A recent article by Dr. Jane Ballantyne and Dr. Mark Sullivan in the New England Journal of Medicine suggesting that reduction of pain intensity should not be a goal in the treatment of chronic pain patients has provoked a great deal of anger amongst pain patients, and rightly so. It’s obvious that these doctors have never been in mind-numbing chronic pain and don’t understand that it’s not always possible to suck it up and just go about one’s life. It’s also inhumane to not do everything possible to relieve suffering.
The article reflects a great deal of ignorance, not only about the nature and extent of suffering but also about the causes of pain and the efficacy of treatment. The authors, after establishing that opioids have not relieved pain in many patients and have caused harm to many others, apparently dismiss all possible treatments as essentially dangerous or worthless, throw up their hands and advise physicians not to bother treating pain.
It’s true that opioids have caused a great deal of harm. According to a recent Kaiser Family Foundation poll, 27% of Americans said they or a family member or close friend was addicted to opioids and 9% said someone close to them had died of an overdose. This problem would not have reached epidemic proportions if physicians were not prescribing opioids for every little ache and pain their patients have. I was prescribed 60 Vicodin after a tooth extraction. I used two doses of ibuprofen instead. Many are dying after being prescribed opioids after athletic injuries, despite the fact that the National Safety Council reports that ibuprofen works as well as Oxycodone and that a combination of ibuprofen and acetaminophen works better than oxycodone for pain. Doctors routinely ignore medical guidelines that advise only using opioids as a last resort. They also rarely tell patients that the medication could be addictive. If doctors only used opioids as a last resort and warned patients of the risks, we would not be in the midst of the worst drug epidemic in U.S. history.
The real problem is that the only way doctors know about to treat pain is to reach for their prescription pad. Ballantyne and Sullivan say that alternative treatments only teach people better acceptance of their pain. They are wrong. Mind/body based treatments (biofeedback, neurofeedback, cognitive behavioral therapy, trauma resolution techniques), body based practices (chiropractic, physical therapy, massage), energy based treatments (acupuncture, homeopathy, energy healing), nutrition, herbs, exercise, low level laser therapy and other therapies all affect the underlying physiology of pain and reduce it.
Physicians, due to their medical training and their professional culture, are highly resistant to referrals to non-physician providers, to the detriment of their patients. I had one of those discussions Ballantyne and Sullivan recommend with a seemingly compassionate orthopedic surgeon many years ago after 3 years of unremitting, agonizing back pain. He spent 45 minutes examining me and talking to me, told me he didn’t know what was wrong with me or how to fix it and advised me to go about my life as best I could. I did appreciate that he seemed to hear me and care about me, but my pain was still there. Not long after that I discovered biofeedback on my own and it helped tremendously. I also discovered self-hypnosis and exercise and eventually got better. Many years later I became a Licensed Clinical Social Worker and a certified biofeedback practitioner and started working with pain patients. Fifteen years after my initial contact with that orthopedic surgeon I wrote him a letter describing my journey. I told him I believed that I was now in a position to help patients like me whom he couldn’t help. I asked to meet with him. He refused and has never referred a patient. I ran into a similar stone wall with pain specialists in my community. Some made vague references to “liability” if they referred, others ignored me completely.
Too many physicians are so loathe to admit that a non-physician might have a better answer that they would rather cause harm and prolong suffering. I don’t know how they can sleep at night.
Cindy Perlin is the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free. Cindy lives and works in the Albany, NY area where she has been helping her clients reach their health and wellness goals for 25 years. You can find out more about her book Here and her clinical work Here.