September is Pain Awareness Month. It’s a good thing that there is a month designated for pain awareness because the plight of the pain patient has been pretty much ignored recently. As alarm has spread over the increase in opioid addiction and overdose, the needs of the pain patient for relief have taken a back seat and many are being harmed.
To understand what’s happening now, we need to go back to the early 1990’s. At that time, non-pharmaceutical approaches to pain treatment were growing. Treatments including chiropractic, acupuncture, biofeedback, cognitive behavioral therapy and therapeutic massage were growing in popularity and availability and the evidence of their effectiveness in treating pain was growing. These treatments were getting at the root causes of pain. Interdisciplinary pain clinics, where MDs, psychologists, biofeedback therapists, physical therapists and other specialists were collaborating on patient care plans, were proliferating and proving to be the most effective model of care. Insurance companies were increasingly covering these types of care.
Then, in 1996, Purdue Pharma began marketing its extended release opioid, Oxycontin, claiming falsely that it was not addictive and was safe to prescribe for chronic pain patients. Insurance companies saw this as a cheaper way to treat pain and began cutting back on reimbursement for other types of pain treatment. They stopped paying for interdisciplinary pain clinics, whose ranks subsequently decreased from over 1000 to less than 100 today. They also put increasing restrictions on the number of physical therapy, chiropractic and psychotherapy sessions they would allow. And, as evidence of effectiveness increased for other types of non-pharmaceutical pain treatments, such as massage, acupuncture and medical marijuana, insurance companies refused to consider coverage. As a result, pain patients became increasingly reliant on pharmaceuticals, especially opioids, for pain relief.
Because the treatments they were receiving were not getting at the underlying causes of their pain, fewer patients were recovering and the number of chronic pain patients has been growing. One hundred million Americans are in chronic pain, which costs our economy over $600 billion annually. Many patients have become addicted to their pain medication. In addition, as opioid prescriptions proliferated, some of the medication fell into the hands of non-patients, many of whom also have become addicted. Some of those who became addicted began turning to heroin, which has a similar chemical makeup and similar effects to opioids.
The United States is now experiencing the worst drug epidemic in its history, with record numbers of opioid addicts and record number of opioid overdoses. Individuals, families and communities have been devastated. Federal and state governments have responded with efforts to curtail access to opioids. Guidelines have been developed by the CDC and others related to maximum doses and physicians have been prosecuted as drug dealers for allegedly overprescribing.
In the rush to curb the opioid epidemic, the needs of pain patients are being completely ignored. Many chronic pain patients are losing access to their medication, which they have become dependent on for relief. Doctors, frightened of losing their licenses or going to jail, have been cutting patients off from their medication, often abruptly. Patients who lose their doctors due to retirement, loss of licensure, or the patient’s change of location are finding it nearly impossible to find new doctors to prescribe their medication. Patients are often thrown into opioid withdrawal, which drives some to buying even more dangerous illicit drugs on the street.
An argument can be made for limiting use of opioids that goes beyond the risk of addiction. Studies show that those patients who take long term opioids tend to have worse outcomes than patients who don’t—they have more pain, more disability and lower quality of life than similar patients who don’t use opioids. However, abruptly cutting off their supply before another at least equally effective treatment is in place is cruel, inhumane, counterproductive and unnecessary. Dozens of non-pharmaceutical options exist that individually or in combination can manage pain as well as opioids, but patients are not told about them by doctors who are not educated about them, and insurance companies won’t pay for them. This has got to change!!!
In commemoration of Pain Awareness Month, please sign my petition on Change.org to require insurance companies to adequately cover all pain treatments that have been proven to be effective. Let’s make sure that pain and addiction stop ruining lives.