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Bring Pain Back

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One nice thing about being an elder is that you have real perspective on how much and how quickly things have changed.

Today I am thinking about the new American attitude toward pain. As a nation, we have basically become pain-averse, and that fact is resulting in more deaths annually from prescribed opioids than from traffic accidents.

It is amazing to realize that this problem raised its ugly, drugged, head in only 1995 with the launch of OxyContin by Purdue Pharma. The market was soon flooded with other narcotic pharmaceuticals that are all expected to account for about $15 billion in sales in 2016. Sales and overdoses are both growing rapidly.

Danger in a Bottle

Danger in a Bottle

A large part of the problem is that through a combination of aggressive marketing, patient demand, and  insurance coverage, physicians became enablers of swiftly forming addictions. This is very different from the way pain was treated in my youth, and I’m sure many leading-edge baby boomers have memories similar to the ones I will share.

In high school, I tore a ligament in my knee. It was very swollen and painful, and draining was the only relief offered for discomfort. In college I was put in a cast for a leg injury suffered in a car accident. Again, no pills. In 1997, I broke my wrist in a skiing accident and was given something a step up from aspirin. The assumption at the time still seemed to be that when you get injured, it hurts. Deal with it.

But then in 2006 I had hand surgery and left the clinic with little bottle of Vicodin, an opioid narcotic analgesic. I have to say that there was one day when I was glad for it, but I didn’t at all like how fuzzy it made my brain. How people get into this kind of thing, I don’t know, but there must be some systemic vulnerability involved.

Then in 2011 I fractured my ankle, and this time the new reality was very apparent. At the Urgent Care Center, I was offered a pain prescription, which I declined. A few days later, the podiatrist offered the same, and again I declined. I’m not real tough; the pain just wasn’t that bad and yielded readily to a homeopathic. Later I thought, “Well maybe I should have gotten those prescriptions filled. You never know . . .” You can see what happens.

And let me say that I have been very fortunate in this matter. There are an estimated 100 million people suffering from chronic pain, and I think back pain would be one of the worst types. The irony is, however, that opioids are reportedly the worst way to treat chronic pain. Not only do they produce addictions, they can also cause a reaction called hyperalgesia, which makes users even more sensitive to pain over time.

In addition, the opioid approach also forestalls other therapies that could be more helpful, therapies like biofeedback, physical therapy, body work, and acupuncture. I suffered from sciatica for many months once without relief until it was completely eliminated by acupuncture. Another problem with our system is the fact that many therapies that would do more than mask symptoms are not covered by health insurance.

Now there is another weirdness on the horizon. More and more pregnant women are demanding opioid painkillers for discomfort like back and joint pain that was once an accepted part of pregnancy. Doctors are writing prescriptions in spite of the fact that, although there is clear reason for concern, research has understandably not been done to assess the effect of narcotics on fetuses.

The state of Tennessee does not need this research. There is a big push to pass a law that would criminalize women who give birth to babies with illegal narcotics in their systems. A woman could be imprisoned up to 15 years. A woman giving birth to a baby with prescription narcotics in the system would not be affected, however.

Is this crazy or what? The Tennessee legislation has passed both houses, and the governor, Bill Haslam, will decide whether or not to sign it in the next few days. The politics are complicated, I’m sure.

One of the articles I read on pregnancy was titled “Surge in Narcotic Prescriptions for Pregnant Women” by Catherine Saint Louis.  In it Dr. Cresta W. Jones, an assistant professor of maternal-fetal medicine at the Medical College of Wisconsin, made a very telling comment about trying to limit the use of narcotics: “We do have a lot of patient pushback,” she said. “You have to approach it with empathy and understand the societal expectation in the U.S. of the immediate resolution of pain.”

Just think what that expectation has cost us in so many ways. But how can patience, stoicism, and the willingness to try alternative forms of relief become the preferred way? It’s hard for Americans to think about going backward to a time when we were more tolerant of pain, but in some ways we were safer then.

I will conclude by circling back on OxyContin, the drug that pioneered the acceptability of opioid prescriptions. In 2007 Purdue Pharma pleaded guilty to criminal charges of deliberately misleading the public about its addictive qualities and paid $600 million in damages. By then the drug had been reformulated in a way that will supposedly prevent abuse.

Just to put this in perspective, sales on Purdue Pharma’s opioids are about $3 billion per year and rising. Based on statistics for 2007, the Centers for Disease Control and Prevention placed the cost of prescription opioid abuse at nearly $56 billion. That figure is also rising.

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