suffer," said Bob Tedeschi.

In the article, a 43-year-old chronic pain patient, Michael Tausig Jr., points out, "... you’ve got the governmental people stepping in, who have no idea [what pain patients endure]. All they know is drugs are bad.

Admittedly, legislators without medical training can find the information about opioids confusing and overwhelming. They can err on the side of seeking to curtail opioid prescriptions because they rarely have to look pain patients in the eye.

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But you might reasonably expect doctors to have better pain management information and more compassion. At the least, you'd presume doctors share a goal with their patients: put patient needs first. As such, this would prompt healthcare providers to reach a consensus about how best to treat patients with chronic pain, even as they want to reduce the number of opioid-related overdoses.

 

Unfortunately, that’s not what’s happening in far too many cases. Within the medical community, healthcare providers argue about the merits of using opioids to treat pain, even in the absence of effective and affordable alternatives.

However, providers can't seem to agree on how to strike a balance. The conversation even among healthcare providers has too often conflated the legitimate needs of those living with chronic pain with the imperative that we do a better job of tackling the growing epidemic of opioid-related addiction and overdose deaths in the United States. One result: a chilling effect on the willingness of many physicians to appropriately treat chronic pain patients at all.

President of the American Academy of Pain Medicine, Dr. Daniel B. Carr, puts it succinctly: “There’s a civil war in the pain community. One group believes the primary goal of pain treatment is curtailing opioid prescribing. The other group looks at the disability, the human suffering, the expense of chronic pain.”

Dr. Sean Mackey, who oversees Stanford University’s pain management program, takes it a step further. “There’s almost a McCarthyism on this, that’s silencing so many people who are simply scared.”

Whichever metaphor you prefer, civil war or McCarthyism, the real problem is that the in-fighting among health professionals takes the focus away from where it should be: on patients who suffer from chronic pain. Via patient anecdotes, Tedeschi underscores just how extreme the problem is, as opioid distribution limitations can leave patients completely disabled with insufferable pain.

Somehow, we need to more appropriately address the twin issues of patients' need for pain treatment and our recognition of the dangers of opioids. What are the critical challenges and possibilities that we face in trying to find a balance?

The new presidential administration provides us with a fresh opportunity to debate our national health policy. The debate should articulate the importance of incentivizing innovation in treatments, of short-circuiting abuse/misuse of opioids through development of more advanced abuse deterrent technologies, of expanding access to a broad array of effective medical and behavioral health options, and more.

We must find medications that have a chance to prevent addiction rather than just treat addiction. The 21st Century Cures Act provides $1 billion to treat addiction but no funds are specifically dedicated for pain research.

Dr. Robert Califf, commissioner of the U.S. Food and Drug Administration, posted on the FDA blog, "Pain is a vexing issue that seems to fall between the cracks in research funding; we need to keep the pressure on funding entities to move pain to the forefront as a research issue."

This is the vision we hope more policymakers have. We must push for more funding to discover safer and more effective therapies and for payers to cover the innovations that can save lives and relieve suffering. We must acknowledge the scope and depth of legitimate needs of patients with chronic pain. Additionally, we must provide meaningful support and programs for people with addictions.

Our nation’s disjointed conversation about how to address the chronic pain of 100 million Americans is finally starting to boil over in the media and beyond. It’s time to bring reason, compassion and science to the discussion that affects the lives not only of those with chronic pain, but also their families and their workplaces. We must let compassion lead us forward but allow science to light the way.

 

Dr. Lynn R. Webster is vice president of scientific affairs for PRA Health Sciences. He is a past president of the American Academy of Pain Medicine. In addition, he is the author of the award-winning book, “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us” (Oxford University Press). Visit him online at www.thepainfultruthbook.com. Find him on Twitter: LynnRWebsterMD.


 The views expressed by contributors are their own and not the views of The Hill.