Doctors are considering a future in which they won’t be using opiate painkillers to treat chronic pain, and deciding that it might not be so bad after all.
Some medical professionals maintain that eliminating pain is not only impossible, but unnecessary, writes Melissa Healy for the Los Angeles Times. Doctors currently try to reduce pain as much as possible, but others believe that approach is flawed.
Elimination of pain should not be the aim
“Zero pain is not the goal,” Dr. Thomas H. Lee, chief medical officer of the healthcare consulting firm Press Ganey, wrote in the Journal of the American Medical Assn on Tuesday. “The reduction of suffering is — and that is something more complex than analgesia alone.”
As it stands medical staff attempt to reduce pain, an approach which has led to an explosion in the amount of prescriptions for opiate painkillers like OxyContin, Percocet and Vicodin. These painkillers have been blamed for a surge in opiate addiction and death in the United States.
As a result the Centers for Disease Control and Prevention (CDC) has issued new guidelines to doctors, imploring them to only prescribe these medications to those with acute cancer pain, those in palliative care and those reaching the end of their life. Chronic pain due to arthritis and back problems should be treated with Tylenol, Advil and other non-addictive medications.
Opiate painkillers becoming a scourge on society
Dr Tom Frieden, director of the CDC, said that the benefits of opiate painkillers are “unproven and transient” for most patients. He went on to claim that they medication can be “just as addictive as heroin.”
According to the CDC there have been over 165,000 fatal overdoses of prescription painkillers since 1999. Around 1.9 million people are thought to be addicted to or abusing the medications.
Compared to these harms the benefits are dubious, according to Frieden and Dr. Deborah Houry, director of the CDC’s National Center for Injury Prevention and Control. The pair wrote a commentary published in the New England Journal of Medicine on Tuesday.
According to the scientists, several studies conducted on post-surgical patients and menopausal women with chronic pain conditions suggest that long-term use of opiate painkillers does not effectively relieve pain. On the contrary the drugs could make pain worse and lower their functioning, potentially by magnifying the experience of pain.
Functioning more important than pain level
The reduction of suffering has always been a purpose of healthcare, but Lee believes that modern medicine needs to understand that it is different than trying to eliminate pain. Suffering includes a variety of factors apart from physical pain, including functional impairment, fear, uncertainty and confusion.
Suffering can be reduced when doctors communicate effectively with patients using compassion and skill, coordinating their efforts with other physicians. This is true even if the patient is still in pain.
“Quality does not mean the elimination of death,” Lee wrote. “And compassion for patients does not mean the elimination of all pain.”
Dr Mitchell Katz, director of the Los Angeles County Department of Health Services, wrote a guide to fellow physicians on his approach to pain. He said that he may ask chronic pain patients to rate their pain from 1-10, but it is far more important to evaluate how well they can function.
“When a patient tells me that the opioid enables them to sleep at night, get out of bed and do their usual activities, I feel much more reassured than I do by the patient report of any pain score,” he wrote in JAMA Internal Medicine.
