Pain Mismanagement

Anyone who has listened to the news lately has heard there is a heroin epidemic, which has lead to many deaths. Heroin is a drug in the opioid family. As a result, there has been a massive crackdown on opioid prescription medication, especially for those of us who live with chronic pain. It was difficult to have chronic pain managed correctly before the crackdown, generally because many doctors don’t have proper training in managing chronic pain, including pain management doctors. Diseases like fibromyalgia were viewed with skepticism by the medical community, leading to under or non-medication of the pain.  Anyone who advocated for themselves and asked for proper pain management was treated like a drug seeker. And now, because lawmakers are panicking over heroin overdoses, proper pain management will become even more difficult to achieve, especially if states follow through with laws curtailing legal prescription opioid use.

A few statistics
The CDC states that there were over 8,200 heroin-related deaths in 2013.  Compare that with an estimated 100 million Americans who live with chronic pain, 10 millions of those with fibromyalgia alone.  For the sake of argument, let’s assume that every one of those heroin-related deaths came about because of an opioid pill addiction that let to heroin use.  That would mean that lawmakers would severely limit access to prescription opioids for chronic pain patients because 0.0082% formed an addiction and died.  Let’s compare that with an estimated 33,636 firearm-related deaths in 2014, 88,000 alcohol-related deaths each year from 2006-2010, (1 in 10 deaths each year) and more than 480,000 tobacco-related deaths each year.  Measuring for a period from 2005 – 2009, 163,700 cancer deaths were attributable to cigarette smoking.  These Merchants of Death continually get a free pass, even though they are responsible, directly or indirectly, for well over a half a million deaths each year.  Meanwhile, the chronic pain community is made to worry whether or not they will be able to walk this month because a doctor and/or a lawmaker decided that 2-3 Tramadol for the month was more than enough.

David versus Goliath

Advocacy
It doesn’t require too much critical thinking to understand why the Merchants of Death are able to peddle their wares without much governmental interference, while advocacy groups like the National Fibromyalgia and Chronic Pain Association barely get any notice.  It all comes down to money and power.  A negative rating for a congressman from the NFMCPA means nothing.  Anything less than an A rating from the NRA, however, is political suicide for a Republican.  While President Jan Chambers of the NFMCPA lobbies tirelessly for the rights and needs of the chronic pain community, advocacy lies primarily with us, the patients.

Government
We are a nation of laws and beauracracy.  So what on earth are we supposed to do when lawmakers and governmental agencies institute policies designed to curb drug abuse, but lead to nothing but harm for those in the chronic pain community?  The DEA, CDC, and FDA are all trying to attack the problem of drug abuse by limiting the quantity of pills prescribed and increasing the frequency of office visits in order to obtain a new paper prescription.  No longer are doctors allowed to call in refills for drugs like Tramadol and hydrocodone.  For people like me, this is a minor annoyance.  But for people who live far from their doctor, rely on others for transportation or have no transportation, or cannot afford to pay the copay or co-insurance for an appointment just to get a prescription, this is a hardship.  The NFMCPA conducted a survey, (one in which I took part) to assess the impact of the new opioid prescribing regulations.  It only took 100 days before unintended consequences took hold for law-abiding chronic pain patients.

“People also cited higher expenses from more frequent doctor’s visits, changes to other prescription medications, higher medication co-pays, greater transportation expenses for extra doctor visit and lost work revenue related to unrelenting pain.”

And these aren’t even the worst problems caused by the new regulations.

“Shockingly, 27% (n=931) reported suicidal thoughts due to being denied their hydrocodone prescriptions.”

You see, if regulators had taken a half a second to pull themselves out of opioid hysteria, (it kind of reminds me of when there was panic in the 90s over marijuana) and think, they would have realized that less access to medications that allow chronic pain patients to function would lead to an increase in suicide and illegal drug-seeking.  And it’s not because we’re addicted.  It’s because, when you hurt because you simply exist, you’re going to become depressed.  It’s likely the reason depression is often comorbid with chronic pain.  When you can’t stay in bed because it hurts, but you can’t get out of bed to go to the bathroom because touching your feet to the floor hurts more; when you can’t play with your children and are constantly having to tell them no because it hurts too much to walk down the street to the playground and sit on horrible park benches; when you’re unable to stand and cook dinner for yourself and your family; when your house is so dirty and cluttered because it hurts too much to vacuum or pick things up off the floor; when you can’t spend time with friends the way you used to because it causes too much pain and fatigue to leave the house; when having stress in your life means that your body will respond with increased pain….that’s pretty goddamn depressing!  And now, on top of that, you’re going to deprive us of the medication that allows us the ability to do the few things we can do?  I will admit, even now, my thoughts have turned to suicide.  The idea of spending the next 40-50 years in debilitating pain, which is likely to get worse as I age, is pretty overwhelming. I don’t want to think about how I’ll feel if I can’t have my pain managed properly.

State and federal lawmakers have also joined the heroin abuse hysteria.  Some, like Vermont Governor Peter Shumlin, have ignorant beliefs like, “You can’t convince me that we’ve got 250 million Americans in chronic pain.”   Once again, we see another instance of lawmakers taking medical decisions out of the hands of the doctors and patients, creating laws and policies from a myopic point of view.  I believe Dr. Steven Stack, President of the American Medical Association, explained it best when he said, “The complexity of the problem makes it difficult to create a successful one-size-fits-all approach.”

Fortunately, President Obama, Senator Mitch McConnell, and some state lawmakers and governors  are on our side when it comes to not limiting doctors and patients in their opioid prescriptions.  Not only did President Obama acknowledge the reality of our pain, he understood that simply taking away an avenue to pain relief is unrealistic.

“If we go to doctors right now and say ‘Don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real…”

Alternatives
The American healthcare system has set us up to fail.  Insurance companies and pharmaceutical companies as bedfellows have created a corrupt system where medication is the only available option for treating chronic pain.  Functional medicine doctors, who employ an integrative approach of traditional and complementary medicine, often don’t accept insurance.  Physical therapy is often touted as a treatment option.  If it helps, insurance may not cover sessions or ration the number of sessions you’re allowed.  Aqua therapy is a wonderful method for building strength and getting the exercise that doctors are always badgering you to get.  I was lucky that my sessions were a part of physical therapy and were covered by insurance.  If you’re not that fortunate, good luck finding a class that’s at a reasonable time, location, and price…or at all.  Chiropractic care, if covered, isn’t always in network. Unless you have a Cadillac insurance plan, acupuncture, (which is very beneficial to chronic pain sufferers) isn’t covered. When I went to sessions, we were spending $320 per month.   The list goes on.  For many of us, our hands are tied.  Unless you’re well-to-do, your treatment options are severely limited to what insurance will pay for.  And what insurance will cover is medication.
Millions in our country are suffering silently because of chronic pain.  If state and local government has its way, they will suffer even more.  To interfere with the doctor-patient relationship, which determines the best treatment options for the patient, will create unintended consequences, many like the ones they’re trying to curtail now.  Desperate patients may turn to the black market, illegal drugs like heroin, or make the most desperate and hopeless decision of taking their lives so that the pain will stop.  Rather than pour as much focus, energy, and money into this so-called crisis, why not allocate it to research to understand and cure diseases like fibromyalgia.  I would give up my opioids and other medicinal cocktails in a heartbeat if it meant there was a cure for my pain.  Given the conversations I’ve had with dozens of other chronic pain patients, they’d be willing to do the same.  In fact, no one I have ever spoken with, (including myself) has ever been pleased to add more pills to their daily regimen.  Rather than treating us as criminals or potential criminals, lawmakers need to listen and believe us when we say our pain is real.  And until we find a cure for the pain that ravages our bodies, we need to be allowed access to what works.

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2 thoughts on “Pain Mismanagement

  1. It’s becoming a very scary situation. Doctors need a way to tell addicts from regular people looking for pain relief but that’s something that would take more than 10 minutes of their time so it will never happen. I only refill my hydrocodone about every five months but, if I needed more, I know I couldn’t get them. It really pisses me off because I’m ultra conservative with them. I have rules: no more than 1 in a 24 hour period and no more than 3 in a week and I stick my rules. (This is partly due to the side effects. If I take more than that I pay for it!) However, my mom, who has addiction problems, is able to get enough to take four a day every day. I don’t know what will happen if they ever cut her off.

    I would prefer getting regular massages and acupuncture treatments but my insurance no longer pays for that, or anything else. My copay is $50, just to go in to talk about more or different medication.

    • I’d get massages every other day is insurance covered them. I hate it when doctors ask me condescendingly if I’ve tried massage or acupuncture. It’s like the idiots who asked me if I had tried eating crackers when I was pregnant to help with nausea.

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