There are different views on the war against pain patients, and I think the medical industry’s view is interesting, especially from a doctor’s perspective. Do doctors even believe there is a war against pain patients?
The article we’re talking about today is entitled “The Complex Pain Patient.” (Complex, meaning your patient wants drug treatment.) First, let’s look at the publication in which the article was published:
PAINWeek is the largest US pain conference for frontline practitioners with an interest in pain management. Convening at The Cosmopolitan of Las Vegas for its 9th year on September 8-12, we expect to welcome 2100+ physicians, nurses, pharmacists, and other healthcare professionals for a comprehensive program of course offerings…
* In the last several years, the following organizations have presented full-day tracks
AMERICAN ACADEMY OF PAIN MEDICINE*
AMERICAN CHRONIC PAIN ASSOCIATION
AMERICAN HEADACHE SOCIETY
AMERICAN OSTEOPATHIC ACADEMY OF ADDICTION MEDICINE
AMERICAN PAIN SOCIETY*
AMERICAN SOCIETY FOR PAIN MANAGEMENT NURSING*
AMERICAN SOCIETY OF PAIN EDUCATORS*
EASTERN PAIN ASSOCIATION
FOUNDATION FOR ETHICS IN PAIN CARE
INTERNATIONAL MEDICAL & DENTAL HYPNOTHERAPY ASSOCIATION
INTERSTITIAL CYSTITIS ASSOCIATION
NATIONAL ASSOCIATION OF DRUG DIVERSION INVESTIGATORS*
NATIONAL FIBROMYALGIA & CHRONIC PAIN ASSOCIATION
NATIONAL STROKE ASSOCIATION
NATIONAL VULVODYNIA ASSOCIATION
NEVADA PSYCHIATRIC ASSOCIATION
PAIN SOCIETY OF OREGON
POWER OF PAIN FOUNDATION
RHEUMATOLOGY NURSES SOCIETY
TNA THE FACIAL PAIN ASSOCIATION
US PAIN FOUNDATION
VETERANS HEALTH ADMINISTRATION*
WESTERN PAIN SOCIETY
Next, let’s look at who wrote this article: Darren McCoy, Nurse Practitioner, Certified Pain Educator at Pain Consultants of East Tennessee.
And here’s part of the article:
Some states place limits on the total daily dose of opioids prescribed. Other states place limits on how many days’ supply may be prescribed or dispensed. Still others have placed limits on how long certain medications may be prescribed. Additionally, some pharmacy corporations have instituted company-specific limits on how many patients each store may have under a medication agreement at any one time, thereby preventing a “new” chronic pain patient from being able to easily access what may otherwise be a very reasonable medical management regimen…
Some providers seem to go out on a limb to try to “help” a patient who has not shown a willingness to put forth much effort. It is not fair for a patient to ask a provider for a sleep aid when that patient consumes a lot of caffeine or smokes routinely. It is not fair for a patient to ask for a stimulant to help with weight loss when the provider knows all it would take is a little consistent diet and activity modification for the patient to lose a pound a week. Finally, it is not fair for a patient to ask a provider to prescribe an opioid analgesic when the medical record does not indicate significant functional improvement…
This is the new catch phrase for doctors treating pain: “significant functional improvement.” In fact, I’ve seen this kind of language within New Mexico’s Medical Cannabis Program — for a doctor to re-certify, the patient must show “improvement” while using cannabis.
One has to wonder what that looks like for a pain patient. When you’re in constant pain, just the fact that you’re still breathing could be considered an “improvement” (to the alternative). Keeping your pain levels stable should be considered an improvement, but that’s not technically an “improvement.” Would doctors only consider a decrease in pain levels to be an improvement? How do they take into consideration an increase in pain levels due to a worsening of the condition and the possibility that the treatment isn’t strong enough?
Patients want to reduce their pain, while the number one goal for doctors is to increase a patient’s functionality. While these goals are not dissimilar, their priority is.
In the writer’s comparison, he goes from treating lack of sleep and weight loss to pain. Obviously, these conditions can overlap, but they are three separate medical conditions. Treating insomnia and weight loss is a lot different than treating pain, especially chronic pain.
So, when treating insomnia, improvement would be the patient getting more sleep. For being overweight, the patient would be losing weight. Both of these improvements would include the patient becoming more functionally active.
But what kind of improvements are expected from a chronic pain patient taking opioids? Functional improvements are one thing — better pain management, sleep, activity level. But what does “significant” functional improvement look like?
I don’t know what doctors expect opioids to do. They’re not a cure. The only goals for the drugs are to reduce and manage pain. Nothing else. What kind of “significant” improvements should be experienced by someone taking drugs to manage pain?
So here I am, the perfect pain patient, dutifully reporting every month to my doctor how much I’m improving:
I slept for three hours straight the other day, doc! It was a miracle! I was able to walk for 30 minutes on Tuesday (but then paid for it on Wednesday). Of course, there was nothing I could do about the different stressors throughout the month, which caused an increase in my pain levels for 7 days out of the 30. And there were a few sneezing attacks that made my head pound more. But don’t worry, doc, even though my pain levels increased, I didn’t adjust my medications to compensate. That would be illegal.
However, I did have about 3 good days out of the 30 (shout out to chocolate and peanut butter no-bake cookies). And because you and the DEA are so obsessed with my pill counts, I admit that during those three days, I was able to cut back on one or two doses. Where did those pills go? Well, I used those doses during the 7 days of increased pain I mentioned earlier… isn’t that what I said? No? Well, I admit, it’s hard to keep all these different numbers in my puny little female brain. That’s why you make me write it all down on these charts, right?
What I meant to say is that I’m improving, I’m not selling my medications, the dosages are fine, everything’s fine.
Then the doctor says, well, you’ve improved so much, these drugs have helped you so much, that now it’s time to stop taking them.
But, doc, there’s no cure for chronic pain. Without the drugs, what will happen to all my improvements? Where will they go? You’re the pain management doctor, how am I supposed to manage my pain?
The doc (looking a little lost) says: Have you tried reiki? Magnets? Different kinds of tea? Epsom salt?
The medical industry is trying to make you better. Perhaps they haven’t figured out yet that chronic pain doesn’t get better. The functionality you gain during “good” days is so easily lost during the more-frequent bad days. Why does a doctor — that sees you for 15 minutes every month — think he is capable of rating your functionality?