Tag Archives: Bad Pharma

Chronic Pain

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Chronic Pain

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I was half listening to my latest audible book on the way to my first day of orientation at the new job. I say half because it is probably the 3rd time through those last few chapters. It isn’t because the book isn’t holding my attention, it is just it is one of those books I am talking back to as I drive and listen. It is one of the books that I will order in print and highlight and take notes in the margins.  I will review the book in more detail in some future post.

But she said something that had me wanting to scream.  She said that not treating patients in chronic pain amounts to torture.  I may be assuming too much, but it seems she was overly emphasizing opioids as a treatment for chronic pain. Firstly, opioids suck at treating most chronic pain and cause many more problems that they solve most of the time. Secondly, no one has a right to a pain free life. No one.

I was getting all judgy, as I am wont to do. Talking back to the book.  Really? Torture?  How is it my fault that you smoke, don’t exercise, drink like a fish, are 75 pounds over weight and now your knees and back hurt? Really? Sounds like that chronic pain is on your side of the net that divides us in this debate over opioids. I am not going to continue every patient in pain on the unholy trinity of Norco, Soma, and Xanax.

Then, doing my best Tevye impression ( from Fiddler on a Roof), I said, “On the other hand”, What about the obese, sedentary smoker who needs medication to control their blood pressure and blood sugars both of which are out of control because of their lifestyle choices? Do I want to say, No more Metformin for you unless you start exercising? No. Of course not.  But on the other hand, I don’t see Metformin sending the patient down a slippery slope of every escalating medications with all motivation sucked out of them now do I?

I should hold off my opinion of this book until I finish it completely.  I am finding it to be a fascinating if not somewhat biased account of the state of chronic pain diagnosis and treatment.  As loud as I shouted in the car at the author, she did not respond, so I am just venting a bit here.  Torture and not giving opioids to every chronic pain patient are entirely different things. Seriously.

I am not just frustrated with the patient, I am more upset with the system that got us on opposing sides in the opioid wars.  We all know it doesn’t work to just give folks opioids. It is so much more complicated than that.  Pain management is always a trial with an “n” of 1.   Each person is different.  Even that one person is different on a day to day basis.  Not giving out opioids to every patient is NOT torture.  Please review the history of any war of your choice to get a much clearer idea of what torture is and is not.

Medicalization

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Pristique  More times than I can count during my week and often my day, a patient presents with what they tell me is anxiety or depression and requests that I write a prescription for whatever pill they have seen advertised on television or a tranquilizer that works for their friend or relative. I can, however, likely count the number of times I have actually written such a prescription. I am not against medications. I am not a practitioner of “woo”, as some of my more conservative colleagues would call me. I just don’t know when being fully human became a disease.

One patient came into the office in tears, telling me that she needed Ativan or Valium because she could not stop crying since her husband died. She couldn’t sleep. When I asked when he died, she told me
” Last night”. A fairly young adult asked for antidepressants because he had problems sleeping since his wife of 10 years left him two months ago. He also sometimes felt very sad, like he wanted to cry. People have lost their jobs, their home is danger of foreclosure and their son just went to jail. They don’t think that they should cry, or worry or have problems sleeping.

I will save the discussion or rant about Big Pharma and disease mongering for another day. Today, I just want to ask, why isn’t it okay to cry your eyes out and not be able to sleep when your loved one dies? Why is not okay be anxious, sleepless and worried when you lose your job and your life seems to be falling apart? I think not only is it okay, but it is important to fall apart now and then.

There was a time when it was expected to show appropriate emotion. The Bible talks about sack cloth and ashes and gnashing teeth when grieving. In some cultures women used to cut off a finger when their husband died. Thank Goodness that now they only chop their hair off very short as a demonstration of grief. In many cultures people wore black as a symbol of their mourning for a full year after the death of someone they love.

Today, people want a pill or six so they can go about their lives “normally”, as if it all didn’t matter really. Not the marriage, or the job or home or the damn kid in jail. There is very little chance that I am going to give them a pill. I am going to talk to them about normal human emotions of sadness, grief, despair, worry, nervousness and problems getting that elusive 8 hours of uninterrupted sleep brought to you by a beautiful moth. I am going to talk about the importance of crying, and pacing the floor, of looking through photo albums and crying until you can’t cry. Cry until you cry yourself to sleep.

Yes, it is okay. It is healthy. I prescribe a good cry or several. I suggest we stop spending so much time, energy and money trying to avoid feeling sad, hurt, angry, lonely, sleepy, or whatever scary emotional reaction we are having to a situation.

In the real world, not everyone gets a pony, eats rainbows and poops butterflies. Life is sometimes messy and painful. We will get through it. We will. We can do it without sedation. I don’t believe that we should be trying to take away unpleasant feelings for the most part. I believe that we can’t dampen the negative side of life without also dampening the joyful side of life. Human emotions are not a disease. I am not talking about psychosis or self harm. I am talking about healthy reactions to painful situations.

We need to make it okay again to get the blues, feel melancholy, sad, scared, hurt, angry, lost, confused or lonely. We need to talk to each other again. We need to accept that humans have a full spectrum of emotions and rarely is it a disease to feel things deeply.