Opioids, Long-term Chronic Pain, and Quality of Life

I hear about and read references to “quality of life” often when the subject of rheumatoid disease and other diseases that cause chronic pain come up.

A few days ago, one such reference stopped me. It was in a Washington Post article, “Opioid Drugs Make Pain Tolerable, Most Long-Term Users Say.” The article cited a recent poll that found that many people with long-term chronic pain believe that opioid pain relievers work for them. These patients believe these drugs, the article stated, improve their “quality of life.”

The article contrasted that belief with the CDC’s March 2016 Opioid Prescribing Guideline for Primary Care Physicians, which states that they don’t consider opioid analgesics effective for long-term chronic pain—even though they admit that research into their use for that reason is “limited.”

If you’ve taken these drugs for the chronic, unpredictable, and often severe joint pain that is a major symptom of rheumatoid disease, and you haven’t experienced any unpleasant side-effects that might prevent you from taking them again, you’ve probably noticed that while they usually don’t erase the pain, they do blunt it to a great degree.

A blogger friend of mine uses music as a terrific analogy about the way opioids work for her when she’s flaring: If you have your music (your pain) turned up high, you pretty much can’t ignore it. That music is now front and center in your life. But if you turn it way down (take an opioid pain reliever), the music (pain) goes into the “background.” You can still hear (feel) it, but most of the time, it’s low enough that you can mostly ignore it. You can concentrate on other things.

For many of us, turning down the volume on our pain can make all the difference between having a decent “quality of life” and—to put it bluntly—suffering through a poor one.

But what is “quality of life?” It’s a concept that’s fairly vague, and it can change in subtle ways depending on context. I did some googling on the subject, though, and I think the World Health Organization’s definition is the best. It takes each individual’s circumstances into consideration and honors their own perception of the concept.

WHO defines “quality of life” as the individual’s “perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.”

The Merriam-Webster Online Dictionary puts it more simply. “Quality of life” can be “How good or bad a person’s life is.”

Having so recently discovered just how much my own “quality of life” changed for the worse when my primary care doctor denied my opioid analgesics, my reaction to the Washington Post’s article was, first, “well, duh!”

And then it made me grateful. Finally, after months of negative press regarding opioids because of the U.S. government’s sudden, negative, clumsy, all-out response to the “opioid crisis,” an article comes out that give a voice to legitimate patients who use these drugs responsibly to treat long-term chronic pain. It shows that opioids can and do work for long-term chronic pain. They can and do improve these patients’ “quality of life.”

How could the CDC reasonably think otherwise?

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