By Janice Reynolds, Guest Columnist
One thing we need to keep in mind when discussing the so-called opioid epidemic is that people in acute pain are being persecuted and harmed, as well as those with persistent (chronic) pain. In fact, much of the witch hunt may have started with acute pain.
It has long been known that when acute pain is left untreated or undertreated it can lead to persistent pain, as well as a multitude of harmful side effects from pain. I know my persistent post-craniotomy pain was at least partially caused by poor pain treatment after my surgery. Eight years later, I can still vividly recall the second night post-op, when the pain was horrendous. I cried and really wanted to die.
People in pain have always experienced prejudice and bias. The current situation has allowed bigots to speak and act with impunity. As with anything, you tell a lie often enough and it must be true.
Anyone who has worked in medicine has heard a physician, nurse, pharmacist, physical therapist, etc. make derogatory statements, refuse to prescribe appropriate medication, express opiophobia, and sometimes even hatred for people in pain. Sometimes it can even be family members.
I have two favorite stories that I’ll share. And believe me, after over 20 years as an advocate for people in pain, I have a lot of stories.
As a new nurse, I once had a patient admitted with severe abdominal pain and headaches. The doctor would only give her Tylenol. He would go off duty, and I would call the covering physician and get morphine ordered. The doctor would come in the next morning and discontinue the morphine, leaving her with nothing but Tylenol.
The patient was diagnosed with cancer, and the doctor claimed her pain was just a reaction to her diagnosis (and some nurses bought into that!).
I finally couldn’t take it anymore and told the family they could request another doctor (I could have lost my license for coming between a doctor and his patient). I suggested an oncologist, who was also a palliative care doctor, who I knew as compassionate and good at pain management.
The oncologist took over and got her comfortable. She died two weeks after the admission for acute pain.
The second story was in the midst of the AIDS epidemic. I had a patient who was dying (she had been a prostitute and IV drug user). When I attempted to get more morphine for her because she was literally writhing in pain, the doctor refused, saying, “She should have considered her lifestyle choices before.”
In 2001, when the Joint Commission of Accreditation of Healthcare Organizations (JCAHO) came out with the first standards for pain assessment, we were ecstatic. We were going to make pain visible and more people would get better treatment.
Unfortunately, that is not how it worked out. The anti-opioid activists were vocal about how the standards would push doctors to prescribe opioids, enable drug seeking, and so on. Some even blamed the pharmaceutical industry, even though it had absolutely nothing to do with the standards. They were written by a professor of pharmacology and a nurse practitioner experienced in pain.
Fifteen years later, so many of these myths were still circulating that the Joint Commission felt compelled to come out with a statement refuting them.
Many actions now being taken affect acute pain care the most, such as removing pain questions from patient satisfaction surveys and poor treatment in hospital emergency rooms. A hospital in New Jersey won praise and international attention for sharply reducing the use of opioids, until it was found to be in the bottom 3% of hospitals nationwide for quality of care.
Now they want to prevent opioids from being ordered for so called “minor” procedures and to limit the amount of opioids or number of days they can be prescribed for acute pain. And although pain care for cancer patients and the terminally ill is still touted as sacred, it isn’t as good as it should be and is losing ground.
You would think because pain can affect anyone at anytime that there would be more compassion. Yet we have politicians saying, “Yes, children need their pain relieved, however with the opioid epidemic they shouldn’t be receiving these powerful drugs” or “We need to be able to objectively measure pain.”
Torture, for the most part, relies on pain. I realize there is water boarding and psychological torture, however inflicting pain is the method used throughout history. Politicians and the media are against torture, yet they do not see the mistreatment of pain as torture. It is actually torture of the worst kind, perpetuated by those who profess to have your best interests at heart.
A quote I always used in my classes and presentations comes from The Culture of Pain by David B. Morris:
“Failure to relieve pain comes perilously close to inflicting it.”
Janice Reynolds is a retired nurse who specialized in pain management, oncology, and palliative care. She has lectured across the country on pain management and is co-author of several articles in peer reviewed medical journals.
Janice has lived with persistent post craniotomy pain since 2009. She is active with The Pain Community and writes several blogs for them.
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.