Why Punish Chronic Pain Patients?

By: Gerald Aronoff, MD

Reading Time: 3 minutes

Date: 05/22/2017

Filed Under: Clinician Perspective, Opioid Epidemic, chronic pain

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After reviewing several articles regarding the controversy chronic pain patients are facing due to physicians changing policy in fear of the CDC Opioid Guidelines, I feel it necessary to address the seriousness of turning away legitimate chronic pain patients seeking medical care, because of the perceived stigma attached to opiates.

Currently we are facing two crises: the well publicized epidemic of opioid abuse (prescription and illicit street abuse), and the under publicized neglected chronic pain patient epidemic. There are several reports of patients being  turned away from their long-term Chronic Pain Treatment Providers due to providers fear of treating patients with opioid analgesics.

Pain News Network recently published the results of a survey of nearly 3,400 patients, physicians and other healthcare providers.   Some of the reasons why it was harder to find providers to treat chronic pain were disturbing:  59% of the persons responding to the survey reported pharmacies refusing to fill opioid prescriptions for patients,  57% responded that insurance carriers refused to pay for chronic pain treatment they thought was unnecessary,  and 36% reported worrying about being prosecuted or sanctioned for prescribing opiates. In contrast, the same survey stated  20%  reported discharging patients for failed urine drug screens and only 15% of respondents reported having referred patients for addiction treatment. We are witnessing a crisis in healthcare and I believe we will see some patients who do not have a history of substance abuse considering turning to emergency rooms or worse, the streets for treatment, out of  desperation.  However, the most staggering result was that only 12% of respondents reported that their patients were better off without opiate medications. How did we reach this crisis?

In 2008, I was President of the American Academy of Pain Medicine, whose goal is to optimize physicians’ pain education, improve management of patients in pain, and eliminate the major public-health problem of chronic pain by advancing the practice and specialty of Pain Medicine. During that year, I was pain consultant to the Federation of State Medical Boards. One of my goals was to provide education on the importance of providing adequate analgesia to chronic pain patients and develop guidelines for the appropriate manner of doing this. The vast majority of legitimate chronic pain patients, do not have problems with substance abuse or pathologic dependence. Chronic pain patients are generally monitored by their pain physicians or other pain providers to ensure that they use their prescribed medication to alleviate their severe pain, improve functional daily activities and quality of life. In so doing, they often become more productive in their various social roles including vocational and educational roles.

I contrast this with the untreated substance abuse/dependent population commonly known as drug addicts whose use of drugs is dysfunctional and includes craving, loss of control over their drug use, compulsive drug use, continued use despite harm and at times diversion of medications they receive to sell on the Street. They do not take medications for their therapeutic value. It is inappropriate to penalize legitimate chronic pain patients because of substance abusers.

The crisis  of prescription opioid abuse is drawing the attention of many government officials and lawmakers.  In fact, the Trump administration is allocating an estimated $485 million dollars to address the Opioid Crisis.  I implore all parties to help us find legitimate solutions to the crisis without penalizing patients who do not fall into a category of chronic pain that can be treated by interventions and are not  categorized as palliative care or cancer pain patients. In the proper practice of medicine, treatment plans are individualized.  I outline the basic principles of  responsible medication management with individualized treatment plans in Chapter 1 Basic Principles of Pain Management in my book, Medication Management of Chronic Pain: What You Need to Know.

The Hippocratic Oath “First Do No Harm” applies to both aspects of Pain Management.  We, as responsible healthcare providers, do not wish to create or contribute to substance abuse; nor do we want to be negligent in caring for the true needs of our patients.

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