Monday, November 16, 2009

Re-thinking narcotic pain control for chronic pain sufferers

There is an ongoing discussion about pain control with the majority of medical providers taking the position of being very negative toward using narcotics.

For example, this news article quotes a committee on pain management:

Chronic pain, if not recognized and treated as a chronic illness, takes an enormous personal toll on millions of patients and their families, and leads to increased health care costs. Chronic pain can also compromise the productivity of the U.S. workforce.

The article answers:

"Maybe Portenoy and Foley and the other Committee Members contributing to this report would like to address the epidemic in this country of OxyContin deaths and addictions which has taken 'an enormous personal toll on millions of patients and their families'."

Oxycontin deaths? Are they talking about pain management or are they talking about drug abusers? I would bet they are talking about drug abusers and not folks WHO NEED good pain management. And in the case of drug abusers, have they considered the large number of people killed on the road by drivers inebriated by alcoholic beverages, a highly addictive drug to which no one, it seems, objects and which has little to no value, medicinally? Have they considered the large numbers of those addicted to alcohol? Somehow this does not deter folks from enjoying their occasional drinks... on the contrary.

And for kids suffering from connective joint disease (this has really increased, in our society), perhaps narcotic pain meds should be considered, as, young folks, if in serious pain, (which is not really helped that much by NSAIDS etc) tend to "bootleg" drugs if the docs do not prescribe them, an act which could endanger them much more than prescribed drugs.

Addictive people can get addicted on legal drugs like alcohol and cigarettes (cigarettes is one of the worst addictions to shake too with a very small percentage able to give it up without numerous tries) but no one even MENTIONS those addictions.

But somehow when it comes to chronic pain, people get very strange ideas.

Why is it, I wonder, better to cook your liver and burn holes in your stomach with the NSAIDS for limited relief than to use narcotics? Or better to endanger your heart with drugs in cox 2 inhibitor class?

An 80 year old friend of mine (R.I.P.) had a vioxx-related heart attack (and his heart was healthy before that - he exercised regularly etc etc) so after this happened, there was really no relief from his severe arthritis pain since he was not given narcotics. He suffered stoically but would have had a much better quality of life in his last 3 years of life, if he had been given even small doses of a medication like oxycontin.

Pain management providers point out that those who NEED narcotics do not get "hooked" anyway... they may get DEPENDENT but that's a different thing from addiction and yet, many do not make the distinction.

People should NOTE that 95 percent of Dr Kevorkian's "patients" who sought "assisted suicide" were NOT terminally ill - they were in CHRONIC PAIN and/or depressed - most of them told Kevorkian they just wanted to stop the pain. But it seems our society is actually more accepting of "assisted suicide" as a "treatment" for chronic pain than narcotics which are the only medications which are reasonably effective.

A study a few years ago found that 65 percent or more of the elderly did NOT have good pain management because of our society's non acceptance of narcotics for pain control.

And one of the doctors on a Discovery Health CME about "none small cell carcinoma" of the lungs commented that many medical providers will not give narcotics to terminal cancer patients for "fear of getting them hooked" and he asked if this wasn't more than a bit ridiculous.

In a society which considers personal privacy so precious that it does not protect the life of an unborn baby if the mother wants to terminate, why are we invading people's PRIVACY over their own bodies and the opportunity to get relief from chronic pain? This over zealousness about prescribed narcotics seems more than a contradiction of our beliefs about a "woman's right to do as she pleases with her body" (especially as medicine does not consider the unborn baby as a part of a woman's body but rather simply HOUSED there).

In our society which has a lot of aged folks due to modern innovations in medicine etc, we must realize that a LARGE percentage of the elderly suffer with ELDERLY diseases which DO cause chronic pain.

But interestingly enough I once asked a pain management specialist what type of patient are most of his patients who are on large amounts of narcotic pain medication and surprisingly he did not answer, the elderly... his answer? Pain caused by chronic disorders like fibromyalgia or ... surgery! i.e. joint replacements, back surgeries etc. A close friend who is an RN studying to be a nurse practitioner confirmed the thing about back surgery. She has several herniated discs in her back (she is 59 going on 60) but said she would not have surgery because she finds in many patients, the surgeries just worsen things. Many of the chronic pain sufferers I know, had gastric bypass (for weight loss) several years ago. Some of them get narcotics and some of them do not - many doctors balk at prescribing these for fear of repercussions from the Drug Administration and those who do not get pain meds suffer a huge amount of depression. A study on 10 year post op weight loss surgery patients found that there was a much larger percentage of suicide in this population than even in severely obese people.... (and obese people are basically shunned by society and medicine alike)

If we are really worried about addiction, why not go after the liquor lobby? Besides the huge number of people killed or maimed by drunk drivers, consider that every drink of an alcoholic beverage kills liver cells (and we wonder why in a society where liquor freely flows, we have a large percentage of liver failure?) Or the cigarette companies (especially when cigarettes and tobacco usage are a factor in 400,000 deaths a year in the USA and 95 percent of COPD and 90 percent of lung cancers)?

I think healthcare may be broken but not because of the 30 million uninsured (of which, some pundits tell us, the present "reforms" will only cover half of these, still leaving 15 million uninsured) but because of, for one, the prevalent strange attitudes on pain control.

As the committee mentioned in the article stated, chronic pain takes a toll on everyone, and most of all the sufferer, many of whom stay in and are not active due to poor pain management and worse yet, suffer reactive clinical depression due to very poor quality of life.

I would bet that none of the writers of the affore mentioned news article suffer chronic pain!


Classic Creations by Claudia said...

I so agree with you, Sue. I sometimes worry about my husband and son, both on hydrocodone for chronic pain, but without it they cannot function on some days.

My husband has a herniated disk, a ruptured disk and--oh, I forget what it is with his neck--and they are all inoperable (which he would have really had to think long and hard about having back surgery). He also has degenerative disk disease in both hips, one knee and right elbow. On top of that, he has ulcerative colitis, which intensives joint pain.

My son was in a major auto accident in 2003 (hit by a drunk driver) and had 13 surgeries and procedures. Ten in the month immediately following, three in the following 27 months. He has hardware in his left arm, a titanium rod in his right leg and his foot bones had to be fused as they would not heal and kept breaking down (Michael is a big boy at 6'4" tall). He also lost a toe (it could be worse; I'm happy it's not). On top of everything else, his job is quite physical.

Both will try and take breaks from the hydrocodone on days when their pain is not too bad as they worry about becoming addicted--where the medicine is more of a craving than a need. I am happy about that.

There just needs to be more research done about managing chronic pain.

Great article, thanks for taking the time to write and post this.

KrishaLiva said...
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