An Epidemic of Undertreated Chronic Pain

By Roger Chriss, Columnist

The undertreatment of chronic pain is fast becoming another “epidemic” in America.  As the CDC guidelines, state laws and regulations, and federal agencies like the DEA push to reduce opioid prescribing, chronic pain patients are being forced to reduce dosages, change medications or make do without pain medication at all.

It may be difficult to believe that chronic pain is undertreated. After all, media reports on the so-called opioid epidemic make it seem like opioids are everywhere.

“Before launching into hysteria that the recent, small drops in opioid prescribing reflect a ‘war on pain patients,’ we should recognize that U.S. consumption dwarfs that of other developed countries,” Keith Humphreys, PhD, a professor of psychiatry at Stanford University, wrote in The Washington Post.

But the focus should not be on overall consumption. It should be on whether opioid medications for chronic pain actually work.  And they do, for many patients.

“Many patients currently receiving long-term opioids were started when opioids were still considered a viable treatment option and if satisfied with their pain control and using their medications appropriately should not be unilaterally compelled to wean off opioids,” Kurt Kroenke, MD, and co-author Andrea Cheville, MD, recently wrote in JAMA

But tragically, this is already happening. Painful conditions are increasingly undertreated.

Nursing 2017 notes that “many patients with sickle cell disease are undertreated and labeled as drug seekers due to their chronic pain.”

A 2016 article in Pain Research and Management found that “painful diabetic neuropathy is poorly assessed for and treated in primary care.”

Reuters Health recently reported that in a large study of 1.4 million nursing home residents, roughly two out of five had intermittent or chronic pain. “Among the residents with persistent pain, about 6 percent received no medication at all and another 32 percent didn’t get enough drugs to properly address their symptoms,” Reuters said.

Fox News reported on a nationwide survey that found 34 percent of physicians believe restricting opioid prescribing may actually be hurting people with chronic pain.

"If you open the discussion publicly, you see the carnage that is happening to people in pain because of these rules,” David Nagel, MD, a pain management specialist in New Hampshire told WMUR-TV.

Moreover, a recent survey of over 3,000 pain patients by PNN and iPain found that 23% reported they were no longer receiving opioid prescriptions and 47% were on a lower dose. Most significantly, 84% reported having more pain and a reduced quality of life.

Demonizing opioids can endanger lives. A Utah woman said her husband suffered from severe cancer pain, but was reluctant to take opioids because he didn’t want doctors “prescribing heroin” to him. He finally relented and started taking opioids when his pain became unbearable.

“My husband would have died from pain without opioids. The same doses that would kill a healthy person were life-saving for him,” Julieann Selden wrote in an op-ed in the Salt Lake Tribune. "The increasingly prevalent anti-opioid rhetoric in Utah, while helpful to some, damages others. The addiction concerns are justified but should be balanced with an emphasis on individualized medical care."

“Our state and federal representatives must consider the needs of the people who use opiates as prescribed when enacting laws or rules for doctors to follow,” Dennis Conklin wrote in a letter to the Chicago Tribune. “People who suffer from severe chronic pain must be allowed access to opiates in order to continue to maintain a reasonable quality of life.”

But this lifeline is under attack. Unnecessarily and inappropriately. Chronic pain patients have a low risk of developing a substance use disorder, yet federal and state opioid guidelines, along with close scrutiny of doctors by the DEA, are having a chilling effect. Widespread fear and confusion about the overdose epidemic and opioid medications are causing chronic pain conditions to be poorly treated.

Chronic pain patients rely on opioid medications to maintain a reasonable quality of life in the same way that people with epilepsy rely on anti-seizure medication or people with low thyroid function rely on thyroid replacement pills. So if they seem defensive about their medication — the “hysteria” that Dr. Humphries is so quick to dismiss — it’s only because they do not want to lose their last line of defense against pain.

The current backlash against opioids for pain management must end before we have another epidemic on our hands.

Roger Chriss.jpg

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society.

Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.