Nagging, unrelenting pain, the kind that colors every moment of life, is something you wouldn’t wish on your worst enemy. But what should be done when the relief for that pain becomes an enemy to both users and society at large?
A better way for physicians and patients to address chronic pain must be found. Clearly, the strategy of the last decade or so is having serious, if unintended bad consequences.
Self-inflicted overdoses of prescription painkillers are responsible for almost 15,000 deaths a year in the U.S. That death toll exceeds the combined deaths from heroin and cocaine overdoses. In some states, the public interest journalism group ProPublica reports, painkiller deaths exceed car crash deaths. The Centers for Disease Control and Prevention has labeled opioid drug overdoses an epidemic. Certainly, in parts of Maine, addiction to those drugs — Percocet, Vicodin and OxyContin — is at epidemic levels.
ProPublica found one smoking gun — the influence of the pharmaceutical-company funded advocacy group, the American Pain Foundation. But castigating an industry shill distracts from solving the problem. And it’s a problem whose solution ought to be within reach, if not grasp, because just about all the drugs that are sold and used illicitly can trace their existence to the tip of a doctor’s pen.
One less discussed factor in the painkiller dilemma is the 21st century American relationship with pain. In short, we don’t tolerate it. It hurts, and there ought to be a pill to make it go away.
Chronic pain is nothing to be dismissive about. Doctors shouldn’t tell the logger who shattered part of his spine to simply deal with the pain. The woman who suffers blinding headaches, also, shouldn’t be told think about something else. But the pendulum has swung too far toward total annihilation of pain.
Surveys of physicians a dozen years ago found that too many were withholding pain medication, including to terminally ill patients, because of fears that they might become addicted to morphine. The now-common query from emergency department docs rating pain on a number scale came out of the move for more responsive pain management.
But there are ways to manage, if not eliminate chronic pain that do not rely on a magic pill. They include therapies such as chiropractic, acupuncture, massage and even hypnosis and meditation. Natural, nonaddictive substances such as (prescribed) marijuana also can be used to ease some chronic pain.
The larger issue is the role pharmaceutical manufacturers and their media marketing campaigns and sales staff play. While OxyContin isn’t advertised on TV, every other pill that purports to solve every malady under the sun is. Physicians report patients ask them for prescriptions for pills they’ve seen advertised, and when told it doesn’t address any condition they have, they still demand it.
Some in Congress have proposed banning the direct-to-consumer marketing of prescription drugs. Every other industrialized nation (except New Zealand) bans such advertising.
Jerry Avorn, a physician and professor of medicine at Harvard and author of “Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs” writes that “Congress allocates the Food and Drug Administration about $2.4 billion per year to regulate our foods, drugs and cosmetics. Yet twice that amount is spent by the pharmaceutical industry on direct-to-consumer advertising of its ware. Something is very wrong here.”
Indeed. And the scourge of painkiller addiction and wrecked lives we see in Maine is part of what’s wrong.