As I understand it, the consensus among physicians and researchers regarding treatment for chronic pain seems to be this: try mild, non-narcotic pain-relieving drugs and various methods of alternative pain relief before prescribing narcotic pain-relievers to your patients. Be sure to allow an abundance of time to assess the effectiveness of each individual alternative method. And if your patients ask specifically for narcotic pain relief, do everything you can to make them feel like criminals.
While the know-it-alls are patting themselves on the back for their sharp eye on patient care and safety, I’d like to point out something they’ve missed.
Pain doesn’t wait.
I’ll use myself as an example. As a chronic pain patient with rheumatoid disease (arthritis), my pain is occurring right now. It fills my mind, stops my body from moving efficiently (and sometimes, completely), and it makes me fearful in spite of myself. My pain affects everything in my life, from waking up and finding the courage to face the day to going to bed at night aware that it will probably ruin the sleep I need so badly. The pain caused by my RD makes me want my mama--and I’m 58 years old!
Here’s the thing: I need relief from my pain now, not in some amorphous future. Mild, over-the-counter, anti-inflammatory analgesics don’t relieve this pain. They only chew up my liver and eat holes in my stomach. Believe me, I’d be OK with those nasty side-effects if the drugs actually worked on my pain.
And hey, I’m all for alternative methods for pain relief. I really do believe they can be effective, given time and patience. The trouble is that meditation, exercise, mindfulness, biofeedback, and the like can take weeks or months to be even mildly effective. Some of these techniques, such as exercise, require me to endure extra pain on top of what I’m already dealing with. Others, like meditation, require serious focus and concentration. My pain often makes that extremely difficult. I have a hard enough time focusing on mundane, every-day things, like making a shopping list. And I’m supposed to focus all my attention on my belly-button while it feels like someone’s wrenching my shoulder--slowly and with relish--right out of its socket?
My pain is disabling me today. It’s depressing me today. It’s making me fearful for my future today. Sometimes it makes me wonder if I can cope with it for the rest of my life. How am I going to do that?
And if over-the-counter pain relievers and alternative pain-relief techniques could adequately control the pain of my fellow 1.5 million American rheumatoid disease patients and myself, would we really bother asking our doctors for narcotics? We are not addicts. The vast majority of us don’t abuse drugs. We are not criminals. We’re responsible human beings coping with real, intractable, often-overwhelming and all-consuming pain caused by an incurable disease that we did nothing to deserve and are doing everything we can to treat.
We know that when we ask for the real pain-relievers, the ones based on opium, our doctors (and now, our pharmacists) are going to give us the side-eye--and maybe even the stink-eye. I’d like to challenge them to put themselves in our shoes for a moment: faced with such sharp suspicion and obvious, dripping disgust, would they really ask for those drugs if they weren’t in excruciating pain?
Not unless they really were addicts intending to get those narcotic drugs illegally by malingering.
So here’s my final point: I know our doctors have strict controls in place--mandated by our government--to identify patients who abuse narcotic pain-relievers. Those controls are the reason that I can only get my month’s supply of serious pain relief if I beg my doctor for them--in person--every 30 days. He’d know in an instant if I was abusing my drugs, because I’d have to beg for a new prescription sooner.
I’m tired of begging. I’m tired of being treated not only like a child, but like a criminal. Somehow, we must change this paradigm so those of us who cope with legitimate chronic pain can get the help we need with respect, dignity, and compassion.
Right now, what RA tips would most be helpful for you?