Chronic pain: We are adding to our patients’ suffering
Tuesday, July 16, 2019
I started my professional practice in chemical dependency. Now, many decades later, I find myself advocating for chronic pain patients just to get them the drugs they need to continue functioning.
More and more, they are erroneously considered “addicts” and being titrated down, cut off or given inadequate substitutes to what had been working well enough for them.
Most simply want to attend to their activities of daily living without being immobilized by pain. Many have worked hard to find a stable regimen that enables them to maintain some quality of life.
This current prescribing practice only contributes to our patients’ suffering versus offering relief. It infuriates me!
I’m not alone. More than 300 healthcare professionals sent a letter on March 6 to the Centers for Disease Control and Prevention (CDC) urging clarification on its 2016 opioid guideline. This group, Health Professionals for Patients in Pain (HP3), is concerned that the ongoing misapplication of it by physicians and insurers is harming pain patients, to the point of suicide.
Remember when we first learned about pain? Margo McCaffrey, MS, RN-BC, FAAN, a pioneer in the field of pain management taught us, "Pain is whatever the experiencing person says it is, existing whenever he says it does."
Time and time again, I’ve witnessed providers debate, diminish or deny it. Worse yet, snicker and label that patient “a drug abuser.”
Perhaps we’ve forgotten there’s a difference between tolerance, dependency, addiction and pseudo-addiction. Only one of these, addiction, is what the CDC is really trying to address with the opioid crisis. Those of us in hospice and palliative care know that patients who need opioids for medical reasons rarely become addicts.
I have watched a 73-year-old chronic pain patient go into withdrawals because her doctor would not give her the same prescription again. He substituted it with what he thought would work better for her even though she said it never had before. It took weeks to stabilize her after that unnecessary, traumatic event.
Moreover, an 87-year-old patient had to set up a special meeting with a behavioral psychologist in what amounted to a one-hour lecture accompanied by a handout listing 22 alternatives to medication therapy — most of which she had tried already — before she could get one Vicodin a day for intractable knee pain. She could barely hobble along with a cane and was not a candidate for knee replacement surgery.
Just recently, I had to wrangle with a doctor’s office buoyed up by the pharmacy manager right at my side to get an opioid prescription mishap rectified in time to obviate withdrawals in yet another elderly chronic pain patient.
From a consensus statement of the American Society for Pain Management Nursing and the American Pain Society:
“Health care professionals are obligated to comfort all patients and provide pain treatment to optimize patient comfort. The ethical principles of beneficence, nonmaleficence, justice, and autonomy underpin this obligation. Beneficence is defined as taking positive action to help others and the desire to do good; it is a core principle of patient advocacy. Nonmaleficence is defined as the duty to do no harm. Justice is defined as fair treatment of individuals and equitable allocation of healthcare resources. Autonomy is the rights of self-determination.”
CDC or otherwise, let’s apply these ethical principles as well as the goals of hospice and palliative care — to relieve suffering and improve quality life — to all our patients in all our practices. To help them instead of inadvertently harming them further.
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