Distortion of Pain Medicine

Distortion of Pain Medicine; adapted from a post to the Chronic Pain forum of Spine-Health.com about the “Out of Pain Medicine” topic. Alexander DeLuca, M.D.; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-10-19.

I have been participating a little on the chronic pain forums of Spine-Health.com recently. Patients present their cases and their lives and their current problems and try to help guide each other through a baffling array of barriers to care.

What is so frustrating in these stories patient after patient relates in these forums, stories I have sadly become very accustomed to hearing in my work as a pain advocate for the Pain Relief Network, is a core medical irrationality, a double bind, a lie really. I’ll try to explain what I mean.

The doctors prescribe very low dose regimens to begin with. Which might be okay if they saw the patient every few days and aggressively titrated up the dose and changed to more potent medications at the right time such that the patient was titrated to analgesic effect which is the medical standard of care for the treatment of chronic pain. (I think it is important for pain patients to really understand what these phrases mean, and to thoroughly grasp the modern, medical understanding of chronic pain –> see: the Recommended Reading section at end of this post).

BUT TITRATION TO EFFECT IS ALMOST NEVER DONE. At the same time, opioid contracts, usually offensive documents directed at detecting diversion of medication, are required of patients even before a real doctor-patient relationship, which would be based on mutual trust, could develop. In testimonial after testimonial it seems obvious to me that the doctors and clinics are in fact placing the need to catch bad patients ABOVE the professional ethical obligation to hold the best interests of the individual patient before them above all others.

Pain relief is in the best interest of the pain patient. This seems obvious on its face in a society that considers itself civilized. Beyond that, relief of suffering, where that can be accomplished, is a core medical obligation. Yet pain relief seems almost an afterthought to these doctors and clinics, and even when they actually try to provide a trial of chronic opioid therapy when this is obviously indicated, they do so clumsily and badly and with loathing.

An appropriate titration is almost never accomplished and so the outcomes tend to be terrible with the vast majority of chronic pain patients remaining in needless ongoing pain even when they are lucky enough to get started on opioids. And that unrelieved pain will cause the disease of chronic pain to progress in many cases, leading to the medically bizarre current state of affairs in which doctors supposedly involved in a doctor-patient relationship to relieve pain, watch their patients deteriorate over years, all for the want of a few hundred milligrams of morphine equivalent.

Understand how grotesquely the ethical norms and best practices of medicine have been distorted in pain management, as physicians labor to serve drug war imperatives.

Imagine if Type I (”insulin-dependent”) diabetics were routinely prescribed oral hypoglycemic agents instead of the injected insulin the physicians actually knew was indicated (the medical standard of care). And even as their patients go into diabetic ketoacidosis, most respectable diabetes doctors (the community standard) would only grudgingly prescribe insulin, and then in doses that improved blood sugar only the slighted amount, and not enough to prevent the inexorable progression of the disease.

Insane, huh? Yup, but that is how mainstream “pain management” is mostly practiced these days.

An academic article on medical ethics:
Ethical Analysis of Barriers to Effective Pain Management - Rich, Cambridge Quarterly Healthcare Ethics, 2000.

What chronic pain is:
A Modern Understanding of Chronic Pain from The Treatment of Chronic Pain in Veterans - a Brief Review; Testimony: House Committee on the Judiciary, Subcommittee on Crime, Terrorism, and Homeland Security; Alex DeLuca; PRN; 2007-07-12.

Standards of Care:
The ‘Bounds of Medical Practice’ and the ‘Standard of Care’ - Alexander DeLuca, M.D., MPH; Comment in response to: Instruction to Hurwitz Jurors by John Tierney; TierneyLab; 2007-04-22.

Aberrant Drug-Related Behaviors aka Red Flags:
Red Flags and the Standard of Care for Pain Management; Alexander DeLuca; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-07-17.

[END]

As always, we ask that you help PRN fight to protect the rights of patients and the doctors who treat them. Thank you for clicking the link below.



www.painreliefnetwork.org
info@painreliefnetwork.org