Bob! via Flickr
In the recent media coverage and onslaught of online talk and the social attention to the
increasing, nearly uniquely American, addiction and misuse of prescription pain medications, there
are 2 other groups of victims besides the overdosed person that are rarely remembered.
This is not to minimize in any way the loss for the families and friends of loved ones who are
currently dealing with prescription drug misuse or sadly overdose use, but instead to also call
attention to the persons affected in the collateral damage of this societal epidemic.
Family physicians as primary care providers end up issuing the vast majority of pain medications, not
only as initial pain care treatment providers but as longterm pain control for those providers who
started patients on started pain medications after surgical, emergency or dental care.
The societal pendulum is swinging again.
Reacting to the past societal complaints of the late 90’s and early 2000’s when the health care
industry was accused of NOT treating pain enough, physicians and hospitals responded with
mixed feelings and perhaps even naive abandon to avoid getting sued for NOT treating pain.
This resulted in over a decade of educating and legislating medical practice changes to increase
awareness to individual’s pain level (remember the Happy Face Pain Scale and the habit of
ranking pain severity on a scale of 1-10?) and also instituting pain as another vital sign in
assessing patients.
The pendulum has now swung fully the other way to focusing attention on the unintentional
contribution to the over treatment of pain and too easy access to the powerful pain medications in
general (both in legal and illegal modes).
Ironically, now personal physicians and hospitals are getting implicated in high profile celebrity deaths and are reacting once again with mixed and ambivalent feelings to this current sad state.
The result, many of my colleagues have simply chosen not to use these pain medications altogether, refusing to pay the higher cost to update their continuing education and DEA requirements for pain credentialing and in effect abandoning their controlled pain patients to the few primary providers and pain specialists who are enduring
and trying to comply though ever more difficult and controversial.
In this highly charged, emotional, financially draining and deadly problem lies the hard working
family physician (who tries their best to stay certified amidst all the higher costs and legislated
changes to maintain their licenses to practice) and the chronic pain patient who uses the
prescriptions pain meds successfully and well as part of their overall pain management regimen
(who also has to deal with undeserved negative stigma both from society and the reactive
health care system).
There is already a HUGE shortage of primary care physicians and this just adds to the overall burden and indirectly helps grow the problem as patients scramble around trying to gap their care and resort to street drugs like heroin.
We will not as a society be able to avoid the inevitable swinging back and forth of the reactive
pain pendulum every 10-15 years unless we admit that the underlying issues that created this
massive problem is multifactorial and is deeply rooted in our dysfunctional perception towards
bearing and enduring pain of all types (mostly emotional and spiritual in my humble opinion) as
a culture.
Acknowledging the underlying causes that created this problem will be the TRUE start
of solving it- thus far, regrettably we as a society have simply been only reactive AGAIN
Thank you. Thank you. Thank you. I feel for the physicians caught in the middle of this pendulum AND for the chronic pain patients who are the ones being persecuted by the system. The abuse of opioids and use of street drugs must be addressed, but not at the expense of the chronic pain patient who is managing pain from an accident or disease and just trying to function as a productive member of society.