The Grand Illusion
The past six-month period has been one of the worst for us that I can recall in years in terms of the number of friends who have suffered, some of whom have died. All this suffering that I’ve witnessed has brought home to me a tremendous short-coming in our modern medical system or structure. It’s simple enough. In prolonging life, especially in treating some forms of cancer, in saving wounded soldiers and victims of accidents who surely would have died in earlier times, in fact as recently as a decade or two ago, we have created a massive problem and source of suffering – a huge increase in people suffering agonizing pain.
So many forms of medical treatment can now keep people alive, but at the cost of continual pain. According to the National Institutes of Health, 17% of all Americans suffer severe pain intermittently, and 65% of those – 11% of the U.S. population – suffer daily, chronic, and severe pain. Yet while we have relatively effective forms of pain control for mild pain, the only substances currently effective for severe pain are opioid-based, and the problem with these is that with continued use, they become both addictive and less and less effective. So those in pain take more and more, and often mix those painkillers with alcohol, just so they can dull the pain and sleep, which is another reason why there are so many deaths as the result of combining alcohol and painkillers.
Yet this problem is scarcely recognized by most people. Nor is there any real recognition of why this pain problem has occurred. I certainly didn’t grasp its magnitude until recently, when more and more people I know ended up with excruciating pain. Instead, there’s an incredible push to stop the “overuse” and “abuse” of opioid painkillers. In my home state of Utah, the LDS Church effectively blocked even a modest piece of legislation that would have allowed the medical use of cannabis products and extracts [all specified as non-hallucinogenic]. The upshot of all these efforts appears to be that even terminally ill people are often being denied painkillers adequate to mitigate their suffering, but if they’re terminally ill, why worry about whether they’ll become addicted?
I’ve seen reports on promising new developments in non-addictive and non-hallucinogenic painkillers, but it will be years before any of them are widely available. In the meantime, what are we going to do for the more than 25 million Americans dealing with severe pain on an on-going basis? [And, no, I’m thankfully not one of them.]
Just tell them to hold on because we don’t want them addicted to opioids or marijuana?
This post hits rather close to home for me, my girlfriend of 16 years has been suffering from back pain for several years now, and has had two spinal surgeries to correct issues with bone spurs. The last of which was actually pressing upon her spinal cord.
She is indeed in constant pain, the severity of which waxes and wanes but never goes away. She is prescribed at least three different medications that are supposed to ease the pain, however none of which seem terribly effective unless used in a combination that leaves her unable to function mentally or physically on anything like a normal level.
It’s a terrible thing to watch someone you love deeply suffer such pain on a daily basis and know that there is nothing you can do to ease their suffering.
This strikes home for me also (luckily not my own chronic pain …)
I just lost a friend of 25 years who was suffering chronic pain due to back pain, and pain from post cancer surgeries. Her doctor tried to wean her off her pain meds; she was down to one pill a day — which led her to drinking too much and medical marijuana. She died in her sleep.
I admit I was pretty judgmental about her alcohol use, until she bent down to pick something up and I saw how deformed her back was. She was self-medicating because she had been cut off from getting enough pain medication. I am sorry she suffered in pain for so long.
Alison,
That is something I fear, she’s already made more than one comment about not wanting to live the rest of her life in pain. I encourage her and support her as much as I can, yet I dread the thought that she may indeed decide that life is not worth living if it means endless suffering.
The perception of pain is a very personal thing. I’m lucky; although I have displaced vertebrae from an old (50+ years) back injury and the pain has got successively worse over the past 5 or so years, I can reduce it to tolerable levels by the way I move. I can still walk about 100 feet before I have to stop and recover, but I can still do it without needing painkillers of any kind. I must, I think, have an unusually high pain threshhold because after a recent operation for something else I was given a ten-day supply of powerful painkillers but stopped taking them after just one day as unneeded (much to the astonishment of the nurses). So my heart goes out to those who also have continuous pain but a far lower threshold to help them bear it.
I’m not from America, but here in Australia I have similar issues with the way we deal with chronic pain.
My Gran has a pinched nerve in her spine, which causes near constant pain. There is a procedure (involving alternatively freezing or burning the nerve) she has every few months which apparently helps a lot, but it’s only a temporary fix.
And yet, even in the period when the pain is at its worst, there isn’t really any relief that she is allowed.
This just seems crazy to me, for chronic pain that has been medically diagnosed but is beyond a permanent fix; it seems like a prescription for stronger meds for the interim between when the procedure starts to wear off and she has the next one is the obvious solution.
From the medical side, this is a hot-button topic on both sides of the issue and divides docs nearly as much as abortion, gun rights, and the like.
There is no quick fix for chronic, severe pain, whether or not it is related to terminal cancer. Anyone who tells you otherwise has their own agenda. And even in the situation of terminal cancer, there isn’t necessarily a good answer for people.
Part of the problem is expectation: people want to be pain free. This is rarely going to happen. What is more likely: we (the medical community) can keep your pain controlled well enough to keep you functional and with a decent quality of life.
In the case of chronic pain, there are many modalities of treatment that can be tried. A medical truism: when there are multiple things to be tried, it means that none of them work well.
Chronic opiates have been shown time and again to be detrimental for long-term treatment of non-cancer pain. 1. They flat out do not work for the most common kind of chronic pain called neuropathic (i.e. where the nerve is directly damaged). 2. There is a up-regulation of pain receptors when people are exposed to chronic opiates causing a need for dose escalation. 3. High dose opiates sometimes just kill people – it is an idiopathic reaction and not necessarily related to overdose: methadone is the best studied of the drugs that do this, but the reality is that they all have the potential. It (most likely) has to do with a direct effect on the heart. 4. Addiction is a real risk; addiction is NOT the same as dependence. 5. Opiate side-effects can make a person’s suffering worse (severe constipation can cause pain every bit as bad as appendicitis and if you want to see suffering, go see someone with acute urinary retention).
“Just hold on.” That is a cavalier comment and negates the work that those of us on the front lines of medicine perform every day. And making light of the trials that those who are addicted to various forms of pain medications (yes, there are more than just opiates and marijuana out there that cause problems) does no one any favors.
Feel free to make a suggestion if you have one. If it is half-way reasonable, it’s being tried. We don’t like seeing anyone (including our own family and selves) in pain. We don’t like having little to offer.
Thank you. Your response is perhaps the best and most concise statement of the state of pain and pain medication I’ve seen anywhere.