Wednesday, May 09, 2007

I Don't Have A Drug Problem, I Have a Pain Problem

That statement was one of the best lines ever uttered by fictional TV doctor Greg House. For those who don't watch this incredible medical drama, House had an infarction in his right thigh muscle, which killed the muscle. Instead of having his leg amputated, which is apparently the standard course of treatment, House chose to have the muscle removed, which left him in severe chronic pain.

Now you would think that this guy would have no problem getting access to medication to manage his pain. I mean come on, House is doctor who works with other doctors who both know his medical history (his thigh muscle was removed at the same hospital in which he works), and the medical realities of his condition. Yet House must do constant battle with his colleagues to get prescriptions for pain medication, who accuse him of being a junkie, challenge his decisions believing that his use of opioids affects his judgment, and refer him to drug rehab every chance they get.

Sadly, the experiences of Dr. House are a dead-on depiction of many real people -- including me -- who live with intractable pain. I've fought those same battles for years, even when I was patient at Johns Hopkins hospital. Thanks to Nancy "Just Say No" Reagan's war on drugs and the well-publicized cases of people who abuse prescription drugs, doctors today are trained to treat anyone requesting pain relief as a drug-seeker. Many doctors are downright hostile to people complaining of severe pain, either dismissing them on the spot or forcing them to jump through hoop after hoop to prove that they are really in pain.

Here's one of the more frustrating experiences I had. After being in severe pain for more than a month after yet another non-narcotic medication failed miserably (and left me with every side effect known), I finally got an appointment with my pain management doctor. He asked me what I wanted to do, and knowing that asking for narcotics was a one-way ticket out the door, I told him I really wanted to find a non-addictive medication that would give me pain relief. This doc, the same person who had told me over the last year that there were "thousands of options" like that available, declared that I had totally unrealistic expectations. I broke into tears out of sheer frustration and fear that I would once again get nothing that helped, and finally said that if that was the case, we should try opioids. The doctor's response: I can't give them to you because you're depressed and might hurt yourself. He finally agreed to give me a prescription for low-dose oxycodone after I agreed to get a complete psychiatric work-up by a three person panel of shrinks and my husband promised to keep the medication away from me and dole out the dosage to me at the appropriate times.

Study after study has shown that people in pain who have adequate access to pain medication tend to use less than they did when they were uncertain if they would be able to get more medication. After Dr. Jack Kevorkian brought the issue of assisted suicide to the forefront of public debate in the early 1990s, experts across the country - and around the world -- testified that barriers to adequate pain relief caused severe depression, and that fears of patient addiction and/or investigation by the Drug Enforcement Agency kept doctors from prescribing narcotic pain medication, even to people expected to live for less than six months. Yet the same problems exist today.

Enough is enough. It's about time for doctors to worry less about people potentially developing drug problems and start being more concerned about their very real pain problems.

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