People suffering in chronic pain need to learn to accept it because “achieving a balance between the benefits and potential harms of opioids has become a matter of national importance,” wrote two influential doctors who advocate for changing opioid prescribing practices in a commentary for the esteemed New England Journal of Medicine.
Jane Ballantyne, M.D., and Mark Sullivan, M.D., authors of the commentary, wrote,
“Is a reduction in pain intensity the right goal for the treatment of chronic pain? We have watched as opioids have been used with increasing frequency and in escalating doses in an attempt to drive down pain scores — all the while increasing rates of toxic drug effects, exposing vulnerable populations to risk, and failing to relieve the burden of chronic pain at the population level. For many patients, especially those who have become dependent on opioids, maintaining low pain scores requires continuous or escalating doses of opioids at the expense of worsening function and quality of life. And for many other people, especially adolescents and young adults, increased access to opioids has led to abuse, addiction, and death.”
Dr. Ballantyne is President of Physicians for Responsible Opioid Prescribing (PROP), an organization that advocates for state and federal policies that promote cautious prescribing habits, proper enforcement of laws that prohibit marketing of drugs for conditions where risks of use outweigh benefits.
Dr. Sullivan is the Executive Director of Collaborative Opioid Prescribing Education (COPE), an organization that educates healthcare providers on how to safely treat and manage the care of people with chronic pain in order to improve patients’ lives and end the prescription opioid epidemic.
The authors framed the topic of opioids this way:
“For three decades, there has been hope that more liberal use of opioids would help reduce the number of Americans with unrelieved chronic pain. Instead, it produced what has been termed an epidemic of prescription-opioid abuse, overdoses, and deaths — and no demonstrable reduction in the burden of chronic pain.”
The reference cited for the above statement, The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health 2015;36:559-574, was authored by Ballantyne’s colleague, PROP Executive Director, Andrew Kolodny.
Reduce pain intensity, or suck it up?
“We propose that pain intensity is not the best measure of the success of chronic-pain treatment. When pain is chronic, its intensity isn’t a simple measure of something that can be easily fixed. Suffering may be related as much to the meaning of pain as to its intensity,” they wrote.
“Patients who report the greatest intensity of chronic pain are often overwhelmed, are burdened by coexisting substance use or other mental health conditions,” they added.
Instead of opioids, the doctors say that an interdisciplinary and multimodal treatment coupled with coping and acceptance strategies are critical. In addition, they conclude that a “willingness to accept pain and engagement in life activities despite pain, may reduce suffering and disability without necessarily reducing pain intensity.”
Comments on the New England Journal of Medicine’s website related to the article included:
“Intensity of pain is relevant mostly when pain limits the actions and abilities of the patient to live a life with any minute level of fulfillment. Humane treatment should be a goal in any medical plan, one dealing with pain should start there” – Kimberly Miller
“Chronic pain is an injury to central nervous system functions that profoundly impacts a cascade of measurable biological functions and associated adaptive behaviors which are rarely accounted for by the addiction or the interventional pain models and often discounted when reported, leading to increased disability. It does a disservice to patients to infer that chronic pain serves to maintain emotion and reward seeking behaviors or that the degree of experienced sensation is somehow illegitimate.” – Terri Lewis, Ph.D. (who is also a contributor to National Pain Report).
“Many patients are not much interested in learning behavioral strategies which may help them function better with chronic pain, nor changing their expectation of complete relief. They wish a simple pill to swallow or a procedure to be performed on them, and many do not want to stop doing things making their pain worse. While basic research continues, with a goal to finding improved treatments for chronic pain, we have a difficult task before us changing the population’s attitudes towards what is possible and practical for our patients in pain.” – Leo Martin, MD
“Thank you for your interesting article pointing out that the suffering associated with chronic pain is related to its meaning and not only to pain intensity and therefore treating it only pharmacologically with opioids does not work. … Without a philosophical/spiritual context no strategy will significantly ease the burden of chronic pain, no matter how biopsychosocial it is.” – Alberto Montoya, MD