There is no doubt that more opioids are being used than necessary with associated unintentional deaths—almost 45 Americans per day in 2010! (1) Yet, voices rise after hearing condemnation of opioids or when having difficulty in obtaining them. They are the people who already found opioids helpful or believe that they are helpful. Then, there are those who do not have access to any adequate treatment and proclaim “undertreatment” of pain? Fewer opioids, more opioids, or undertreatment of pain seem to be the prominent arguments in the pain community.
True, some people can function well on intermittent use of opioids. However, if numerous patients are so mentally clouded by the opioids that they use and/or do not do anything for themselves in the form of enhancing their own function or mental/physical health (aka self-care), then those drugs’ benefits are not outweighing the risks. And we cannot just blame the patients; the medical system must take responsibility too.
But herein lies the dilemma. Physicians are so poorly trained on the various treatments of pain in medical school that patients have less of a chance to receive the best care for their pain. If better treatments with less risk are NOT emphasized or taught to physicians, then how on earth are patients going to recognize their importance? The savviest of pain patients may realize that there are better ways than pills, injections, or surgeries (when no red flags are present). Unfortunately the journey to ideal pain care can be arduous, complicated, and delayed. It should be easier, but we must focus on the real issue.
The excess of opioids and overdose deaths are the consequences of too many physicians giving out too many opioids for the symptom of pain for several reasons:
Opioids address symptoms, but they should be a last resort or a temporary bridge in most cases, not an approach that lasts for years. (2) This can lead to lost time, which can complicate the original problem. Other physical and emotional complications can arise while the primary issue simmers, creating a more difficult situation to tease out later.
Too many opioids is not the true problem. Undertreatment is not the true problem. Opioids and undertreatment, in and of themselves, are symptoms of a much greater, invisible problem—inappropriate treatment. Why do these two symptoms and others exist?
Undertreatment of chronic pain can result from:
Undertreatment of pain is the consequence of multiple forces within the medical system. Physicians are either limited by the tools that they were taught or limited by third-parties who restrain their ability to get the best care for their patients.
There are many other symptoms, but suffice it to say that trying to fix these cultural symptoms without addressing the cause—inappropriate treatment—will not truly improve this PAIN-epidemic or PAINDEMIC®. (3) Sending physicians to conferences, which typically rehashes different ways of using medications without discussion of other human factors (e.g. biomechanics, connective tissue, nervous system, etc.) is not expanding the physician’s toolbox and is a disservice to patients.
How Do We Reverse this Country’s PAINDEMIC®?
If we want to do the right thing, then we are all in this together.
Let’s start the conversation:
What have you done to help this country’s PAINDEMIC®?
What can you do in the future?
What constructive advice would you suggest?