The art and science of managing pain has challenged practitioners of both traditional and alternative medicine for centuries.
In Maine, the widespread abuse of opiate-based drugs used to treat pain has complicated health care providers’ efforts. It’s a problem that has evolved into a public health and public safety issue.
Part of the challenge is that providers must rely on patients to explain their symptoms.
“Pain is a totally subjective experience,” said Dr. Ben Zolper, who heads a team of pain specialists at his Northeast Pain Management practice in Bangor. “It’s not a measurable event, not something you can put a number to. If someone says ‘I have a broken leg,’ an X-ray can confirm that. But when patients come in and say ‘I have pain,’ they are the only ones who can confirm that.”
Maine Public Safety Commissioner John Morris attributes a 5.4 percent increase in crime in Maine between 2010 and 2011 to addicts committing crimes to feed their cravings for illegal and prescription drugs.
Zolper and his colleagues have built their practice on the premise that pain is not a diagnosis, but rather a symptom of some underlying medical problem.
“We have an anti-pain pill philosophy that reflects standard medical practice,” he said. “We do a history, a physical, imaging and then an examination of treatment options. The goal is to devise a treatment strategy that allows us to cure or moderate the problem so the patients don’t need pills and can still have reasonable function in their lives. Our solutions often involve exercise, physical therapy and the use of other classes of drugs.”
While Zolper’s pain management team of four physicians and four nurse practitioners seldom prescribes opioids in managing pain, Dr. James Whalen, an orthopaedic specialist now in his 33rd year of solo practice in Machias, has never prescribed opioids, and never will. Whalen would like to see a statewide ban on prescriptions for methadone, suboxone and OxyContin.
“There are two universal facts about addiction,” Whalen said. “The first is its habit of use often outlives the initiating reason for use. The other is that people with addiction issues are invariably intelligent and skillful at persuasion. … Addicts know how to exploit physicians and providers to achieve their pills.”
Like Zoper, Whalen sees pain as an indicator of some other problem.
“It tells me there is some underlying issue that you have to figure out,” Whalen said. “And, as a physician, you are supposed to have the intellectual capacity to figure it out.”
Zolper said his patient base includes people with pain who either don’t want any part of opioids and their addictive side effects, or have been on opioids and are eager to be weaned off their dependence on them.
“In my experience, the average person does not want to be on pain pills,” Zolper said.
A previous version of this story misspelled Dr. Ben Zolper's name.