Treating chronic pain beyond medicine

By robert j. ferguson,
Posted Jan. 11, 2011, at 7:50 p.m.

The fact that Maine leads the nation in rates of admission for treatment of prescription opioid addiction comes as little surprise. In her summary of Maine’s opioid abuse problem in a Jan. 4 article, Bangro Daily News writer Meg Haskell pointed to the widespread availability of the drug OxyContin in 2000 as one triggering influence. However, it was a perfect storm of other medical-sociological factors that gave rise to current problems rather than one drug.

In the late 1980s, a well-intended push was on to make opioid therapies more widely available to those with acute (short-term) pain such as post-surgical pain or those with pain from advanced cancer. Unfortunately, there was little distinction made between the short-term use of these potent medicines and longer-term use for individuals with chronic, noncancer pain.

At the time, the risk for addiction was widely underestimated with an oft-cited research article published in the New England Journal of Medicine years earlier. The study touted the rarity of addiction with opioids. The problem was, the study suffered significant sampling bias in that it studied patients only in acute care settings. The study thus had little applicability to those with chronic pain, where opioid therapies can have diminished effect with time, and many patients with chronic pain often may be prescribed the drugs for years.

At the same time, the mid-1990s brought booming development of more opioid drugs on the market riding the anti-pain wave. OxyContin, for example, received FDA approval in 1995. These were heavily marketed by drug manufacturers through drug representatives and advertisement. With little pain education in medical schools or postgraduate medical education, marketing fueled the drive to overrely upon opioid therapies alone to treat problematic pain.

Little, if any, distinction was made between problems of acute, short-term immediate pain and the more burdensome problem of chronic pain, which requires a more comprehensive approach than simple prescription. The result was overprescribing to individuals with heightened addiction risk.

Combine this with Maine having arguably one of the poorest business and employment climates in the country, and a black market of significant proportions could take hold. This brings us to our present day.

Clearly, opioid therapies are effective pain treatment. However, in chronic, long-term pain, while they can be helpful, there are no empirical data to support the idea that opioids are a panacea for total pain reduction. Chronic pain, unfortunately, has no cure.

While opiods can be part of the plan, treating chronic pain as a chronic condition that combines patient and family pain education and training, behavioral and lifestyle change through use of cognitive-behavioral therapies, in combination with medical care is key to producing best quality of life and functional results. We as a so-ciety have learned this with other incurable chronic diseases to some degree (e.g., diabetes, heart disease), but despite more than a half-century of research and development, we are slow to address chronic pain with a comprehensive approach.

Treating chronic pain using medications alone (opioid or nonopioid drugs) is akin to treating diabetes by prescribing insulin with no training in blood sugar monitoring or behavior change support in diet or exercise. That now is widely accepted as inadequate and ultimately costly.

We can change the chronic pain treatment approach through better education in our medical schools and other health professions such as clinical psychology and nursing along with sound public education. Alternatively, we can maintain the current system that is perfectly designed to produce current results.

Robert J. Ferguson is a clinical psychologist with specialized training in behavioral medicine. He works for Eastern Maine Medical Center in the Department of Rehabilitation Medicine and Lafayette Family Cancer Center where he works in cancer survivorship with concentrations in symptom and pain management.

http://bangordailynews.com/2011/01/11/opinion/treating-chronic-pain-beyond-medicine/ printed on September 21, 2014